New fight emerges over HIV and AIDS care


    (MGN)

    An ongoing legal battle over which managed-care plan should be picked by the state to provide care to low-income AIDS and HIV patients in South Florida has triggered a new round of litigation that pits two competitors.

    The AIDS Healthcare Foundation this week asked a circuit judge to order competitor Simply Healthcare to stop communicating with the foundation’s Medicare patients.

    While Medicare is a federal program, the AIDS Healthcare Foundation has been battling to reverse a decision by the state Agency for Health Care Administration to award Medicaid contracts to Simply Healthcare. The new lawsuit involves patients who qualify for Medicaid and Medicare --- known as “dual eligibles.”

    In the lawsuit filed Thursday in Miami Dade County circuit court, the AIDS Healthcare Foundation accuses Simply Healthcare of providing Medicare patients with false information, advising them that they are required to drop their current coverage and enroll in Simply Healthcare.

    “By contacting AHF’s patients and disseminating false information to them, Simply is intentionally and unjustifiably interfering with (AIDS Healthcare Foundation’s) business relationships,” attorneys for the foundation argued in the complaint.

    Simply Healthcare did not immediately respond to a request for comment about the lawsuit.

    The AIDS Healthcare Foundation has participated in recent years in the Florida Medicaid program, which offers health care to poor, elderly and disabled people. It also participates in the federal Medicare program, which mostly serves seniors. Some people --- the dual eligibles --- qualify for both.

    Florida recently negotiated new, five-year Medicaid managed-care contracts with health plans. The AIDS Healthcare Foundation was not chosen to be a Medicaid managed-care provider in Broward, Miami-Dade and Monroe counties, essentially precluding it from participating in the program for the next five years. Simply Healthcare was awarded contracts to serve patients with HIV and AIDS.

    The foundation has legally challenged the contracting decisions by the Agency for Health Care Administration, with an administrative law judge siding with the foundation. But the agency did not go along with the judge’s decision, leading to the foundation filing an appeal.

    In the meantime, the state is moving ahead with transitioning Medicaid beneficiaries from the foundation’s Medicaid managed-care plan to Simply Healthcare.

    In the lawsuit, the foundation argues Simply Healthcare has been contacting dual eligibles and advising them they have to switch health plans by March 1 because the foundation no longer has Medicaid managed-care contracts.

    “Apparently emboldened by AHCA’s improper actions, Simply began a pattern of contacting existing dual eligible patients (enrolled in the Medicare managed care plan), telling them they needed to change not only their Medicaid enrollment to Simply but also were required to change their Medicare plan enrollment to Simply,” the lawsuit said. “Those statements are factually incorrect as, no matter what ultimately occurs in relation to the pending procurement challenge and the Leon County litigation (over the Medicaid contracts), patients’ ability to utilize their Medicare benefits with AHF through PHP (the foundation’s Positive Healthcare Plan) are not affected.”

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