The Citrus County Hospital Board has recouped $2.65 million on behalf of the county after a yearslong battle with the Centers for Medicare & Medicaid Services (CMS).
The hospital board, which owns Citrus Memorial Hospital on behalf of the public and leases it to the Hospital Corporation of America, battled CMS for the money, claiming that before the 2014 lease began, the hospital was underpaid for its Medicaid cases.
In a letter this week from one of the board’s consulting lawyers, the Citrus County Hospital Board trustees were told CMS finally relented and agreed to pay $2.65 million in contested Medicaid reimbursements from 2013 and 2014.
“We achieved the goal we wanted to achieve and that was to recoup funds that were due the citizens of the county,” said Hospital Board chairwoman Debbie Ressler.
Before the lease began in 2014, and while the hospital was still under the operation of what is now the Foundation Resolution Corp., the hospital operators failed to register the hospital as a Disproportionate Share Hospital (DSH), a federal designation available to hospitals that treat a disproportionately high number of indigent patients which provides a higher reimbursement rate.
Due to the amount of time that had passed, the hospital board had missed its opportunity to petition for the lost money dating back to 2013 and further. That changed when Florida’s Agency for Health Care Administration (AHCA) audited its payments to the hospital during the past several years, essentially opening those billing years up again to the hospital board for review.
AHCA claimed that it had overpaid the hospital $5.8 million between 2006 and 2016 and would recoup that money from future Medicaid payments.
Hospital board consulting lawyer Karen Schapira, and the board’s attorney Bill Grant, fought the AHCA. Sunrise, Florida-based Schapira specializes in health care law.
The two lawyers determined that the hospital had been underpaid by Medicaid in 2013 and 2014 — and that allowed Schapira and Grant to claim to AHCA that if it had been underpaid in those years, it was also likely underpaid during other years.
As part of an agreement with the hospital board, AHCA agreed to stop seeking the $5.8 million from future Medicaid payments.
But the legal fees were not cheap. Schapira charged the hospital board $210,000 for her work and another $75,000 for associated costs such as her own consulting auditors and accountants. To fight the AHCA claims that it overpaid $5.8 million, Schapira charged the hospital board $142,077 for her work and another $9,705 for associated costs.
Grant is paid a flat $60,000 annual salary for his board work.
Ressler said the legal fees were an investment that paid off.
“We achieved our goal, and that was part of our mission to protect the taxpayers,” she said.
Schapira said the hospital board trustees were “bombarded” with criticism about spending money on lawyers trying to recoup the money.
“But they voted to take a chance. They stood by us,” Schapira said.
That recouped money will go to the Citrus County Community Charitable Foundation, which uses it to fund local nonprofit organizations providing health care services, mostly to the uninsured and underinsured.
Grant echoed Ressler's sentiments.
“Wouldn’t you take that as an investment?” he asked a Chronicle reporter. “If I can spend $285,000 of taxpayer money ... and recover $2.65 million, I would do it every day and the trustees understood that,” he said.
Meanwhile, the hospital board is working to recover more money having to do with the hospital’s former pension.
The Foundation Resolution Corp, which is the remains of the organization that operated the hospital before the lease, is suing Aon Hewitt Investment Consulting. It claims Aon gave it faulty pension termination advice during lease negations.
The FRC claims the bad advice cost it several million dollars. The hospital board had to loan it $17.5 million to wind down the pension and ensure all the hospital’s employees were paid.
If the FRC recoups the money from Aon, it will hand that over to the hospital board to repay the board’s loan to the FRC. The board would in turn give the money to the charitable foundation.
Ressler said the board will decide soon whether to try and recoup other money it might have been underpaid.
The hospital board members plan to dissolve the hospital board by early 2023 and have another governmental agency take over its role. By then, the hospital’s financial issues will be resolved, pension plan dismantled, and its current lawsuit against Aon Hewitt Investment Consulting concluded.
The next issue the board tackles will likely be what to do with the approximate $8 million fund it uses to pay current and future legal fees, administrative costs and to potential health-related services.
Many hospital board critics want the money given to the charitable board now, while Grant argues it’s to be given to whatever governmental body replaces the board.
Grant said he will deal with that when the time comes. For now, the $2.6 million recouped money and the halt on AHCA’s $5.8 million “is a victory and let’s keep moving.”