Flurry of accusations fly against Florida Agency for Health Care Administration over Medicaid procurement process

by | May 24, 2024

Multiple healthcare providers lodged protests with a common theme: inconsistency, bias, and lack of transparency, among many complaints as AHCA prepares to defend its provider evaluation process.

A flurry of protests have emerged following Florida’s Agency for Health Care Administration’s (AHCA) recent award of state Medicaid contracts, all following a common theme accusing state officials of presiding over a “fundamentally flawed” process that failed to follow the state’s own guidance. Last month, AHCA awarded billions of dollars worth of Medicaid contracts to a number of health care providers after subjecting competitors to a series of evaluations centered around a state-developed scoring system designed to make the process fair and transparent.

But that’s not what happened, the protests claim.

Among a slew of other complaints, the protests accused state officials of undue favoritism towards incumbent providers, claimed that they failed to apply consistent evaluation criteria, relied on unqualified personnel, and used undisclosed and arbitrary measures in the state’s decision-making. One complaint, filed by ImagineCare, claims the process violated Florida law and the state’s own specifications, resulting in the selection of vendors lacking the necessary experience and capability.

Another, Molina Healthcare, described the procurement process as “fundamentally flawed” in their official protest. That same sentiment was echoed by other providers, who alleged similar inconsistencies , invalid decisions, key non-disclosures, and clear biases toward certain providers that were more “familiar” to state officials than others. In addition, the protests claim, certain evaluation criteria were changed mid-process without notifying all competitors.

Major players like United Healthcare and Molina Healthcare have voiced strong objections, and were joined by companies including Sentara Care Alliance, which echoed the same sentiments, describing the AHCA procurement process as “riddled with errors and prejudice.”

Sentara argued that the procurement decision contradicted AHCA’s governing statutes, rules, policies, and the ITN (invitation to negotiate) specifications. Sentara also raised alarms about the potential risks posed by awarding contracts to vendors lacking the necessary network or ability to serve the Medicaid population adequately.

Their protest used a vivid analogy: “The decision is akin to the State hiring a vendor with experience paving parking lots for a project to build a bridge to an island, even though the State knows the vendor has never built a bridge.”

Molina Healthcare stated in their protest that the contract awards “do not comply with Florida law. AHCA’s actions were contrary to the governing statute of the ITN, such that its decision was clearly erroneous, arbitrary, and capricious, and contrary to competition.” They emphasized the procurement process’s lack of adherence to statutory requirements, leading to what they consider unjust and inappropriate awards.

United Healthcare’s protest underscored key non-disclosures and questionable qualifications of decision-makers, pointing to a procurement process marred by procedural irregularities.

The litany of complaints didn’t end there. Sentara also expressed concerns over the qualifications of some AHCA negotiators, stating that their lack of understanding and knowledge could result in Florida’s Medicaid members being denied access to innovative and beneficial models for care.

ImagineCare highlighted what they termed “unreasonable and unsubstantiated bias” in favor of incumbent plans. They accused the AHCA negotiation team of allowing vendors with known deficiencies to offer new services, despite their lack of experience. ImagineCare detailed further issues such as unannounced criteria and weighting, and reliance on personal relationships, which they argue tainted the legitimacy of the agency’s decision.

The outcome of the protests could have significant implications for the future of Medicaid services in the state.


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