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HomeMy WebLinkAbout2002 06 10 Regular O Reimbursement from MCPG .~-. COMMISSION AGENDA ITEM 0 Consent Informational Public Hearing Regular X June 10. 2002 //' 7fItJxI/I "/f"/rJ;r- Meeting /~~ r MgL / Att. / Dept. REQUEST: Authorize the City Manager to execute a Settlement Agreement with the State of Florida Attorney General's Office regarding Medicaid overpayments, Further, instruct the City Attorney's Office to seek reimbursement from MCPG for the costs associated with the investigation conducted by the Florida Attorney General's Office and for any fees collected by MCPG on the overpayment. PURPOSE: The City of Winter Springs entered into an agreement with Medical Claims Processors Group, Inc, (hereinafter "MCPG") on or about October 1, 1998, for the purpose of providing billing and collection services for emergency medical services treatment and transport. On or about April 26, 2001 the Winter Springs Fire Department (hereinafter "WSFD") was contacted by investigators for the Office of the Attorney General, Medicaid Fraud Control Unit to discuss billing practices and submissions, On or about April 27, 2001 MCPG notified the WSFD that due to a computer problem at MCPG, MCPG submitted erroneously coded billing statements to the Florida Agency for Health Care Administration, which resulted in Medicaid making overpayments to the City of Winter Springs. MCPG indicated it was working with the Attorney General's Office to resolve the issue. On March 11, 2002 and March 14, 2002 the WSFD received correspondence from the Attorney General's Office indicating it had concluded its investigation and that the City had realized $1,346.91 in Medicaid overpayments due to erroneous billing statements. Further, the cost to Attorney General's Office to investigate the matter was $2,741.00. At which time the WSFD sought the Page 1 of 2 assistance'and counsel of the City Attorney's Office, To avoid further expenses associated with the collection of the Medicaid overpayments the Attorney General's Office provided a proposed settlement agreement which has been reviewed by the City Attorney's Office, which includes the cost of the overpayments and the investigation, The City Attorney's Office is reviewing the agreement between the City and MCPG and will seek reimbursement from MCPG under the agreement for the costs associated with the Attorney General's investigation and for the percentage retained by MCPG on the overpaid bills, APPLICABLE LAW AND PUBLIC POLICY: Chapter 409, Florida Statutes CONSIDERA TIONS: MCPG has admitted that due to a computer "glitch" it submitted erroneously coded billing sheets, on behalf of the City, which resulted in overpayments by Medicaid. If a settlement cannot be reached, the Attorney General will have no choice but to file suit for collection, which will result in increased costs to the City. The agreement between the City and MCPG provides that MCPG shall indemnify and hold the City harmless for any claims, costs, or expenses, including attorney fees, incurred as a result of the provision of the services provided by MCPG. STAFF RECOMMENDATION: Authorize the City Manager to execute the Settlement Agreement and to issue payment as directed within ten (10) days, Further, instruct the City Attorney's Office to seek reimbursement from MCPG for the costs associated with the investigation conducted by the Florida Attorney General's Office and for any fees collected by MCPG on the overpayment ATTACHMENT: Settlement Agreement Service Agreement with MCPG COMMISSION ACTION: F:\Lawyer\jeflbICity of Winter Springs\Agenda SheetsIMedicaid Overpay Settlement 041502.wpd Page 2 of 2 SETTLEMENT AGREEMENT THIS SETTLEMENT AGREEMENT (the "Settlement Agreement") is entered into on the last date signed below by both. parties, between the. City of Winter Springs (hereinafter known as "CITY") which term whenever used herein shall mean the City of Winter Springs, including all departments, divisions, officials, agents and attorneys and the Office of the Attorney General (hereinafter the "OAG"). WIT N E SSE T H: WHEREAS, the OAG commenced an investigation of billing submissions made on the behalf of Winter Springs Fire Department, by Medical claims Processors Group, Inc., which resulted in over payments from the Agency for Health Care Administration (hereinafter (AHCA); and WHEREAS, the CITY and the OAG, desire to conclude the aforementioned investigation and to settle and compromise all claims arising out of such investigation that were asserted or maintained, could have been asserted or maintained, or which in the future could be asserted or maintained by the OAG or the AHCA against the CITY for such overpayment and; NOW, THEREFORE, in consideration of the premises and the mutual promises, agreements and covenants herein, including, but not limited to, the payment of the Settlement sum as described in paragraph 4 below, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto stipulate and agree as follows: 1 I. As used herein the term "Investigation" shall mean the GAG's examination of CITY's alleged improper receipt of Medicaid overpayments due to erroneous Medicaid billings by the CITY's billing and collection service provider during the period January 1, 1998, through and including January 31, 2001, 2, The term "Parties" as used in this Settlement Agreement shall collectively refer to the CITY and the GAG. 3, It is expressly understood and agreed between the Parties that this Settlement Agreement, and the payment and release provided hereunder, are not and shall not be construed to be an admission of liability or any acknowledgment of the validity of any of the claims which were or which could have been asserted by the GAG against the CITY, arising out of the Investigation, which liability or validity is hereby expressly denied by the CITY. 4. The CITY agrees to pay. to the State of.Florida the.sum of $4.,087.H1.. 