There is is no debate that health care costs continue to escalate in Florida. A deep national recession and a service-based economy in the Sunshine State have combined to swell the ranks of Floridians who count on Medicaid for healthcare. It costs nearly $21 Billion dollars annually to cover the three million Floridians who utilized Medicaid. The federal government comes up with over $10 billion each year to pay over half of the bill, leaving Florida taxpayers to come up with the other $10 billion. Just a decade ago, the entire Florida Medicaid budget was $9 billion.
The Florida Legislature has been struggling with ways to address this burgeoning bill for the past decade. About 6 years ago then Florida Senate and House Leaders touted financial savings through a planned Medicaid pilot program that would take Florida Medicaid patients and place them in private HMO networks.
Unfortunately, the Florida Medicaid HMO Pilot program had problems from the start. Patients complained of denial of care and extremely long wait times. The lowlight of the Florida Medicaid Pilot Program came in 2007 when federal and state investigators raided Tampa-based HMO WellCare. In 2009, WellCare paid $80 million to settle state and federal criminal probes that alleged it had overcharged Florida Medicaid for medical services. A Georgetown University Study released in April of this year concluded that Florida's pilot program had not shown any clear signs of cost savings during its five years of existence.
Despite calls from patient advocates to avoid a repeat of the corruption and reported substandard care that plagued the Florida Medicaid HMO Pilot Program, the Florida Legislature voted last week to begin moving all three million Floridian Medicaid plan participants into a private HMO program that is almost identical to Florida's prior pilot program. If the federal government agrees to this plan, Florida will become the first state in the nation to move its entire Medicaid population into HMO's.
But there is ONE major difference in this latest plan. Unlike the Florida Medicaid Pilot Plan, this new plan would begin shifting elderly patients into HMO's first. In Florida's prior pilot program, and similar programs throughout the U.S., younger, healthier patients were the first to be shifted in private managed care. Under this plan, the elderly and disabled would the first moved to HMO's. Florida Speaker of the House Dean Cannon has stated that targeting elderly Floridians for removal from nursing homes first is a good idea because they can benefit from staying at home and remaining independent through the utilization of home health care.
Obviously Speaker Cannon is not a student of Florida Medical History. For if he was... he would be acutely aware of the rampant fraud and abuse that has germinated in the Florida home healthcare Industry over the past decade. Miami-Dade has been cited in numerous publications as the cradle of home healthcare fraud.
The federal General Accounting Office noted that in 2007 Miami-Dade home health agencies received more than $550 million in Medicare fees for home health services, which amounted to four times the amount for similar services billed in Atlanta, Dallas, Chicago and Houston. And the kicker... there are more people over 65 in each of those metro area than in Miami-Dade.
In February of this year eight South Florida home healthcare nurses pleaded guilty to billing Medicare $18.7 million dollars for home health services that weren't performed. Last month a South Florida health care provider plead guilty to stealing $200 million dollars from Medicare in connection with the provision of needless outpatient mental health services to elderly patients suffering from Alzheimer's and Dementia. Good luck on the cost savings angle with folks like this providing care...
So how will participating HMO's determine how many Florida Medicaid patients to move from skilled nursing care to home health care? That's simple. During the first year of the program, which is set begin in mid-2012 if approved by the feds, participating HMO's will receive financial bonuses from the State of Florida for evicting 2% of the elderly nursing home patients who participate in Medicaid. Each year after, participating HMO's will receive bonuses for evicting 3% or more Medicaid nursing home patients, until they have discharged enough to reduce the overall population to 35% of the total number of folks eligible for nursing care.
Leave it to the Legislature to come up with a plan that appears to both heartless and a potential financial boondoggle. The only folks excited about this plan are the medical fraudsters.
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Scott Farrell, 10 news Contributor