The bill amends sections of Florida Statutes related to Medicaid managed care organizations and plans, specifically focusing on enhancing the integrity of the Medicaid program. It authorizes the Agency for Health Care Administration to conduct reviews, investigations, analyses, and audits to identify potential violations of Medicaid program integrity by managed care organizations, plans, and their subcontractors. The bill introduces penalties for violations, including suspension, termination, fines, and other sanctions. It also mandates that managed care organizations establish program integrity functions to reduce fraud and abuse, including a provider credentialing system and a compliance plan.

Key provisions include prohibiting managed care organizations and their subcontractors from referring Medicaid recipients to entities with which they have financial relationships, thereby preventing conflicts of interest. The bill requires detailed reporting on Medicaid fraud and abuse, including the number of cases investigated, overpayments recovered, and recommendations for policy changes. The effective date for the bill is set for July 1, 2025.

Statutes affected:
S 1478 Filed: 409.967