The state of Florida stands to receive a large sum of money in reimbursement after several private health insurers overstated how much they had spent on patient care. The insurers, who participate in the State Children’s Health Insurance Program, owe state health officials $3.1 million, according to a new federal report from the Department of Health and Human Services. In accordance with the health care reform of last year, insurers are required to spend no less than 85% of the money they collect from premiums on medical services. Any shortfalls are to be refunded to the state, which is then passed down to policyholders.
Florida’s lax regulations are partly to blame, according to the report. The report also notes that the Florida Healthy Kids Corporation, the organization that oversees the insurance program, was wrought with oversight and lacked both the means and manpower to handle the clerical needs of the program. The Department of Health and Human Services will be reviewing the findings of the report and determine whether any action should be taken against the organization.
The American Health Care Association has come under fire because of the federal report. Many question whether the association has the capacity to ensure that insurance companies are adhering to regulations and federal laws. Among the skeptics is Representative Elaine Schwartz of Hollywood, Florida. She questions whether the AHCA truly has consumers best interest at heart.