LEE MEMORIAL HEALTH SYSTEM D/B/A LEE MEMORIAL ETC.
v.
STATE OF FLORIDA, AGENCY FOR HEALTH CARE ETC.
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Lee Memorial Health System's appeal of an AHCA overpayment determination is reversed because AHCA is statutorily barred from conducting retrospective reviews of previously authorized Medicaid claims under section 409.905(5)(a), Florida Statutes.
AHCA is barred from conducting a retrospective review of prior authorized Medicaid claims and therefore cannot assess an overpayment against the health system.
[1] An agency is barred by section 409.905(5)(a), Florida Statutes, from conducting a retrospective review of Medicaid claims that were previously authorized and paid.
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Join FLexlaw to unlock all legal intelligenceLee Memorial Health System provided services to undocumented aliens and received Medicaid reimbursement. AHCA subsequently issued a final order findin…
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PER CURIAM.
Appellant, Lee Memorial Health System, challenges a final order issued by the Agency for Health Care Administration (“AHCA”), finding it was overpaid with Medicaid funds for services provided to undocumented aliens. As AHCA is barred from conducting a retrospective review of prior authorized claims pursuant to section 409.905(5)(a), Florida Statutes, the Final Order is reversed and no overpayment is owed by Appellant. Lee Mem’l Health Sys. Gulf Coast Med. Ctr. v. State of Fla., Agency for Health Care Admin., 1D16-1969, (Fla. 1st DCA Feb. 27, 2019). REVERSED and REMANDED for entry of an order consistent with this opinion
B.L. THOMAS, C.J., and JAY and M.K. THOMAS, JJ., concur.
_____________________________
Not final until disposition of any timely and authorized motion under Fla. R. App. P. 9.330 or 9.331. _____________________________
Joanne B. Erde and Donna Holshouser Stinson of Duane Morris LLP, Miami, for Appellant.
Tracy Cooper George of the Agency for Health Care Administration, Tallahassee, for Appellee.
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- Brown v. Broward Minority Builders Coal., Inc., 431 So. 2d 230 (Fla. 1st DCA 1983)
- Lee Mem'l Health Sys. Gulf Coast Med. Ctr. v. State, 272 So. 3d 431 (Fla. 1st DCA 2019)