5. The CITY agrees to pay the amount provided in paragraph 4 above in one lump-sum payment to the GAG, within 10 days of the date of this Agreement. If full payment is not made as provided, this Settlement Agreement shall be of no further force or effect and neither party shall have any right hereunder unless the payment date is extended by the GAG in its sole discretion. 6. Upon full payment to the GAG of the amount provided in paragraph 4 above, the GAG hereby agrees to release, acquit, and forever discharge the CITY frol1! any and all actions, causes of action, obligations, liabilities, claims, or demands for compensatory, special, punitive, exemplary, or treble damages, claims or relief, or demand whatsoever 2 in law or in equity, civil or administrative, which were asserted or maintained, could have been asserted or maintained, or which could in the future be asserted or maintained against CITY in any action or proceeding, based upon, arising out of, related to, or connected with, directly or indirectly, any of the matters in the Investigation, 7, The Parties have agreed that the payment and settlement made pursuant to this Settlement Agreement constitute a complete resolution and settlement of all issues and matters relating to or the subject of the Investigation. Upon CITY's fulfillment of its obligations under this Settlement Agreement and payment of the sums provided herein, the Investigation, as defined in paragraph 1, shall be concluded. 8, The Settlement Agreement shall be binding upon and inure to the benefit of the Parties. 9. This Settlement Agreement constitutes the entire agreement between the Parties with regard. to-the subject matter contained herein and all prior,negotiations and understandings between the Parties shall be deemed merged into this Settlement Agreement. 10. No representations, warranties or inducements have been made by the GAG concerning this Settlement Agreement other than those representations, warranties, and covenants contained in this Settlement Agreement. 11. No waiver, modification or amendment of the terms of this Settlement Agreement shall be.valid or binding_unlessjn.writing, signed by the party to be.charged and then only to the extent set forth in such written waiver, modification, or amendment. 12. Any failure by any Party to the Settlement Agreement to insist upon the strict 3 performance by any other Party of any of the provisions of this Settlement Agreement shall not be deemed a waiver of any of the provisions of this Settlement Agreement, and such Party, notwithstanding such failure, shall have the right thereafter to insist upon the specific performance of any and all of the provisions of this Settlement Agreement. 13. This Settlement Agreement shall be governed by, and construed and enforced in accordance with the laws of the State of Florida, without regard to its conflict of law principles. 14. The Parties acknowledge that this Settlement Agreement is being entered into to avoid the expense and length of further legal proceedings, taking into account the uncertainty and risk inherent in any litigation. 15. This Settlement Agreement, any exhibit or document referenced herein, any action taken to reach, effectuate or further this Settlement Agreement, and the terms set forth herein, shall not be construed as, or used as, an admission by or against any of the Parties of any fault, wrongdoing, or liability whatsoever, or as a waiver or limitation of any defenses otherwise available to any of the Parties. Entering into or carrying out this Settlement Agreement, or any negotiations or proceedings related thereto, shall not in any event be construed as, or deemed to be evidence of, an admission or concession by any of the Parties, or to be a waiver of any applicable defense. However, nothing in this Settlement Agreement, including this paragraph, shall be construed to limit or to restrict the CITY's right to utilize. this ,Settlement Agreement,. OJ. payments rnaqe hereunder, to assert and maintain the defenses of res judicata, collateral estoppel, payment, compromise and settlement, accord and satisfaction, or any legal or equitable defenses in any pending 4 or future legal or administrative action or proceeding. 16. If any clause, provision, or section ofthis Settlement Agreement shall, for any reason, be held illegal, invalid, or unenforceable, such illegality, invalidity, or unenforceability shall not affect any other clause, provision, or section of this Settlement Agreement, and this Settlement Agreement shall be construed and enforced as if such illegal, invalid, or unenforceable clause, section, or other provision had not been contained herein. 