This bill amends sections of Florida Statutes related to Medicaid managed care organizations and plans, specifically focusing on patient referrals and program integrity. It authorizes the Agency for Health Care Administration to conduct reviews, investigations, analyses, and audits to ensure compliance with Medicaid program integrity, particularly regarding referrals made by managed care organizations and their subcontractors. The bill introduces penalties for violations, including suspension, termination, fines, and other sanctions for providers who engage in fraudulent activities or abuse within the Medicaid program.

Additionally, the bill establishes new requirements for managed care plans to implement program integrity functions aimed at reducing fraud and abuse. These requirements include maintaining a provider credentialing system, conducting prepayment and postpayment reviews, and designating a compliance officer. Importantly, it prohibits managed care organizations and their subcontractors from referring Medicaid recipients to entities with which they have financial relationships, thereby enhancing oversight and accountability in the Medicaid system. The act is set to take effect on July 1, 2025.

Statutes affected:
S 1478 Filed: 409.967