Just What the Doctor Ordered: More Medicaid Reimbursements May Be On the Way For Florida Physicians

Tuesday, October 7, 2014
By Lance Leider, J.D., The Health Law Firm

Taking Medicaid patients can be seen as a professional obligation for health care providers. In return, good deeds should not bankrupt a practice. There could soon be a resolution to a class-action lawsuit against Florida health and child-welfare officials that would adequately compensate physicians for treating children of poor families.

According to the Miami Herald, the lawsuit was initially filed in 2005 by a group of pediatricians, dentists and nine children, against the Agency for Health Care Administration (AHCA), the Department of Children and Families (DCF) and the Florida Department of Health (DOH). The lawsuit claims that Florida violated federal law by providing inadequate Medicaid services to children and that their care had been hindered by low Medicaid payments to doctors. A final ruling by a federal judge is expected in October 2014.

Allegations Against the State in Lawsuit.

During the trial plaintiffs argued that the state failed to comply with federal requirements that mandate children that have Medicaid receive certain levels of medical and dental services. The plaintiffs request a U.S. Circuit Judge to rule that reimbursements to physicians be set at levels that would prompt more doctors to care for children on Medicaid. If the ruling is in favor of the plaintiffs, Florida will have to come up with around $227 million a year to permanently increase Medicaid payment rates to pediatricians and dentists.

Florida's Medicaid Reimbursements by the Numbers.

Under the Affordable Care Act (ACA), Medicaid payments to primary care doctors, including pediatricians and dentists, were increased for two years nationwide. However, this does not come close to achieving parity with federal Medicare levels for similar services.

Many Florida doctors have reduced their Medicaid patient case load to less than 10 percent, due to low payments, among other factors. Doctors even report operating at a loss when they treat patients under Medicaid. According to the Miami Herald, Florida was one of 13 states that ranked worst in the nation for access to and affordability of health care. To read the Miami Herald article, click here.

Why So Many Physicians Are Reluctant to Take Medicaid Patients.

Florida doctors argue that low Medicaid reimbursement rates are just one of many issues keeping Medicaid patients from adequate access to health and dental care.

Others complain that it takes an unacceptably long time to get reimbursements back from Medicaid. To add insult to injury, the amount of complex paperwork office staff is forced to fill out is also increasing. Health care professionals also report that Medicaid patients often require more time and attention than the average patient. Physicians feel that the social and behavioral needs of these patients require a disproportionate share of their time and that of their support staff.

The catch 22: Health care professionals must be willing to see Medicaid patients, and the government needs to recognize the program in order to make treating Medicaid patients worth a physicians' time.

Be sure to check this blog regularly for the ruling on the class-action lawsuit.


Have you decreased your Medicaid patient load lately? If so, what is your reason for doing this? Please leave any thoughtful comments below.

Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.
The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or (850) 439-1001.


Madigan, Nick. "Pediatricians in Florida Could See Relief from Low Medicaid Payments." Miami Herald. (August 18, 2014). From: http://www.miamiherald.com/2014/08/18/4296626/pediatricians-in-florida-could.html

Ubel, M.D., Peter. "Why Physicians Are Hesitant to Take Medicaid Patients." Kevin MD. (November 18, 2013). From: http://www.kevinmd.com/blog/2013/11/physicians-hesitant-medicaid-patients.html

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

Tag Words: physician, pediatrician, dentist, primary-care doctors, Florida, Medicaid, Florida Medicaid, Medicaid reimbursements, Medicaid payments, low medicaid payments, Agency for Health Care Administration, AHCA, Department of Children and Families, DCF, Department of Health, DOH, children Medicaid, Affordable Care Act, ACA, defense attorney, defense lawyer, health law firm, The Health Law Firm

"The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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