Category Archives: Health.Care

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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Unhealthy Skepticism

Source: Suzanne Gordon and Jasper Craven, Washington Monthly, July/August 2018

The Department of Veterans Affairs was back in the news this spring—and, as usual, the news wasn’t good. … But here’s a different story about the VA, from the exact same time period, that major media outlets didn’t bother to report: In March, researchers at the nonprofit research organization RAND published a study revealing the gross inadequacies of New York State’s health care system to effectively treat veteran patients. A month later, RAND found that the quality of VA care was generally better than private health care. These were just the latest of scores of studies that have come to the same conclusion for nearly two decades now. … As the U.S. continues to debate what to do about its unsustainable health care system—and as conservatives continue to push for “free market” solutions, including privatizing the VA itself—the fact that a government-owned and -operated system is outperforming the private sector should be a major story. If VA care is as good or better than the alternative, how would pushing vets into private-sector care make them better off? But that question rarely gets asked, because too many people are unaware that the premise guiding these policies—that the private sector inevitably outperforms government—is false.

… The point is not that the VA has no problems; it does. The point is that by failing to compare it to other health care systems, journalists can present a distorted impression that plays into ongoing efforts to privatize an agency that outperforms the rest of the U.S. health care system on most metrics. … Most recently, with bipartisan support, Congress passed the VA Mission Act, a “reform” package that could massively divert more veterans’ care from the VA to private-sector providers—which, in turn, would likely force the closing of many VA hospitals. Meanwhile, the Trump administration would clearly like nothing better than to be able to outsource lucrative contracts for VA care to its friends in the private sector. If the press doesn’t get this story right soon, America’s biggest and most successful example of government-provided health care will soon pass into history.

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For the first time, a senator is opposing the VA secretary nominee
Leo Shane III, Military Times, July 11, 2018

Senate Veterans’ Affairs Committee members on Tuesday voted to advance the nomination of Robert Wilkie to be the next secretary of Veterans Affairs, but the move came with a symbolic and historic opposition vote against the move. The panel by voice vote sent Wilkie’s nomination to the Senate floor, but with Sen. Bernie Sanders, I-Vt., opposing the move. … Sanders, the former chairman of the committee, said he also intends to vote against Wilkie when his nomination comes to the full Senate for a vote. … “This has less to do with Mr. Wilkie than President Trump,” Sanders said following the vote. “Trump has been very clear about his desire to move to the privatization of the VA, and I suspect any of his appointees will try and move the agency in that direction.”

VA nominee pledges to oppose privatization
Source: Nahaniel Weixel, The Hill, June 27, 2018

President Trump’s nominee to lead the Department of Veterans Affairs on Wednesday said he doesn’t believe in privatizing the agency and pledged to oppose privatization efforts. “My commitment to you is I will oppose efforts to privatize,” even if it runs counter to the White House agenda, Robert Wilkie told a Senate panel. Under questioning from Sen. Bernie Sanders (I-Vt.), Wilkie said he would keep the VA “central” to the care of veterans, but indicated there can be a balance. Democrats and some veterans service organizations believe the White House is being influenced by Charles and David Koch, conservative billionaires who back the group Concerned Veterans for America (CVA), which is pushing to loosen current restrictions on veterans receiving private-sector care. …

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St. Luke’s sues prison contractor over $12 million in medical bills

Source: Audrey Dutton, Idaho Statesman, July 16, 2018

St. Luke’s Health System is suing an Idaho prison contractor over $12.6 million in medical bills it says the contractor hasn’t paid. The lawsuit was filed June 28 against Corizon Health, a company hired by the Idaho Department of Correction to provide medical care to Idaho’s inmates. The dispute stems from Corizon’s decision to pay St. Luke’s at the Medicaid rate for services the health system provided between July 1, 2014, and March 26, 2018. The Medicaid rate is “substantially lower” than the rate the health system says Corizon had agreed to pay, according to the lawsuit. St. Luke’s said it should have received 76 percent of its billed charges. St. Luke’s also seeks more than $3 million in interest on the medical bills, as well as a total of more than $600,000 for individual patients’ bills it says Corizon underpaid. … The lawsuit is the second filed by Idaho health care providers against the contractor. Saint Alphonsus Health System in April sued Corizon over similar claims, saying it was owed $14 million for medical care to inmates. Saint Al’s also sought $5 million in interest from the allegedly unpaid bills. …

