Category Archives: Health.Care

Iowa’s Medicaid privatization: Kim Reynolds says right track; Fred Hubbell says ‘disaster’

Source: William Petroski and Brianne Pfannenstiel, Des Moines Register, September 4, 2018

Two months ahead of Election Day, Iowa’s gubernatorial candidates painted a vastly different portrait of the state’s Medicaid system Tuesday. In the morning, Republican Gov. Kim Reynolds defended the state’s decision to shift administration of the program that serves 685,000 low-income or disabled Iowans to private management, telling reporters that initial problems have been addressed and the system is on the right track. In the afternoon, Democratic businessman Fred Hubbell held a roundtable with providers where he described a system in crisis and criticized Reynolds’ handling of the program. The results of privatizing the massive federal and state program in Iowa have become one of the issues that will influence — and may decide — this year’s governor’s race. …

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A private Medicaid company that pulled out of Iowa has yet to pay thousands of medical bills
Source: Jason Clayworth, Des Moines Register, August 30, 2018
 
A Medicaid company that terminated its Iowa contract almost a year ago has yet to pay as much as $14.6 million for medical care provided to disabled, poor and elderly Iowans, a Des Moines Register investigation shows.  AmeriHealth Caritas’ outstanding bills include nearly 6,000 individual charges totaling more than $1 million at the University of Iowa Hospitals and Clinics and $541,000 at Broadlawns Medical Center, public records obtained by the Register show.  Several private and nonprofit medical groups told the Register they have tens of thousands of dollars in outstanding bills that they say are hamstringing their operations and efforts to provide medical care. …

Iowa agrees to give Medicaid management firms 7.5% raise to continue running program
Source: Tony Leys, Des Moines Register, August 24, 2018
 
Iowa has agreed to give 7.5 percent more state money to the two private companies managing its $5 billion Medicaid program, officials announced Friday.  The agreement will keep UnitedHealthcare and Amerigroup in Iowa, but it will mean state leaders must come up with about $103 million more than last fiscal year.  The new agreements cover the current fiscal year, which began July 1. The increase in state spending is more than double the 3.3 percent increase the state agreed to for last fiscal year.  Overall, the new contracts will give the two companies raises of 8.4 percent in state and federal money, totaling $344 million. …

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Justice says he’s working on PEIA possibilities independently of Task Force

Source: Brad McElhinny, West Virginia Metro News, August 26, 2018
 
Gov. Jim Justice wants the PEIA Task Force, which has been meeting for a half-year now, to continue its work aimed at shoring up health insurance for state employees and retirees.  But Justice said in a Friday interview that he’s also working independently on possible changes to the Public Employees Insurance Agency.  He hinted that might have an element of privatization, the way the state dealt with workers compensation years ago, and also that he is looking toward long-term stabilization of the program that he believes is possible because of West Virginia’s improved economic outlook. …

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WV officials unsure PEIA would benefit from privatization
Source: Phil Kabler, Charleston Gazette-Mail, September 19, 2017
 
Privatization of West Virginia’s Workers’ Compensation insurance was successful, particularly in lowering employer premiums and increasing competition, Brickstreet Insurance CEO Greg Burton told legislators Tuesday.  Whether those successes would apply to privatization of the state Public Employees Insurance Agency health insurance remains to be seen, he said.  “I’m not sure all the successes that happened with Workers’ Comp privatization, particularly with the decreases in rates…would translate over to PEIA,” he told a legislative interim committee studying PEIA. … According to a report on state employee health benefits published by the National Conference of State Legislatures on April 2, only two states exclusively use private insurers to provide health insurance to public employees, Idaho and North Dakota. According to the NCSL, 29 states, including West Virginia, have fully self-funded health insurance plans, while the remaining 19 states provide employees with coverage options, including self-funded plans. …