17. This Settlement Agreement, was executed after arms length negotiations between the Parties and reflects the conclusion of the Parties that this Settlement Agreement is in the best interest of all the Parties. 18. Each of the Parties participated jointly in the drafting of this Settlement Agreement, and therefore the terms of this Settlement Agreement are not intended to be construed against any of the Parties by virtue of draftsmanship. CITY OF WINTER SPRINGS, FL OFFICE OF THE ATTORNEY GENERAL DEPARTME GAL AFFAIRS Ron McLemore, City Manager RICHARD DORAN Deputy Attorney General for the State of Florida Date: s- D) - v~' Date: 5 6 Received: 3/27/02 5:45PM; 407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 5 . MAR-27-2002 17: 47 CITY OF WINTER SPRINGS 407 327 4753 P.05 CITY OF WINTER SPRINGS FIRE DEPARTMENT TERM CONTRACT NO. 98-01 Billing & Collection Services for File Department Emergency Medical Transport TO: Medical Claims Processors Group, Inc. P.O. Box 8063 Jupiter, FL 33468-8063 This is to infonn you that the City of Winter Springs hereby enters into a Tenn Contract subject to the following: TERMS AND CONDITIONS 1. Acceptance: This contract is our acceptance of your offer to operate as an Agency for the patient billing and collection services of the Emergency M;edical Services of the City of Winter Springs, Florida Fire Department. It is subject to all terms and conditions herein. 2. Term of Contract: 2.1 This is a term contract for the time period specified herein. It is entered into for the sole purpose of purchasing services which are covered by this contract. The City is not obligated to purchase any minimwn amount of service, unless otherwise stipulated in the contract. 2.2 This contract shall be effective beginning October 1, 1998, and shall remain in effect through September 30, 1999. ' 2.3 Thirty (30) days prior to the expiration date listed in section 2.2, the City shall advise the Agency of its intentions regarding the possible extension of the contract The City shall have the option to extend this contract for up to four (4) additional years past the expiration date listed above, and any extension pursuant to section 2.3. 2.4 Both parties agree to a trial period of no more than ninety (90) days during which the right to terminate the contract shall be suspended except as permitted under Paragraph 4.3. 2.5 The Agency will deposit collected funds into the City's designated bank account on the same day as they are received. In addition, the Agency shall provide the City with validated bank deposit slips on a weekly basis, It will be the responsibility of the City to provide the agency with preprinted deposit slips. Page 1 of7 Received: 3/27/02 5:45PM; 407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 6 MAR~27-2002 17:47 CITY OF WINTER SPRINGS 407 327 4753 P.06 '. 3. Compensation 3.1 The City shall pay the Agency for the services described in section (1) herein 3,82% of the amount collected. This rate shall be in effect for twelve (12) months from the date hereof with an option for an extension for up to four (4) additional years at the same rate of 3.82% collection rate. In addition, the City shall compensate the Agency at a rate of5.5% for any revenue generated by the Agency on all accounts which were previously assigned to prior vendor. All payments by the City will be made in accordance with the "Florida Prompt Payment Act". 4. Code of Ethics and Debt Collection Practices 4,1 The Agency shall maintain and operate under a "Code of Ethics" to insure integrity and confidentiality of the City and patients. A copy of this code is attached and incorporated herein by reference. 4.2 The Agency covenants and agrees that it shall comply with, keep and follow the guidelines, laws and regulations set forth in Chapter 599, Florida Statutes, and that it shall not violate Florida Statute 559.72 prohibiting certain practices concerning consumer or comm~cial collection, and all other laws, rules and regulations concerning commercial collections. The Agency warrants that it is aware of and fully knowledgeable of the laws regarding collection practices including those set forth in Florida Statutes Chapter 559 and warrants that it shall at all times remain knowledgeable of the laws set forth therein and any amendments thereto, and any successor laws, roles and regulations pertaining thereto. 4.3 A violation by the Agency of either the Code of Ethics or any provision of Florida Statutes Chapter 559, or any other law, rule or regulation concerning commercial collections shall be grounds for the City's immediate termination of this Agreement upon the Agency's receipt of notice from the City, without the thirty (30) day waiting period. In addition, the Agency agrees to comply with the Federal Debt Collection Practices Act set forth in 15 U.S. Code Section 1692 (a) - (0), and that any violation of that Act will also be grounds for immediate termination of the contract. 4.4 Uncollectible account receivables will be written off after twelve (12) months from the initial billing date. The City and the Agency will discuss this issue before any action is taken to remove the set accounts. The City reserves right to make the final decision on the accounts. 