A South Florida hospital has agreed to reimburse the state more than $800,000 to settle Medicaid claims about care for undocumented immigrants who sought treatment.
The payments from Homestead Hospital to the state are part of an ongoing tussle between hospitals and state officials over Medicaid coverage for people who may be in the country illegally but qualify for the program because of medical emergencies or because they are in labor or need dialysis.
Mallory McManus, a spokeswoman for the state Agency for Health Care Administration, which oversees Medicaid, said the state paid hospitals $484.2 million to care for undocumented immigrants between July 2014 and June 2017.
Homestead Hospital has reached two settlement agreements with the state this year to settle payment disputes. It is one of the largest Medicaid providers in South Florida, and 20 percent of its revenues are derived from Medicaid, said hospital spokeswoman Dori Robau Alvarez.
Under the latest settlement, finalized May 25, the hospital agreed to reimburse the state more than $327,000 to settle disputes from 2008, but the amount was lower than what the state initially sought.
Alvarez said hospitals “routinely work with the state” on program audits and attributed the disputed payments to a technicality involving Medicaid eligibility rules for people who are undocumented.
“Homestead Hospital is a not-for-profit hospital that provides services to individuals that would otherwise not have access to care,” she said in a statement, adding that “federal law requires that hospitals provide emergency services to patients regardless of their immigration status.”
Homestead Hospital also entered into another settlement agreement in January, agreeing to pay $516,897 to settle allegations that undocumented-immigrant patients received care after emergencies were abated.
The settlements are part of numerous disputes in recent years involving the hospital industry and Gov. Rick Scott’s administration about payments for care for undocumented immigrants. In a recommended order in one case, Administrative Law Judge John Van Laningham referred to an “undocumented alien project.”
Van Laningham presided over a challenge by Southwest Florida’s Lee Memorial Health System to the state’s move to recoup $46,901.85, for services provided to nine undocumented immigrants in 2007.
The judge said the state’s goal was to audit all paid hospital inpatient claims for emergency services provided to undocumented immigrants between July 1, 2005, and June 30, 2010 — before the state implemented a mandatory Medicaid managed-care program — and used the “undocumented alien project” to accomplish the goal.
Van Laningham ruled in favor of Lee Memorial, concluding that the state couldn’t recoup payment for the claims because, among other things, Medicaid had already given the hospital approval to provide care through a prior authorization program.
Before Medicaid managed care, the state tried to hold down hospital costs by requiring hospitals to obtain prior authorization before admitting patients who showed up at emergency departments.
AHCA appealed the ruling to the 1st District Court of Appeal in Tallahassee, and the court heard oral arguments in November. A decision is pending.
The state started reviewing medical claims of undocumented immigrants following a U.S. Department of Health and Human Services Office of Inspector General audit that showed Florida erroneously billed the federal government for emergency services for undocumented immigrants.
The state inked a four-year, $50 million contract with eQHealthSolutions in 2011 to provide a number of utilization-review services to the state’s Medicaid program, including the review of 2,000 medical records annually.
Though the contract was mostly negotiated before Scott took office, it had been amended six times by March 2014, when the mandated number of annual reviews had tripled to more than 6,500 annually.
Medicaid is a program that pays health care costs of poor, elderly and disabled people. It is run jointly by the federal and state governments and is funded by both. There are general requirements that states must follow to participate in Medicaid, but many of the details are established by the states.
Federal law generally bars undocumented immigrants from being covered by Medicaid, but the government has provided states money to cover emergency services for people, who other than their citizenship, meet all other criteria for Medicaid eligibility through a program called Emergency Services for Aliens.
South Florida attorney and longtime social-services advocate Miriam Harmatz worries that policies such as the so-called “undocumented alien project” and a recent state move to save $100 million in Medicaid by eliminating a long-standing policy that gives people three months to apply for Medicaid are punitive.
In lieu of expanding Medicaid to hundreds of thousands of uninsured adults as allowable under the health care overhaul pushed by former President Barack Obama, Scott focused his efforts on continuing supplemental Medicaid funding for a $1.5 billion uncompensated care program that in Florida is known as the “Low Income Pool.” And while the Trump administration agreed to extend the program for another five years, the amount of funding available this year is $730.6 million
“My concern is for the after-the-fact-reviews that are punishing hospitals for exercising their best judgment,” said Harmatz, co-director of the left-leaning Florida Health Justice Project.
Christine Sexton reports for the News Service of Florida.