Signs protest Davenport school district’s outsourcing initiative

Source: Linda Cook, Quad-City Times, August 22, 2018
 
Last week, Davenport Schools Superintendent Art Tate floated the idea of outsourcing some services, if the district could save money and maintain or improve the quality of the service. Teaching jobs would not outsourced. Since then, signs saying “Protect Our Kids, No Outsourcing in our Schools” have appeared along West Locust Street and West Central Park Avenue opposing the concept. Union officials were aware of the signs, but said they have not taken an official stance on the issue. Earlene Anderson, the union representative for the American Federation of State, County and Municipal Employees (AFSCME,) for East Central Iowa, which represents the district’s para-educators, security, custodial and food service-workers, among others, said “everything is still evolving.” …

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Orange Signs Popping Up Around Davenport
Source: Angie Sharp, WQAD, May 1, 2013

It’s a community campaign that is growing every day. Bright orange signs are popping up in front yards across the Davenport Community School District, reading “Protect Our Kids. No Outsourcing In Our Schools.” The signs are part of an effort to stop the District from outsourcing jobs such as custodians, nurses, security staff, maintenance crews, and more. The District’s Resource Allocation Committee, which looks at ways the District can reduce spending and save money, has recommended the possibility of conducting outsourcing studies…

Davenport school board hones in on $3.2 million in budget cuts
Source: Tara Becker, Quad-City Times, March 26, 2013

…To address the uncertainty in state funding, the district’s Resource Allocation Committee recommended that the district cut $3.25 million per year for the next five years to make sure the budget stays in the black. The committee, which is made up of 25 representatives of the school district and the community, recommended several budget reductions and other areas of study. One such recommendation by the committee is to outsource nursing, janitorial and other positions. The board has not yet to direct Tate to do a study on the issue….

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Massena Hospital & Town Take Step Toward Privatization

Source: WWNY, August 21, 2018

Massena Memorial Hospital and the town of Massena have made a step toward privatizing the institution. Right now, the town owns Massena Memorial, but officials from both entities want to transfer ownership to a private, nonprofit organization. Town Supervisor Steve O’Shaughnessy said in a statement Monday that there was an agreement in principle on a plan to transfer the hospital’s assets from the town to a private entity that would run the institution. …

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Interim hospital chief executive officer says privatization her main focus
Source: Bob Beckstead, Watertown Daily Times, July 26, 2018

The interim chief executive officer at Massena Memorial Hospital says that, during the two months for which she is contracted, the focus will continue to be on a process that was first discussed in 2013 — privatization of the hospital. “My priorities right now are to continue to work with the town and hospital board to become a 501(c)(3) and complete the affiliation,” Ann Gilpin said during this week’s Massena Memorial Hospital Board of Managers meeting. Monday was Ms. Gilpin’s first Board of Managers meeting since she was named interim chief executive officer in June following the sudden resignation of former Chief Executive Officer Robert G. Wolleben. Her contract calls for her to serve as interim chief executive officer for up to two months, at a rate of $40,000 per month.

With CEO’s resignation, Massena council will push hospital to privatization, affiliation
Source: Bob Beckstead, Watertown Daily Times, June 19, 2018
 
With Monday night’s surprise resignation of Massena Memorial Hospital’s CEO, town officials will seek a contract with another hospital to run Massena Memorial Hospital and complete the privatization work already underway. Ann Gilpin was hired as interim chief executive officer following Monday’s immediate resignation by Robert G. Wolleben, but it will be a temporary position, Town Supervisor Steven D. O’Shaughnessy said. … Last month, Assemblywoman Addie A.E. Jenne, D-Theresa, introduced a bill that would move the hospital into a public benefit corporation rather than privatizing, which would shift financial responsibility away from the town while keeping the hospital from going private. But Mr. O’Shaughnessy said that was off the table. …

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Multnomah County launches investigation into mental health complaints