5, Indemnification 5.1 The City of Winter Springs, its officers'and employees shall not be deemed-to'assume-- _.. any liability for the acts, omissions, and negligence of Agency, its officers and employees. The Agency shall indemnify and hold the City and its officers and employees hannless from any liability, claims, causes of action, costs or expenses either direct or indirect including attorney's fees incurred as a result of, or arising under, this contract or the provisions of services hereunder. Page 2 of7 ~ece1ved: 3/27/02 5:45PM; 407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 7 MAR~27-2002 17:47 CITY OF WINTER SPRINGS 407 327 4753 P.07 52 The City shall be held harmless against aU claims of bodily injury, siclmess, disease, death or personal injury or damage to property or loss of use resulting therefrom arising out of performance of the contract, unless such claims are a direct result of the City's sole negligence. The City shall also be held harmless against claims for financial loss with respect to the provisions of or failure to provide professional or other services resulting in professional, malpractice, or errors or omissions liability arising out of the contract, unless such claims are a result of the City's sole negligence. 6. Insurance 6.1 The Agency shall be responsible for maintaining a general liability insurance policy covering all actions taken by the Agency in connection with either its duties under this contract or its relationship with the City. The general liability policy shall have a minimum coverage of One Million Dollars ($1,000,000) per occurrence and One Million Dollars ($1,000,000) aggregate. The Agency shall provide to City a Certificate of Insurance on the aforementioned policy immediately upon execution of this contract. 6.2 The insurance company and policy shall be in a fonn that is acceptable to the City. The Agency shall notify the City at least thirty (30) days in advance of cancellation, non-renewal or adverse change to the policy. New certificates of insurance are to be provided to the City at least thirty (30) days prior to coverage renewals. 6.3 Ifrequested by the City, complete copies of the insurance policies, forms and endorsements will be furnished to the City within ten (10) days of written notice. The receipt of certificates or other documentation of insurance or policies by the City, which indicate less coverage than required, does not constitute a waiver by the City of Agency's obligation to fulfill the insurance requirements. 7. Assignability 7.1 This contract is not assignable by either party. 8. Severability: Florida Law 8.1 If any part of this contract is adjudged invalid, all other parts herein shall remain valid and enforceable. Florida law shall govern this contract. 9. Scope of Services 9.1 The Scope of Services attached herein is expressly made a part of this contract. Page 3 of7 MAR-27-2002 17:48 407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 8 P.08 'Rece1ved: 3/27/02 5:45PM; CITY OF WINTER SPRINGS 407 327 4753 10. Miscellaneous Provisions 10,1 Notices. Any notices pursuant to this agreement shall be provided in writing to: City Manager 1126 East State Road 434 Winter Springs, FL 32708 Copies To: City Clerk 1126 East State Road 434 Winter Springs, FL 32708 Agency: Medical Claims Processors Group, Inc. Elaine Hines, President P.O. Box 8063 Jupiter, FL 33468-8063 IN WITNESS WHEREOF, the parties hereto have signed this contract by their duly authorized officers as of the day and year set forth above. CITY OF WINTER SPRINGS, FLORIDA BY:kplUklt.! 11/~ Atte~ 4. :ff~' MEDICAL CLAIMS PROCESSOR GROUP, INC. By: ~~~~CW~) Attest:~ ,~ Page 4 of? Received: 3/27/02 5:46PM; 407 327 4753 _> BROWN,WARD,SALZMAN&WEISS,PA; Page 9 MAR-27-2002 17:48 CITY OF WINTER SPRINGS 407 327 4753 P.09 CITY OF WINTER SPRINGS FIRE DEPARTMENT BILLING AND COLLECTION SERVICES SCOPE OF SERVICES Winter Springs, Florida (City) desires to enter into a contract with an experienced and qualified firm (Agency) to: I. Provide billing and collection services for Emergency Medical Services treatment and transport, as required on a case by case basis, with an emphasis on an accelerated turnaround between services provided and payments received. The price bid or piggyback contract herein shall include all expenses of-billing and collection including, but not limited to, stationary, forms, envelopes and postage. 2. Provide reasonably necessary training to appropriate City Fire Department personnel regarding the gathering of necessary infonnation and proper completion of run tickets. 3. Provide prompt submission of Medicare, Medicaid and insurance claims within ten (10) business days after receiving the completed run ticket, which shall be the Agency's notice to commence the billing/collection service. Secondary insurance provider claims shall be submitted within ten (10) business days after the primary insurance provider has paid or otherwise completed its processing of the claim. The Agency shall follow-up promptly on rejected and inactive claims and establish payer remittance accounts and procedures. 4, Reconcile the number of transports collected with those transmitted to the Agency. The Agency shall contact the Fire Department within twenty-four (24) hours of receipt to report any discrepancies. 5. Agency shall provide a designed liaison for patient/payer concerns. 