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Prison violations led to amputations and death, Idaho inmates say
Source: Associated Press, March 27, 2017

Idaho inmates are asking a federal judge to penalize the state after saying prison officials repeatedly violated a settlement plan in a long-running lawsuit over health care, leading to amputations and other serious injuries and even some prisoners’ deaths. In a series of documents filed in federal court, the inmates’ attorney Christopher Pooser painted a bleak and often gruesome picture of the alleged problems at the Idaho State Correctional Institution south of Boise. The prison is the state’s oldest, with more than 1,400 beds, including special units for chronically ill, elderly and disabled inmates. Pooser and the inmates allege some prisoners were forced to undergo amputations after their blisters and bedsores went untreated and began to rot, and others with serious disabilities were left unbathed or without water for extended periods and given food only sporadically. The prison’s death rates outpaced the national average as well as rates at other Idaho facilities, according to the documents. And despite hearing evidence to the contrary, prison officials failed to double-check the numbers when its health care contractor, Corizon, reported being 100 percent compliant with state health care requirements. Meanwhile, prison officials were falsifying documents to make it look like all employees were trained in suicide prevention when many were not, the filings said. The inmates are asking the judge to hold the state in contempt of court and levy more than $24 million in fines against the Idaho Department of Correction. They say the state could cover some of the fines by recovering money paid under its contract with Corizon, but they also want the state to feel the budget hit so prison leaders will be motivated to make a fix. …

Manlius nursing home residents go without food, medicine; NYC owner fined

Source: James T. Mulder, syracuse.com, July 10, 2018

A Manlius nursing home without enough staff to clean, feed and toilet residents has been fined $22,000 by the state. An inspection of the Onondaga Center for Rehabilitation and Nursing conducted in February found the facility was so short-staffed some residents did not get insulin and other medications on time or at all. The 80-bed home, formerly known as the Crossings, was bought last year by Centers Health Care, a New York City-based for-profit chain that owns 53 nursing homes in New York, New Jersey and Rhode Island. The state Health Department recently posted information about the fine on its website. … The report cited the facility for 24 deficiencies, at least three of which resulted in harm to residents. Many of the problems were repeat deficiencies. … Three certified nurse aides during the day and one to two aides at night typically cared for 35 to 40 residents. … Some residents did not get lunch until after 1:30 p.m. because there were not enough staff to deliver meal trays. … One resident had to be hospitalized after becoming dehydrated because there was no registered nurse on duty to provide fluid intravenously. … Seven residents did not get proper care to heal and prevent bed sores.

… The nursing home made a profit of $1.8 million in the first eight months of 2017 before it was acquired by Centers Health Care, according to SNFdata, a company that reports nursing home financial data. Financial results since Centers Health Care took over were not available. … The state recently fined another one of the chain’s nursing homes in Queensbury near Lake George $10,000 after a resident died in a nursing home van accident last year. …

LePage to end deal early that outsourced Medicaid staff

Source: Matthew Stone, Bangor Daily News, July 11, 2018
 
Gov. Paul LePage’s administration is putting an early end to a contract it awarded to a Massachusetts firm to handle part of the state’s Medicaid application process and take over the jobs of 10 state employees.  The administration entered into the contract this winter without soliciting competitive bids, and even though having the contractor perform the work would be more expensive than keeping state employees on the job, the BDN reported in February. The Maine Department of Health and Human Services awarded the 25-month, $5.6 million contract to Commonwealth Medicine in Shrewsbury, Massachusetts, to have the firm’s specialists determine whether people are disabled for the purpose of qualifying for state-funded health coverage through Medicaid.  Now, the contract will end after a year, and DHHS late last month issued a request for proposals seeking competitive bids to provide the service. …

