Florida health insurance companies overstated how much money they spent on patient care and owe the state health officials a lot of money.  Some experts are estimating they owe Florida about $3.1 million in refunds for the government’s health care plan for children.  This information came out in a recent federal report and is quite staggering.

The Florida Agency for Health Care Administration pays private health insurance companies through a joint state and federal program to offer health insurance coverage to families who do not qualify for Medicaid, but struggle to pay for personal health insurance.  Insurers are required by law to spend at least 85% on medical services and if it pays less it must refund the state 50% of the shortfall.  Companies are not following through on this requirement on a regular basis.  Between 2003 and 2007, eight out of 24 reports from private health insurers reported incorrectly how much they spend on patient costs to avoid making the federal payment based on a report from the Department of Health and Human Services.  The report showed that Florida should have received approximately $3.1 million in refunds during this time frame.

This is not only dishonest reporting but it can be viewed as stealing from the government.  The report suggests that the state repay the federal government its share of $2 million and increase monitoring going forward.  Is there no accountability for the health insurance companies who fudged their records.  This is why health care reform faces so many challenges.  There seems to be limited consequences for not following the rules that are put in place to make health care work.  This information was obtained from the article “Report: Health Insurers Owe Florida $3 Million” by Kelli Kennedy on Businessweek’s website.

Written by Sam Tabes

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