6. Provide survey questiOIUlaires to patients at the City's request. 7. Provide all customer related inquiry services and prepare additional third party claims based on this information exchange. Customer calls will be facilitated as local within metropolitan Orlando or through an "800" exchange. 8. Implement a collection system involving a minimum of three invoices and a follow-up campaign of up to ten (10) telephone attempts to collect all private pay accounts with outstanding balances, including required co-payments and deductibles assessed by Medicare, Medicaid, HMO's or private insurance. Records of telephone calls and contacts shall be maintained and any payment on an_accountshall reset this cycle. The Agency shall make an attempt to locate the correct address for all returned mail to include up to three (3) attempts. The City reserves the right to approve the invoice format. 9, Attempt to collect all balances due for services rendered as well as attempt to assess patient's ability to repay the debt and, if necessary, extend time payments, all subject to such policy Page 5 of7 'Received: 3/27/02 5:46PM; 407 327 4753 -> BROWN,WARD,SALZMAN&WEISS,PA; Page 10 M8R-27-2002 17:48 CITY OF WINTER SPRINGS 407 327 4753 P.10 l1 ~ guidelines as the City may establish. 10. All requests for refunds will be forwarded to the City for any possible reconciliation. Refund requests will be forwarded to the City on a weekly basis. It will be the responsibility of the City to issue any refunds to clients. 11. The Agency shall provide to the City all unpaid invoices along with the complete processing history once collection efforts described herein are exhausted. At the termination of the agreement the Agency shall turn over all existing information in its possession concerning then existing unpaid accounts to the City. Such infonnation shall be transmitted by an electrollic medium (magnetic tape or diskette) reasonably acceptable to the City. 12, The Agency shall provide sufficient personnel to process all billing/run tickets in a timely, efficient and effective manner and shall respond promptly to the City and patients on requests for information or records. 13. Agency shall use any confidential records of care or treatment of patients solely for the purpose of processing and collecting claims and shall not release any such infonnation in any legal action, business dispute or competitive bidding process other than disputes with the City over billing services. 14. Any procedures described in this scope of services represents a minimum effort required by the City of the Agency and shall not limit the Agency's use of its proprietary accounts receivable and billing and collections systems, including modifications as required by major provider groups, or its usual and customary practices. This agreement shall require a minimum standard of 60% collection success rate. The successful collection rate will be calculated on a quarterly basis and reflect the percentage based upon what is billed versus what is actually collected before any other action is taken on the account. The Agency will be responsible for the amount of potential revenue that falls below the 60% minimwn. Payment difference must be made before the end of each fiscal year or may be removed from any fees paid by the City for said services. 15. AccoWlts are subject to being reviewed by the City, and being available during normal working hours to authorized City personnel. A listing of those persoIUlel shall be provided by the City. 16. The Agency, or its representative, must be licensed as a Health Claims Adjuster by the State of Florida. 17. The City reserves the right to terminate this contract after a thirty (30) day written notification to the Agency. 18. The Agency will be able to work previously billed accounts and be expected to collect on accounts. The City agrees to compensate Agency 5.5% of the amount collected for these accounts. A separate account shall be established to track these accounts. Page 6 of7 'Received: 3/27/02 5:46PM; 407 327 4753 -> BROWN,WARD,SALZMAN&WEISS,PA; Page 11 MAR-27-2002 17:48 CITY OF WINTER SPRINGS 407 327 4753 P.ll "f~ J\'I" ',t '.~Z --', " ] 9, The City agrees to work with the Agency to provide the required run information to best facilitate the billing process. 20. The Agency agrees to notify the City when refund to a client is required. The City will be responsible for mailing all refund payments. The City will advise the Agency of all accounts created and provide copies of payments made to same, 21. The following reports shall be prepared and submitted by the Agency for review by the City. All discrepancies shall be brought to the attention of the Agency within ten (10) working days. Reports Patient AccountslRun Number Cross Reference End of Month Report Totals Confirmation Transport Billed Run Number and Invoice Number Accounts Receivable/Aged Trial Balance Payments by Deposit/Collection Report Run Ticketffransport Tracking Report Corrections Patient Account and Claim Follow up Adjustment Report Deposit Total Confirmation Daily Cash Receipt Recap by Deposit Collections by Payee Group Page 7 of? Frequency Monthly Monthly Monthly Monthly VVeek1y~onthly Monthly' Upon Request Monthly Daily~onthly DailylMonthly Monthly TnTOI 0 1 1