Florida SNFs suing managed care groups over delayed Medicaid payments

Share this content:

A group of Florida skilled nursing facilities has filed a class action lawsuit against multiple insurance providers over delayed Medicaid payments.

The suit, filed Wednesday in the United States District Court for the Southern District of Florida, was brought by a group of 10 skilled nursing operators against seven managed care companies including affiliates of Humana, Molina Healthcare and United HealthCare. The suit characterizes the companies as the “gatekeepers to Medicaid benefits in Florida.”

The complaint claims the Medicaid managed care organizations engaged in a “systematic business practice of illegally withholding interest owed on overdue payments” to the providers, who “rely on the prompt payment of Medicaid funds” to deliver care to the plan's beneficiaries. Payments delivered after the set deadline typically accrue interest at 12% per year.

The suit also claims the insurance companies fabricated reasons to reject providers' proper claims, forcing them to “jump through unnecessary, nonsensical hoops,” and purposely delayed payments to generate larger profits.

The Florida Health Care Association, which has testified in the Florida Senate in support for the nursing home providers, has determined that many facilities carry more than $200,000 in outstanding claims, leading to a statewide shortfall of $135 million.

The complaint was brought against the managed care groups on behalf of the skilled nursing facilities and “all other Medicaid providers similarly situated,” according to the complaint. The providers are seeking declaratory, monetary and other appropriate relief in the case.