Disputed Sarasota County Medicaid billing total down about $2.3 million

The Sarasota County commissioners discuss the preliminary 2013 fiscal year budget with staff in June. Photo by Norman Schimmel

The Sarasota County Commission has received some good news regarding the amount of disputed Medicaid bills the county would be asked to pay under a law signed in late March by Gov. Rick Scott.

While early estimates had put the figure at approximately $6.2 million, staff reported July 13 that the preliminary amount is $3,633,171.72 for billings from Nov. 1, 2001, through March 31, 2012.

Under the new law, if a county chooses not to pursue redress of the billing through an administrative hearing, it must pay 85% of the certified amount. In Sarasota County’s case, that would be about $3,088,000, the staff memo says.

The earlier $6.2 million estimate would have left the county on the hook for about $4.7 million at that 85% mark.

The memo adds, “The preliminary certification amount illustrates recognition that the billing system was flawed … However, the county will proceed cautiously in review in making a determination as to whether to accept this amount for payment.”

The money would have to be paid over five years, the memo notes, with a larger percentage the first year.

If a county chooses to pursue an administrative hearing, it must pay 100% of the contested amount that has been certified.

Sarasota County is among 53 of the state’s 67 counties that have joined a lawsuit filed in late April by the Florida Association of Counties to challenge the new state law. County Attorney Stephen DeMarsh recommended that action to the County Commission on April 24, saying he had reservations that the state law was constitutional as adopted.

The commissioners voted unanimously to pay $3,500 to the Florida Association of Counties to participate in the lawsuit. DeMarsh explained the amount was based on the size of a county, and Sarasota fell in the middle range.

Commission Chairwoman Christine Robinson told The Sarasota News Leader, “To go from $6.2 million to $3.6 million — that’s a lot of billing to be reduced. It shows that we were being responsible with taxpayer money.”

In the past, counties did not have to pay Medicaid bills for people who had provided addresses in those counties that were proven to be false. Commissioner Nora Patterson told members of the Siesta Key Association during their annual meeting on March 10 — shortly after the Legislature approved the new action — that the state’s billing system long has been flawed.

Robinson concurred. “The [new] numbers prove that we were correct,” she told the News Leader. “We should have been protesting bills.”

During the County Commission’s June 13 budget workshop, Pauline Tracy, the county’s human services policy coordinator, had told the board, “I’m hoping the amount [the state] first gave us will not be anywhere near what we will have to pay.”

At that time, she said, staff already was sending on to other counties bills that had been marked incorrectly as Sarasota County bills.

One problem staff had identified, Tracy said, was that Sarasota County had wrongly received a number of bills for nursing home patients. Those bills had come to the county, she added, because a state worker who determines Medicaid eligibility for patients going into such facilities in several counties was based in Venice.

The majority of those bills were being redirected to those other counties, Tracy said.

Additionally, she told the commission, the Whitfield area of Manatee County had a number of Sarasota addresses. “We were given all of those [bills],” she added, though they should have gone to Manatee County.

Patterson noted that there is “also a pretty good size section of Lakewood Ranch that uses Sarasota as an address,” though she said she was not sure how many Medicaid patients might be in that area.

Regarding the final certified amount, Tracy said, “We’ll keep our fingers crossed.”

The July 13 Sarasota County staff memo says the official Medicaid certification still is expected by Aug. 1. In the meantime, it says, staff will be reviewing the three files provided by the state’s Agency for Health Care Administration “in preparing to ultimately make a recommendation to the Commission as to whether to accept the certified amount, or to challenge the amount in an Administrative Hearing.”

The staff memo says Sarasota County will notify AHCA of its decision by Sept. 1.