|
Legislative Update - Proposed Amendment
Florida State Senator Skip Campbell (D---Broward County) and
State Representative Ed Homan (R---Hillsborough County) introduced
companion bills aimed at amending the Florida HMO Act.
After reviewing the language of the proposed amendments, we
believe that both bills will greatly benefit providers aggrieved
by HMOs.
Both bills contain the following key features:
- Section 641.31---will
eliminate the prohibition that forbids the assignment
of benefits to non-contracted providers. These clauses often
prevent a non-participating/non-contracted physician from
seeking payment directly from the HMO based upon the patient’s
inability to assign benefits to the provider.
- Section
641.3155---will bar HMOs from seeking overpayment refunds
if the HMO issued the initial payment based upon an erroneous
determination of patient eligibility.
- Section 641.3156---will
mandate that an HMO must pay any claim regardless of whether
the provider holds a contract as long as the provider followed
authorization procedures when obtaining approval.
- Section
641.513---this provision will require HMO’s
to pay non-par physicians (but no facilities) usual and customary
rates for Emergency Room Services set to the average gross
charge for the service provided in the enrollee’s county
of service.
These proposed amendments represent a bold rebuke to the HMO
industry in that it gives all aggrieved healthcare providers
with a private right of action to seek damages and declaratory
relief in Florida’s courts for violations of the HMO
Act.
The proposal would allow the aggrieved provider that prevails
in its claim against the HMO the opportunity to recover not
just the principal but also court costs, pre-judgment interest
and attorney’s fees.
The inclusion of this provision in the proposed amendment
signifies a radical departure from previous legislation and
finally affords adequate relief and access to those wrongly
aggrieved by Florida’s HMOs.
Our office strongly endorses these proposed amendments and
recommends that all healthcare providers across the state of
Florida support the passage of these bills.
The information provided herein does not constitute legal
advice and should not be used as a substitute for securing
legal counsel. Internet messages directed to the firm should
not contain confidential or privileged information nor should
they be understood to establish an attorney-client relationship.
Representation can be secured only upon executing a formal
retainer agreement.
The hiring of a lawyer is an important decision
that should not be based solely upon advertisements. Before
you decide, ask us about our qualifications and experience.
Client references are available upon request.
|