Source: Keaton Thomas, KATU News, August 16th, 2018

Thanks to a whistleblower and report from the Oregon Health Authority, Multnomah County officials are launching an investigation into how they review mental health complaints from the Unity Center for Behavioral Health. … Multnomah County is the local mental health authority. All complaints of abuse or neglect in the mental health system are directed to it. Last week, county leaders ordered an audit of the complaints reported to the Mental Health and Addiction Services Division. … Issues surrounding Unity Health go back to its beginning, according to Greg Monaco. … “When I started going [to Unity] I was just hearing horror stories from staff,” he said. Monaco says he heard about patients who didn’t know they were kept against their will. He heard about injuries to staff. He heard about employees at Unity who were worried about their safety because of understaffing. … Reports from earlier in the year by the Occupational Safety and Health Administration and the Oregon Health Authority back up Monaco’s claims. In March OSHA cited Unity Health for four violations. It found Unity had not properly handled and investigated injuries to staff members on the job. Last month, a report from the Oregon Health Authority looked into patient safety. It “uncovered several issues that jeopardized patient safety.” …

State ending deals with pharmacy middlemen that cost taxpayers millions

Source: Catherine Candisky and Lucas Sullivan, The Columbus Dispatch, August 14, 2018

The Ohio Department of Medicaid is changing the way it pays for prescription drugs, booting all pharmacy middlemen because they are using a secretive pricing method that has cost taxpayers hundreds of millions. Medicaid officials directed the state’s five managed care plans Tuesday to terminate contracts with pharmacy benefit managers using a practice called “spread pricing” and move to a more transparent pass-through pricing model effective Jan. 1.

… The announcement comes after more than 40 stories by the Dispatch this year investigating the mysterious practices of little-known pharmacy benefit managers, or PBMs, that make nearly $400 billion a year as part of the country’s health care system. CareSource, Medicaid’s largest managed care plan, will soon seek bids on a new transparent contract to comply with the directive, said company vice president of pharmacy, James Gartner. The state’s leading PBM, CVS Caremark, “is working with our clients [the managed care plans] to update our contracts moving forward,” said company spokeswoman Christine Cramer. CVS uses pass-through pricing in several other state Medicaid programs. …

Murphy administration demands action from major group home operator after safety problems revealed

Source: Susan K. Livio, NJ.com. August 10, 2018

Gov. Phil Murphy’s administration has halted new admissions at New Jersey’s largest group home operator for people with developmental disabilities and demanded “immediate correction of all concerns” involving safety and staffing shortages uncovered in 18 months of inspections. The state Department of Human Services intends to appoint an independent monitor and to continue random unannounced inspections at all 62 properties operated by for-profit Bellwether Behavioral Health, state Department of Human Services spokesman Tom Hester said.

The state stopped referring people to Bellwether on July 12, Hester confirmed, a decision revealed after an Aug. 3 report aired on public radio station WNYC about ongoing problems at a group home in Branchburg. … In addition to having the largest capacity of any group home provider in New Jersey, at 494 beds, Bellwether has also recorded the largest number of allegations of abuse and neglect. According to state data from March 2017 to March 2018, the state investigated 71 complaints, and substantiated 33. Six residents were repeatedly victimized, the data said. …

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Trapped: Abuse and neglect in private care (Podcast)
Reveal News, August 4, 2018

Deep in the backroads of central Florida, hidden between trees dripping with Spanish moss, sits the campus of an infamous center for the developmentally disabled. Its story shows what can happen when families have nowhere else to find care for their loved ones. After years of complaints, Carlton Palms is finally being shut down. But its parent company, Bellwether Behavioral Health, is still running group homes across the country, where new allegations have arisen. WNYC reporter Audrey Quinn investigates the company and speaks to a family whose son was abused at two of Bellwether’s New Jersey facilities. She discovers that, with national spending on autism services expected to increase 70 percent by 2025, the company is owned by a private equity firm.

Read more about Carlton Palms.

US government failing millions by paying below $15 an hour, study finds

Source: Mike Elk, The Guardian, August 10, 2018
 
The federal government employs more workers making less than $15 an hour than any other employer in the US, a new report has revealed.  The study, compiled by pro-union group Good Jobs Nation, analyzed federal data and showed that the government spends more than $1.6tn on federal contractors employing more than 12.5 million people with 4.5 million of those workers making below $15 an hour.  Many of these workers are employed by contractors as janitors, cafeteria workers, call center workers, administrative assistants and healthcare aides, and union campaigners say they are being kept on poverty wages. …

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Audit at Texas Health and Human Services Commission finds latest in long line of problems

