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Health News Florida

Hospital Loses Appeal on Medicaid Overpayments

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Florida Hosptial

An appeals court Thursday sided with the state Agency for Health Care Administration in a dispute about whether Florida Hospital Orlando was paid too much for treating some Medicaid patients.

The agency in December issued an order requiring the hospital to repay $22,138 in Medicaid overpayments, along with a $500 fine and $7,635 in costs. That order followed a recommendation from an administrative law judge, who heard arguments about payments for the care of patients such as a 3-year-old child who had a form of leukemia and needed chemotherapy treatments, according to case records.

Florida Hospital Orlando appealed to the 1st District Court of Appeal. At least in part, it argued that AHCA's auditor improperly looked at patients' entire files to determine whether inpatient admission was a "medical necessity" -- a key factor in determining Medicaid payments, the appeals-court ruling said.

The hospital contended that the audit should have focused only on information available at the time of admission, not entire patient files. A three-judge panel agreed with the hospital about that legal issue but, nevertheless, said Florida Hospital Orlando "has not shown that AHCA and its auditor relied on hindsight information in penalizing the hospital's admission decisions.

Rather, the record supports the administrative law judge's finding adopted by AHCA that the claims were 'described and evaluated based upon the medical documentation available to the treating physician at the time the services were rendered.' "

Polk Judge to Get Reprimand for Relationship with Bailiff

The Florida Supreme Court said Thursday that a Polk County judge will receive a public reprimand for an "inappropriate relationship" with her court bailiff.

Justices unanimously ruled that Judge Susan B. Flood should appear before them to receive the reprimand. In a seven-page order, the Supreme Court said Flood entered into an agreement with the state Judicial Qualifications Commission that admitted violations of judicial canons.

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Credit Florida 10th Judicial Circuit Court
Polk County Judge Susan Flood

"While we have not been provided with the details of this 'inappropriate relationship,' we accept the characterization by the JQC and Judge Flood’s own stipulation that this relationship went beyond the 'fraternization that normally occurs in a professional workplace,' '' the Supreme Court order said.

"We agree that such improper conduct in the workplace is of greater concern when engaged in by judges, who are held to the high standards of the Code of Judicial Conduct." The order did not set a date for the reprimand.

State Pushes To Continue VA Lawsuit

Attorneys for the state Agency for Health Care Administration and two veterans argued this week against an attempt by the U.S. Department of Veterans Affairs to scuttle a lawsuit about oversight of VA medical centers.

AHCA and the individual plaintiffs filed the lawsuit this summer, seeking, at least in part, for AHCA to be able to inspect VA facilities. The lawsuit came amid a national furor about problems with patient care.

The Department of Veterans Affairs filed a document last month in federal court in Tampa arguing that the case should be dismissed on constitutional grounds. But attorneys for AHCA and the plaintiffs filed a response this week that said the lawsuit should continue. In part, they argued that the lawsuit isn't limited to state involvement in overseeing the facilities.

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Credit VA.gov / Department of Veterans Affairs
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Department of Veterans Affairs
James A. Haley Veterans Hospital

"The complaint is not so limited and instead makes clear that the plaintiffs merely seek for the VA to be held accountable to some objective, independent governmental oversight, irrespective of whether the entity providing the oversight is a state or federal agency,'' said the response, filed Monday.

"AHCA is merely offered as a logical option to provide the necessary oversight because AHCA has authority to inspect and ensure minimum standards of patient care in literally every hospital in Florida except for the VA medical centers."