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Florida hits medicaid plans with $2M in contract breach sanctions

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TALLAHASSEE, Fla. – Managed care plans were sanctioned 187 times and paid more than $2 million in damages during the 2019-2020 state fiscal year for breach of Medicaid contracts, according to information released by the state.

The Florida Agency for Health Care Administration website shows that during the fiscal year, which ended June 30, 13 Medicaid managed-care health plans, one Medicaid specialty plan and three managed dental plans faced sanctions for failing to adhere to contract requirements. 

Staywell Health Plan, which has the largest market share in the state’s Medicaid managed-care system, had the most sanctions with 24 and the largest amount of liquidated damages with $668,150, according to the data, which was made publicly available Friday.

Eight of the sanctions against the company stemmed from “provider services” violations, which included issues related to network adequacy, payment, credentialing and contracting and untimely or inaccurate reporting. 

For those eight violations, Staywell paid $261,750 in damages.

Overall, provider services accounted for nearly one-third of the total number of sanctions during the fiscal year, with the state assessing $673,250 in liquidated damages against plans for 61 violations.

In terms of dollars, though, state regulators assessed $732,050 in damages when managed care plans failed to follow contract requirements for covered services and authorizations. 

The state has contracts with 13 managed care companies to offer health services to poor, elderly and disabled people.

The state also has contracts with five managed care plans to provide specialty services -- such as mental health services, care for people with HIV and AIDS and care for children with chronic medical conditions -- and contracts with three managed dental-care companies.