Amendment No. 11 to Contract FA615 between the Agency for Health Care Administration and WellCare of Florida, Inc. (d/b/a StayWell Health Plan of Florida)

1.

Attachment II, Medicaid Prepaid Health Plan Model Contract, Section X., Administration and Management, Item I., Fraud Prevention, sub-item 4., is hereby amended to include the following:

 

I.

Provide details about the following, as required by Section 6032 of the federal Deficit Reduction Act of 2005:

 

(1)

the False Claim Act;

 

(2)

the penalties for submitting false claims and statements;

 

(3)

whistleblower protections;

 

(4)

the law’s role in preventing and detecting fraud, waste and abuse; and,

 

(5)

each person’s responsibility relating to detection and prevention.

2.

Attachment II, Medicaid Prepaid Health Plan Model Contract, Section X., Administration and Management, Item I., sub-item 7. is hereby included as follows:

 

7.

In accordance with Section 6032 of the federal Deficit Reduction Act of 2005, the Health Plan shall distribute written Fraud and Abuse policies to all employees.  If the Health Plan has an employee handbook, the Health Plan shall include specific information about Section 6032 of the federal Deficit Reduction Act of 2005, the Health Plan’s policies, and the rights of employees to be protected as whistleblowers.

3.

Attachment II, Medicaid Prepaid Health Plan Model Contract, Section XVI., Terms and Conditions, Item 0., Subcontracts, sub-items 9. and 10., are hereby included as follows:

 

9.

The Health Plan must provide that compensation to individuals or entities that conduct utilization management activities is not structured so as to provide incentives for the individual or entity to deny, limit, or discontinue medically necessary services to any Enrollee.

 

10.

Provide details about the following, as required by Section 6032 of the federal Deficit Reduction Act of 2005:

 

(6)

the False Claim Act;

 

(7)

the penalties for submitting false claims and statements;

 

(8)

whistleblower protections;

 

(9)

the law’s role in preventing and detecting fraud, waste and abuse; and,

 

(10)

each person’s responsibility relating to detection and prevention.

 

 

SIGNED

BY:        /s/ Heath Schiesser                                                      

 

NAME:  Heath Schiesser

 

TITLE:  President and CEO

 

DATE:  June 29, 2009

SIGNED

BY:       /s/ Holly Benson                                                      

 

NAME:  Holly Benson

 

TITLE:  Secretary

 

DATE:  6/30/09