Source: Robert T. Garrett, Dallas News, July 18, 2018

Texas’ sprawling bureaucracy for regulating health care and providing social services is vulnerable to a “perception of impropriety” because it routinely lets individual contracting personnel open bids on their own, without any witnesses, a new internal audit says. The Health and Human Services system also unwisely allows program managers and division leaders who control billions of dollars of spending to ask for the same contracting specialist every time, the audit said. That potentially creates a coziness that could harm taxpayers’ interests, it said. Problems highlighted in the audit, which was released to state GOP leaders last week, are the latest in a long line of problems at the Health and Human Services Commission. Six officials have stepped down since early April, when Gov. Greg Abbott called revelations of sloppiness and mistakes in scoring of bids “unacceptable.” …

Another audit released Tuesday by an independent arm of the Legislature looked at nearly 70 percent of the $6.7 billion worth of contracts that the commission awarded in a recent 27-month period. There were problems with every single one of the 28 separate calls for bids or grant proposals that the State Auditor’s Office examined. … Both the commission’s internal audit and the State Auditor’s Office review sharply criticized sloppy handling and scoring of bids for billions of dollars worth of work for the Medicaid program for the poor and other health and social services programs. …

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Pain & Profit series from the Dallas Morning News, published June 2018

  • The preventable tragedy of D’ashon Morris
    Doctors described him as “happy and playful” and told his foster mother he would be healthy by the time he went to kindergarten. That was before a giant health care company made a decision that saved it as much as $500 a day — and cost D’ashon everything.
  • As patients suffer, companies profit
    Imagine being trapped in a bed for more than a year because you can’t get the medical equipment you need. Years of poor oversight by the state have allowed health care companies to skimp on essential care for sick kids and disabled adults.
  • Texas pays companies billions for ‘sham networks’ of doctors
    The state tells foster parents that hundreds of psychiatrists will see their kids. We found only 34. Managed-care companies overstate the number of physicians available to treat the state’s sickest patients.
  • ‘Glossover of the horror’
    A whistleblower says taxpayers are not getting their money’s worth and sick people are not getting the care they need. Texas fails to act when health care companies put patients in peril.
  • Parents vs. the Austin machine
    “You can tell that he’s crying or screaming, but nothing comes out.” Texas families take fight for medically fragile children to the Legislature.

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Insurers Fall Short In Catching And Reporting Medicaid Fraud, Inspectors Find

Source: Chad Terhune, Kaiser Health News, July 12, 2018

Despite receiving billions of dollars in taxpayer money, Medicaid insurers are lax in ferreting out fraud and neglect to tell states about unscrupulous medical providers, according to a federal report released Thursday. The U.S. Health and Human Services’ inspector general’s office said a third of the health plans it examined had referred fewer than 10 cases each of suspected fraud or abuse to state Medicaid officials in 2015 for further investigation. Two insurers in the program, which serves low-income Americans, didn’t identify a single case all year, the report found. Some health plans terminated providers from their networks for fraud but didn’t inform the state. The inspectors said that could allow those doctors or providers to defraud other Medicaid insurers or other government programs in the same state. In addition, some insurance companies failed to recover millions of dollars in overpayments made to doctors, home health agencies or other providers. The inspector general said insurers stood to benefit financially from this because higher costs can justify increased Medicaid rates in the future. (The report didn’t name specific insurers or states.) …

…Health insurers serve about 55 million Medicaid patients across 38 states, and play an increasingly vital role in running the giant public insurance program. … One in 5 Americans is on Medicaid and enrollment is poised to rise even further as more states consider expansion under the Affordable Care Act. About 75 percent of Medicaid patients are part of a privatized system in which managed-care companies are paid fixed fees per patient to coordinate their care. Big, publicly traded companies such as UnitedHealth, Anthem and Centene dominate the business. In some states like California, evidence shows the funding often flows to the plans with little oversight, sometimes regardless of their performance. These companies tout their expertise at spotting suspicious billing patterns and chasing down criminals using sophisticated data mining, but the inspector general found that their fraud-fighting results don’t always match the rhetoric. …

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