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LePage Administration Outsources Part of Medicaid Program
Source: Associated Press, March 3, 2018
 
Republican Gov. Paul LePage’s plan to outsource part of the state’s Medicaid application process will cost the state more. The Bangor Daily News reports that the LePage administration acknowledges in a publicly posted contract document that there will be a “slight increase in cost.” The Maine Department of Health and Human Services in June will eliminate the positions of 10 state employees and enter into a $5.6 million, 25-month contract with a division of the University of Massachusetts Medical School. The agency didn’t respond to request for comment. …

Health provider in scandals loses first 3 state contracts

Source: Doug Thompson, Arkansas Democrat-Gazette, July 7, 2018

The state began closing down the first three of its 16 contracts with Preferred Family Healthcare on Friday, after a year and a half of scandals that include convictions of four former lawmakers on corruption charges. Preferred Family is a nonprofit behavioral health and substance abuse treatment company. It has 47 locations in Arkansas. The Springfield, Mo., company has $28 million in contracts with the state to provide services ranging from therapy and counseling for foster children to court-ordered drug and alcohol addiction treatment and professional consulting to the state Department of Human Services. In addition, the company received more than $33 million a year through the state Medicaid program. Preferred Family operates in five states. … A U.S. Department of Justice investigation has obtained three guilty pleas and one jury conviction against former Arkansas lawmakers in a multimillion-dollar corruption scheme that started at least as early as 2010. … The state was assured by Preferred Family it had dismissed the company executives involved since the first guilty plea Jan. 4, 2017. Then former Preferred Family executive Robin Raveendran was charged last week, accused of filing $2.3 million in improper Medicaid claims for mental health services. Gov. Asa Hutchinson and the state’s Office of Medicaid Inspector General announced the state would cancel contracts with the company and suspend Medicaid payments to it. …

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Troubled Missouri nonprofit settles wage lawsuit amid federal probe of bribery, kickback scheme
Source: Wesley Brown, Talk Business & Politics, July 1, 2018

During the period when a Missouri healthcare nonprofit was doling out millions of dollars in bribes and kickbacks to Arkansas lawmakers, public officials and its own well-paid executive team, the troubled healthcare group was fleecing hundreds of lowly paid hourly workers out of overtime pay, according to allegations in a recent federal lawsuit. In early April, Springfield, Mo.-based Preferred Family Healthcare (PFH) agreed upon a tentative settlement with former employee Frances Smith over allegations that PFH and its handful of Arkansas-based affiliates failed to pay the former healthcare worker and other agency employees overtime compensation for working over 40 hours per week, according to pleadings with the U.S. District Court for the Eastern District of Arkansas. …

Preferred Care settles for $540,000 in whistleblower upcoding case

Source: Elizabeth Leis Newman, McKnight’s, July 6, 2018

Nursing home chain Preferred Care agreed to settle False Claims Act charges for $540,000, the Department of Justice has announced. Federal officials accused the company of upcoding Medicare beneficiaries between July 2012 and October 2017, and of providing “worthless services” at Kentucky’s Stanton Nursing and Rehabilitation Center for three years. … Preferred Care, which owns or operates 100 skilled nursing facilities, declared bankruptcy last November. A bankruptcy court approved the settlement on June 26. As part of the settlement, the company does not have to admit to liability. …

