CAPE MEM'L HOSP., INC.
v.
AGENCY FOR HEALTH CARE ADMINISTRATION
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AHCA is barred from conducting a retrospective review of prior authorized Medicaid claims pursuant to section 409.905(5)(a), Florida Statutes.
[1] An agency is prohibited by statute from conducting a retrospective review of prior authorized claims to determine whether an overpayment occurred.
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Join FLexlaw to unlock all legal intelligenceCape Memorial Hospital provided services to undocumented aliens and received Medicaid reimbursement. AHCA issued a final order finding the hospital wa…
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FIRST DISTRICT COURT OF APPEAL
STATE OF FLORIDA _____________________________
No. 1D16-5310 _____________________________
CAPE MEMORIAL HOSPITAL, INC. d/b/a CAPE CORAL HOSPITAL,
Appellant,
v. STATE OF FLORIDA, AGENCY FOR HEALTH CARE ADMINISTRATION,
Appellee.
_____________________________
On appeal from a Final Order of the Agency for Health Care Administration. Justin Senior, Interim Secretary.
February 27, 2019 PER CURIAM.
Appellant, Cape Memorial Hospital, Inc., 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).
2
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.