Christine Jordan Sexton
Florida regulators who oversee the state’s massive Medicaid program issued 208 final actions against Medicaid managed care plans that breached or violated the terms of their contracts during the past fiscal year.
The consequences?
More than $23.1 million in liquidated damages and/or sanctions were levied against the plans, according to data recently posted by the state Agency for Health Care Administration (AHCA).
The total is one of the larger amounts of liquidated damages and or sanctions in a 12-month period the state has levied against the plans for violating terms of their contracts.
The $23.1 million comes as enrollment in the Medicaid managed care plans reaches an all-time high. There were more than 4.2 million people enrolled in statewide Medicaid managed care programs as of June 30, when state Fiscal Year 2021-22 ended, according to enrollment data.
Sunshine Health Plan and StayWell Health Plan, which are owned by Centene Corporation, had liquidated damages and sanctions levied against them in the amount of $11,724,810 and $4,911,690, respectively. That’s more than any of the other health plans for the year.
Included in the $11.7 million Sunshine figure is a whopping $9.1 million sanction, the largest sanction levied against a plan in the statewide Medicaid managed care program’s history.
Liquidated damages and sanctions are not the same thing. Liquidated damages are not supposed to be a penalty. They are supposed to be reasonable estimates of the state’s projected financial loss and damages that occurred due to the Medicaid managed care plan breaching their contract requirements.
Sanctions are penalties the state assesses when managed care plans violate their contracts.
Meanwhile, Humana Medical Plan leads the pack when it comes to the number of state actions finalized against a Medicaid managed care plan for the year, with 24.
The dashboard contains information on actions finalized between July 1, 2020 and June 30, 2021, not when the complaints were filed with the state.
State health care regulators assign the complaints they receive about the Medicaid managed care program into one of nine broad categories: administration and management; coverage and authorization of services; enrolled services; financial requirements; grievance and appeal system; marketing; provider services; quality of care; and reporting.
According to AHCA data, there were 90 “provider services” complaints, a category that includes, among other things, complaints ranging from the timeliness of provider payments, to network adequacy standards, to the timeliness of transportation services.
Meanwhile nearly one-third (29) of the 90 provider complaints focused on network adequacy, according to the data. The state levied $1.08 million in liquidated damages for the breaches of contract.
Another 28 of the 90 provider complaints stemmed from the timeliness of payments. But the price tag for not paying claims on time was far heftier than the $1.08 million for inadequate managed care networks.
Data show the state issued $10,141,525 in liquidated damages and assessments for failing to pay providers on time, a figure that included the $9.1 million sanction against Sunshine Health Plan.
While it’s not the steepest number of sanctions and liquidated damages assessed against the plans in a single year, it is one of the higher amounts, a review of the data shows. AHCA levied $26.5 million in assessments and sanctions against the plans for 371 contact violations in Fiscal Year 2017-18. The following year, AHCA levied $23.8 million for 137 contract breaches or violations.
Conversely, Fiscal Year 2018-19 saw the least number of sanctions and liquidated damages with 37 actions against managed care plans being finalized that year and $284,750 in assessments.
