2012 Section 103F-107 HRS Medicaid Contracts Report - Hawaii ...

‘Ohana Health Plan
Regulatory Agency: State of Florida - Agency for Health Care Administration
Contract: Medicaid
Category Subcategory Issue Sanction Description Sanction
Date
Fine Monetary Administrative Failure to submit all pharmacy
typical and atypical services
with dates of service in
September 2012 by 10/15/2012.
Fine amount $50,000 ($25,000
for each Company)
Fine Monetary Administrative Failure to meet prompt
payment of claims ratios.
$10,000 ($5,000 for each of
HealthEase and Staywell)
Company appealed.
CAP Monetary Administrative Failure to include Behavioral
Health Claims in the
HEA/STW’s Claims Aging
Reports.
Fine Monetary Administrative Non-compliance with provider
termination requirements. Fine
Amount $7,500. Appealed.
Fine Monetary Administrative Untimely submission of the
claims aging report for Q2
2010. Fine amount $5,000.
Under appeal and review by the
Agency. Pending final
determination.
CAP Monetary Administrative Failure to submit vendor
subcontracts for approval prior
to execution. Fine amount
$10,000.
Fine Monetary Administrative Timely Filing – Regulatory
Report. Fine amount $1,600.
Fine Monetary Administrative Late submission of the 2007
Audited Financial Statements.
Total fine of $48,800 ($24,400
per Company).
Fine Monetary Administrative Untimely filing of the Reform
CHCUP Repot. Fine amount
$2,400 ($1,200 for each
Company).
Fine Monetary Administrative Untimely submission of the
Claims Aging Report. Total
fine amount $5,600 ($2,800 per
Company).
Fine Monetary Patient Care Non-compliant disease
management program. Total
fine amount $4,400 ($2,200 per
Company).
Resolution
Date
Status
Nov-12 NA Appealed
Feb-12 Feb-12 Appealed
Dec-11 Mar-12 Resolved
Sep-11 NA Appealed
May-11 NA Appealed
Oct-10 Nov-10 Resolved
Mar-09 NA Resolved
Jan-09 NA Resolved
Oct-08 NA Resolved
Sep-08 NA Resolved
Jul-08 NA Resolved