Sunshine Health Plan settles $9M+ fine for violating Medicaid contract


Florida’s greatest Medicaid managed treatment strategy paid a $9 million great this week for failing to shell out, or to well timed shell out, 121,227 statements from wellness treatment suppliers.

Agency for Wellness Care Administration (AHCA) Communications Director Brock Juarez informed Florida Politics Sunshine Wellbeing Plan paid out the high-quality April 13, 5 times in advance of it was owing.

Meanwhile, the ban on car enrollment in the Medicaid managed treatment system stays in effect, Juarez mentioned.

Medicaid Assistant Deputy Secretary Brian Meyer on March 17 despatched a letter to Sunshine President and CEO Nathan Landsbaum advising him of the $9,092,025 penalty and other corrective steps the condition was taking from the overall health strategy just after failing to pay back the vendors.

The condition levied a $75 fantastic for just about every delinquent payment. Meyer mentioned there were 121,277 promises from health treatment suppliers in which payments have been either delayed or not built at all. The statements were being determined either by means of complaints produced to the condition from companies or by the well being plan alone.

The $9 million fantastic is the most significant the point out has levied against a Medicaid managed care prepare for deal violations considering the fact that the inception of the Medicaid managed treatment software. Florida Politics initial noted the historic fantastic on March 23.

Sunshine officials have earlier said that the errors have been a end result of a software program challenge subsequent the company’s merger previous 12 months with WellCare which, at the time of the merger, had been the state’s next major Medicaid managed treatment prepare powering Sunshine. Past information accounts comprehensive how, for months, Sunshine failed to fork out companies for some of the state’s severely ill youngsters that get coverage as aspect of Medicaid’s children’s healthcare products and services part. At minimum one provider shut down.

As of March 31, there were being extra than 5.18 million people enrolled in Florida’s Medicaid plan, which is an all-time superior thanks to the COVID-19 pandemic and the Medicaid principles involving the community wellness emergency.

Florida has a Medicaid managed care mandate for most folks who qualify, irrespective of whether they are younger or old. As a end result of the managed treatment mandate there are 4,075,825 beneficiaries who were being enrolled in a Medicaid managed treatment system as of March 31. No wellness approach has extra Medicaid enrollees than Sunshine Well being, which dominates the sector share with 38% of the enrollees. Sunshine’s footprint in the Medicaid managed care market is larger than that of Humana Healthcare Approach and Only Healthcare Ideas, the next and third biggest options, respectively, put together.


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