State expands program to audit hospitals, citing concerns about Medicaid fraud

Published Aug. 25, 2015

Another 100 Florida hospitals — 17 of which are in the Tampa Bay area — will be audited by the state to determine whether they're receiving more in Medicaid payments than legally allowed, Gov. Rick Scott said Monday.

They join 29 hospitals already being audited for failing to provide information about their Medicaid contracts to the state Agency for Health Care Administration before Aug. 1.

Those added Monday responded on time. But in a letter to state Attorney General Pam Bondi, Scott said they still needed to be audited "because of the nature of the explanations they provided in their responses."

"These agreements may ultimately result in overcharging the state for Medicaid and other health care services, and in some instances could constitute Medicaid fraud and even deceptive and unfair trade practices," he wrote in the letter, adding that Bondi's office may be needed to help investigate.

Some of the Tampa Bay area hospitals identified are operated by Hospital Corporation of America. The others are operated by Community Health Systems. Both are for-profit chains.

The facilities are: Bayfront Health St. Petersburg; Bayfront Health Brooksville; Bayfront Health Dade City; Bayfront Health Spring Hill; Brandon Regional Hospital; Largo Medical Center; Largo Medical Center Indian Rocks; Medical Center of Trinity; Medical Center of Trinity West Pasco Campus; Memorial Hospital of Tampa; Northside Hospital; Oak Hill Hospital; Palms of Pasadena Hospital; Regional Medical Center Bayonet Point; South Bay Hospital; St. Petersburg General Hospital; and Tampa Community Hospital.

HCA West Florida spokeswoman J.C. Sadler declined to comment on the audit.

Said CHS spokeswoman Tomi Galin: "We believe that our affiliated hospitals are in compliance with the statute and have advised them to work with AHCA to demonstrate their compliance."

Florida's $23 billion Medicaid program, which serves about 3.5 million of the state's poorest residents, has been under a microscope in recent months.

Earlier this year, the private health plans that provide the health insurance coverage asked the state for more than $400 million to help offset rising health care costs.

In discussing the requested rate hike with insurers, AHCA Secretary Elizabeth Dudek said she learned some of the plans were paying hospitals more than 120 percent of the posted Medicaid rate — a violation of state law — and requested more information from the hospitals.

Scott ordered the audit Aug. 3, at first only for facilities that missed the deadline.

The Tampa Bay area hospitals flagged earlier in the month — Kindred Hospital Bay Area Tampa, Kindred Hospital Bay Area St. Petersburg and Kindred Hospital Central Tampa — insist they're in compliance with Medicaid rules.

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AHCA will conduct additional audits on random hospitals.

"Floridians rely on high-quality, cost-effective health care from providers with proven track records and do not deserve to be charged for unfair agreements that pass on high costs to them," Scott wrote Monday.

Times/Herald staff writer Michael Auslen contributed to this report. Contact Kathleen McGrory at or (727) 893-8330. Follow @kmcgrory.