Jacob Ogles
State health care administrators can’t claw back reimbursements to three hospitals for serving undocumented immigrants, an appeals court ordered Wednesday.
The Agency for Health Care Administration previously found that three Lee County hospitals wrongly received Medicaid dollars for ongoing care to aliens.
But a three-judge panel of the 1st District Court of Appeal ruled the agency has no right to retroactively determine those funds were misspent after the state authorized those expenses in the first place.
“The plain reading of the statute makes clear that the Agency is barred from conducting general retrospective reviews of claims,” Judge M. Kemmerly Thomas wrote for the panel. Chief Judge Brad Thomas and Judge Harvey Jay concurred.
The decision backs up a prior ruling by an administrative judge. AHCA officials appealed the earlier decision. The appeals court final order lays out the history of the dispute.
AHCA since 2002 has pre-authorized Medicaid reimbursements for emergency services provided to undocumented patients.
But in 2009, a federal audit by the Department of Health and Human Services concluded Florida claimed too much in Medicaid reimbursement, and was getting funding for services “beyond what federal regulations defined to be an emergency.”
AHCA then launched its Undocumented Alien Project, which audited prior claims involving undocumented patients. Specifically, the state agency looked at all such claims in the year 2007.
State officials found Gulf Coast Medical Center, Lee Memorial Hospital and Cape Coral Hospital were all overpaid with Medicaid funds for services provided to undocumented individuals.
The state maintained hospitals could be reimbursed for emergency services to patients. But the agency found the hospitals continued services well after the “duration of the emergency,” receiving reimbursements for follow-up care.
In the case of Gulf Coast, AHCA determined the hospital received $46,901.85 in Medicaid reimbursement for care provided “post alleviation” of any emergency.
Gulf Coast officials argued the state could not reverse course years after the fact, and that the decision had already been made by state officials at the time that the hospital was owed reimbursements.
All three hospitals are part of the Lee Health system.
