Rick Scott and The Department Of Health

Attached a troubling article published in the Naplesnews.com and subsequently in today's New York Times reporting a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando. The state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials. The complaint contains allegations raising standard of care issues that fall under the jurisdiction of the Department of Health. With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department. The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.

This raises several problematic issues:

1. If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
2. Rick Scott already said that he wouldn’t get involved except for making the appointment of the head of the health department.



Maybe we should remember that if it looks like a duck, walks like a duck and quakes like a duck then its probably not a giraffe.

Yours
Bernd



Naples Daily News - Printer-friendly story
Rick Scott would pick agency head, but vows to stay clear of any state Solantic probe
The state Department of Health won't say what it has done with complaint against Scott's company

By LIZ FREEMAN

Thursday, October 28, 2010

NAPLES — The state Department of Health won’t discuss its handling of a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.

Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando.

“We can’t acknowledge or deny the existence of a complaint,” said Eulinda Smith, a state health department spokeswoman.

However, a letter obtained by the Daily News under Florida’s public records law shows the state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials.

“The complaint contains allegations raising standard of care issues that more appropriately fall under the jurisdiction of the Department of Health,” Jerome Worley, chief of investigations for the Office of Inspector General with AHCA, wrote in a letter to the state Department of Health. “Please handle the complaint as you deem appropriate.”

The complaint was sent to AHCA anonymously but said the allegations were provided by Dr. Randy Prokes, a former medical director of a Solantic center in Jacksonville. The one-page form lists 10 allegations of wrongdoing and there are 26 pages of abbreviated notes about questionable practices at clinics with names of former or current Solantic employees as potential sources for investigators.

If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.

When asked while campaigning Thursday how he would handle that situation, Scott said he wouldn’t get involved except for making the appointment of the head of the health department.

“I’d recuse myself from any involvement,” he said. “I’m going to appoint the head of the position, but I’m not going to be involved in any decisions.”

Sent to the health department in mid-August, the complaint against Solantic Urgent Care of Jacksonville may have been dismissed as not part of the department’s purview, or officials may have found the allegations insufficient or unfounded. It is also possible an investigation was opened and continues.

Like many government agencies with investigative authority, the health department won’t confirm if it has the complaint in question.

The complaint caused a frenzy in mid-August when it became public after AHCA decided not to investigate and released it to the media. Scott detoured from campaigning in South Florida and held a press conference in Tallahassee. He told reporters his GOP opponent in the primary, Attorney General Bill McCollum, was using allegations received in an e-mail from Prokes for “Chicago-style smear politics.”

Solantic’s chief executive officer, Karen Bowling, likewise denied the allegations at the time and said Prokes was fired in 2009 for writing a prescription for a pain-killer outside the clinic.

Prokes, who couldn’t be reached for comment, stated in his e-mail to the Attorney General’s Office that he was fired after raising his concerns about wrongful practices at the clinics.

Allegations of potential fraud at Solantic brought back to the campaign forefront Scott’s past as chief executive officer of the former Columbia/HCA, which paid a record $1.7 billion in the late 1990s to settle Medicare fraud fines. Scott denied knowledge of the fraud and was never charged.

With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department.

Similar to state investigative agencies, the Office of the Inspector General with the U.S. Health and Human Services “can neither confirm nor deny the receipt of a complaint,” according to Donald White, spokesman for that federal agency.

The state health department has jurisdiction over possible standard of care infractions by physicians and other state-licensed medical professionals; AHCA licenses medical facilities and investigates potential regulatory violations.

The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.

Another claim is that a physician’s medical license was misused by Solantic to apply for a clinic license without the physician’s knowledge.

Both in August and recently, Scott campaign officials have said the allegations are old, were trumped up by the McCollum campaign before the primary and that Solantic aggressively responded to the claims.

“The guy (Prokes) was not even in the position to allege what he alleged,” said Brian Burgess, a Scott spokesman. “My understanding from the Solantic attorney, they would be told if there is even something going on.”

Responding to a recent follow-up inquiry by the Daily News to AHCA about why the agency declined to investigate, spokeswoman Tiffany Vause said Solantic clinics hadn’t filed any claims with the traditional Medicaid program but claims were filed with a few Medicaid managed care plans under state contract.

“The agency’s Bureau of Medicaid Program Integrity referred the complaint to these health plans for review,” she said in an e-mail.

In response to the allegation that Solantic used a physician’s license at another clinic site without the doctor’s knowledge, Vause said state law doesn’t allow the agency to sanction a clinic for such activity.

However, medical facilities can be cited during inspections for a variety of deficiencies with state regulations.

Three inspections at Solantic clinics in Orlando, Apopka and Lake Mary show they were flagged because the medical directors had failed to do periodic reviews of billing claims to make sure no fraudulent or unlawful claims were filed. One of the inspections was in late 2007 and two others were in April and August of this year.

AHCA spokeswoman Shelisha Durden said a clinic doesn’t pass an inspection until there are assurances that the billing review is in place and being done.

“The issue is whether the clinic had a process in place where the medical director conducted systematic reviews of the clinic’s bills, and also whether the director conducted these reviews,” she said.

* * * * *