Editorial: Iowa’s Medicaid money mystery is growing old

Source: The Gazette, July 7, 2018
 
More than two years has passed since Iowa moved to privatized Medicaid. This board, as well as others statewide, have demanded transparency. Unequivocally, we’ve said Iowa taxpayers have a right to know if the switch is saving money, how much is being saved and how those savings are being realized.  Amid these calls, nearly every agency remotely connected to Medicaid has sounded alarm bells. Iowans who rely on the program’s coverage report denied services. Providers who care for these patients point to unresolved claims. Medical suppliers have presented unpaid bills.  The Iowa Office of the Ombudsman saw a 157 percent increase in cases connected to Medicaid managed-care organizations, leading the agency to issue one of the most scathing annual reports in its history.  Accurate numbers and a full, public accounting of the program isn’t unreasonable and shouldn’t be this difficult. Such transparency is, after all, what the governor promised. …

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Iowa’s new private Medicaid manager has paid millions of dollars in penalties in a dozen states
Source: Jason Clayworth, Des Moines Register, July 1, 2018
 
The corporation selected to help manage Iowa’s controversial privatized Medicaid system has faced serious charges of mismanagement resulting in at least $23.6 million in penalties in more than a dozen states, a Des Moines Register investigation shows.  Iowa Total Care, a subsidiary of Centene, was awarded a state Medicaid contract in May by the Iowa Department of Human Services despite scoring nearly 14 points lower on its evaluation than when it had applied and was rejected in 2015, public records show.  But with only two companies bidding for the work, Iowa Total Care won a spot managing Iowa’s annual $4.8 billion Medicaid program. The Centene subsidiary replaces AmeriHealth Caritas, which pulled out because it said it was losing too much money. …

The state has no data to support Medicaid savings claim, health care official says
Source: Michaela Ramm, Sioux City Journal, June 30, 2018
 
As Iowa Medicaid Enterprises Director Michael Randol continues to assure lawmakers and the public that the state’s managed-care model is saving money, the Iowa Hospital Association contends the director has no data to back up the claim.  And as the dispute continues, Iowa hospitals say the state is saving money because the Medicaid insurance companies are not adequately reimbursing health care providers for their services — including a Vinton hospital that says it is owed $90,000 in emergency room visits alone.  According to the latest estimates from the Iowa Department of Human Services, the state of Iowa is saving $140.9 million from having privatized the Medicaid program. …

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Colyer: Kansas Will Pursue Medicaid Work Rules Despite Court Ruling

Source: Jim McLean, Salina Post, July 3, 2018
 
Kansas Gov. Jeff Colyer says he will continue to push for a Medicaid work requirement despite a recent court order blocking a similar policy in Kentucky. Last week, U.S. District Judge James Boasberg, an Obama appointee in the District of Columbia, questioned whether the Trump administration had adequately considered the consequences of Kentucky’s work requirement before reversing longstanding federal policy to approve it.  Despite the setback, Colyer said his administration will continue discussions with federal officials about requiring some of the more than 420,000 Kansans enrolled in KanCare, the state’s privatized Medicaid program, to work or pursue job training. …

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Kansas chooses 3 companies to manage Medicaid
Source: Associated Press, June 22, 2018
 
The Kansas Department of Health and Environment has awarded new contracts to three insurance companies to manage the state’s privatized Medicaid program.  Two of the new contracts announced Friday are renewals for companies currently in the program, Sunflower State Health Plan Inc. and United Healthcare Midwest Inc. The Lawrence Journal-World reported that the third contract went to a company new to the program, Aetna Better Health of Kansas Inc….

KanCare Contractor Must Fix Backlog Problems Soon Or Face Fines
Source: Jim McLean, KCUR, May 30, 2018
 
The company that processes applications for Kansas’ privatized KanCare Medicaid program faces potentially steep fines if it doesn’t fix problems, responsible for massive backlogs, by the end of this week. Maximus, a Maryland-based company that specializes in managing “human service programs” for states and the federal government, has operated the “KanCare Clearinghouse” since 2016. There have been problems from the start. In March 2016, federal officials grew concerned about growing backlogs and ordered the state to provide monthly reports about what it was doing to fix the problem. …

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