Florida fines Medicaid payment vendor $9.1M over billing delays

Florida has fined its largest Medicaid payment vendor $9.1 million over software problems that caused delayed payments for nearly three months, according to the Tampa Bay Times

The billing software glitch at Sunshine State Health Plan affected tens of thousands of healthcare claims for patients under 21 who are eligible for Medicaid and have serious chronic conditions. The patients were enrolled in the Sunshine Health Medicaid program and the Children's Medical Services Health Plan it operates on behalf of the Florida Department of Health.

The glitches, made public in February, were blamed on the Oct. 1, 2021, merger between Sunshine State Health Plan and WellCare of Florida. The agencies noticed the issues in December 2021, then worked with the state to rectify them in January.

In addition to the fine, the Florida Agency for Health Care Administration also demanded Sunshine State Health Plan provide more details about how the problems occurred and how the company responded. 

The agency is also asking the company to demonstrate within 30 days that future claims were being paid promptly and provide weekly updates.

A spokesperson for Sunshine State did not respond to phone or email requests from the Times

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