County Commission to pay slightly more than $3 million in disputed Medicaid claims

Commissioner Jon Thaxton listens to discussion during the Aug. 20 budget workshop. Photo by Norman Schimmel

With consideration for how much staff time already had been allotted to the matter, the Sarasota County Commission voted unanimously on Aug. 20 to pay more than $3 million in disputed Medicaid claims.

By taking that action, the board ensured the county would receive a 15% discount on the total, or $536,134.

The vote also will not obligate the county to withdraw from a lawsuit it and 54 other counties, along with the Florida Association of Counties, filed against the state this spring over the legislative action. The Legislature had voted to require counties to pay past, rejected Medicaid charges from 2001 through April 2012.

Pauline Tracy, the county’s human services policy coordinator, pointed out during the commission’s budget workshop that the original total for the bills was about $6.4 million. The certified figure provided to the county by the state’s Agency for Health Care Administration, as required by the new law, was $3,570,168, Tracy said, a 44% reduction.

The county had been given a Sept. 1 deadline to decide whether to pay the certified amount, and get the 15% discount, or pay the full amount and protest the remaining disputed bills through an administrative hearing.

Tracy added that staff continued to believe Sarasota County improperly was being billed $177,250 out of the certified total, “mostly due to no residential address being given” or the address being a state Department of Children and Families office in Venice.

“They may be Sarasota County residents,” Tracy said, but staff was unable to ascertain that fact. She added that the amount still was less than the county would receive through the 15% discount.

“I think the decision’s probably a pretty easy one, just looking at the magnitude of the numbers,” Commissioner Jon Thaxton said. “Obviously, you have the staff investment in time, and it also looks like you’re kicking the hornet’s nest” to continue to protest the bills.

While he favored paying the certified amount, Thaxton added, he believed county staff should continue working with ACHA staff, so the billing “becomes more accurate coming out of the state in subsequent years.”

Tracy assured Thaxton that staff would continue the dialogue with ACHA officials. “They seem to be willing to look into these issues,” she added.

When Commissioner Nora Patterson asked for clarification about whether the final amount excluded any interest payments, Tracy said the county had five years to pay the full amount. “My understanding is that this is the amount and there is no interest,” Tracy added.

“I guess my concern going forward would be that the methodology [for determining the correct billings] tightens up a lot,” Patterson said.

“I agree,” Tracy responded, adding that state government officials had instructed ACHA staff to be more diligent in the future about determining the correct addresses for Medicaid claims.

Then commission Chairwoman Christine Robinson asked County Attorney Stephen DeMarsh about whether the payment of the certified amount would necessitate the county’s withdrawing from the lawsuit.

She added that “the process itself, to me, is still very flawed.”

DeMarsh replied that settlement discussions had begun, and they included future state action regarding disputed Medicaid bills.

One primary concern with the lawsuit, however, he said, was that it was unconstitutional, because the Florida Legislature did not pass the measure with a two-thirds majority, as required by law. Yet, DeMarsh said, that situation could be corrected by the Legislature in 2013.

“In all honesty,” he added, “I think there’s going to be a lot of effort to settle this case at the statewide level.”

Patterson made the motion for the county to pay the state $3,034,033, as staff had recommended — a total that reflects the 15% discount.

Thaxton seconded the motion.

Although he voted in favor of it, Commissioner Joe Barbetta said, “This is hard to swallow. … The state should be very embarrassed about going forward with something like this.”

Robinson responded, “I have a feeling we’re going to see something like this again with [another matter]. … But going with the 85% is logical … under the circumstances.”