A group of Florida skilled nursing facilities recently filed a class action lawsuit against multiple insurance providers over their delay in Medicaid payments.
The suit was filed in the United States District Court for the Southern District of Florida. It was initiated by a group of 10 skilled nursing operators against seven managed care companies including affiliates of Humana, Molina Healthcare, and United HealthCare.
“Gatekeepers to Medicaid Benefits in Florida”
The lawsuit’s complaint said that the companies were the “gatekeepers to Medicaid benefits in Florida.” The plaintiffs are Skilled Nursing Facilities (“SNFs”) who provide healthcare services to, as the describe in the court document, “some of Florida’s most vulnerable citizens—nearly 71,000 elders and individuals with disabilities—many of whom require 24-hour complex medical care…”
The Skilled Nursing Facilities allege that the Medicaid managed care organizations engaged in a “systematic business practice of illegally withholding interest owed on overdue payments” to the providers, who “rely on the prompt payment of Medicaid funds” to deliver care to the plan’s beneficiaries…the residents of care facilities—primarily Florida’s elderly.
Payments that are delivered after the deadline accrue interest at 12% per year. The plaintiffs claim, “Despite receiving proper claims for payment, Defendants have engaged in a pattern and practice of fabricating reasons to delay payments of claims to Plaintiffs, and then paying an improper amount of interest, if any, on overdue payments.”
The suit also claims the insurance companies made up reasons to reject providers’ proper claims and making them “jump through unnecessary, nonsensical hoops.” This, they said, was a purposeful delay in the payments to increase their revenues.
The providers are asking the District Court for declaratory and monetary relief.
The Florida Health Care Association has testified in the Florida State Senate in support for the nursing home providers. They have found that many facilities carry more than $200,000 in outstanding claims. The statewide shortfall is nearly $135 million. Some of this shortfall is Medicare Part A (Hospital Insurance), which covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.
If you have questions about Florida Medicaid, Attorney John Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact John for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form, and we will get in touch with you.