Brannock Berman & Seider Reverses Summary Judgment in Complex Statutory Interpretation Case

In an exhaustive opinion, the First District Court of Appeal ruled in favor of Brannock Berman & Seider’s clients in a long-running dispute over hospital reimbursements under Florida’s Medicaid laws.

The appeal involved complicated issues of statutory interpretation, retroactivity, and the interaction between the legislative and judicial branches of government.  In short, Medicaid pays hospitals for emergency care of undocumented immigrants.  Florida’s Agency for Healthcare Administration (AHCA) used to audit these payments and then seek refunds for care AHCA disagreed with.  The statute was then amended to require pre-approval for care, and once there was pre-approval, AHCA no longer had the right to audit and request refunds absent fraud.  But AHCA continued conducting audits anyway, claiming millions back for care it had already approved.  Several hospitals sued and won, with the First District confirming that AHCA had overstepped the statute.

Fast forward a year, and AHCA sought an amendment to the statute permitting it to conduct retrospective audits.  But the Legislature passed a different amendment, with the new statute failing to change the prohibition on retrospective audits.  AHCA, however, acted as if the new statute gave it back its power and began conducting retrospective audits all over again.  The hospitals hired Brannock Berman & Seider to assist at the summary judgment stage and then on appeal.  The trial court ruled for AHCA, but the First District reversed, confirming that it meant what it said in its first opinion and that the new statute did not change AHCA’s audit rights.