The bill amends sections 409.913 and 409.967 of the Florida Statutes to enhance oversight and integrity within the Medicaid program, particularly concerning patient referrals by managed care organizations and plans. It authorizes the Agency for Health Care Administration to conduct reviews, investigations, and audits to identify violations of Medicaid program integrity related to patient referrals. The bill introduces specific penalties for managed care organizations and their subcontractors that violate these provisions, including suspension, termination, fines, and other sanctions. Additionally, it mandates that each managed care plan establish program integrity functions to reduce fraud and abuse, including a provider credentialing system and a compliance officer.

Key insertions in the bill include provisions that prohibit managed care organizations and their subcontractors from referring Medicaid recipients to entities with which they have financial relationships, such as ownership or profit-sharing arrangements. The bill also requires that managed care plans implement effective prepayment and postpayment review processes to monitor for fraud and abuse. The effective date for the bill is set for July 1, 2025.

Statutes affected:
H 815 Filed: 409.967