Division of Administrative Hearings, Florida
Filed: Jun. 06, 2017
Did Respondent, Green Cross Home Care Services (Green Cross), submit unsupported or unauthorized claims for treatment of Medicaid patients to Petitioner, Agency for Health Care Administration (Agency), causing the Agency to overpay some claims during the audit period, July 1, 2009, through June 30, 2013 (audit period)? If so, what amount is Green Cross required to reimburse to the Agency? If the Agency overpaid Green Cross, should it assess costs and sanctions against Green Cross; and, if so, in what amount?Using unverified claims of 1 provider to deny claims of another does not meet requirement of 409.913(20). AHCA audit report is not prima facie evidence under 409.913(22). AHCA did not prove home health claims were for periods when patient was in hospital.