Category Archives: Medicaid/Medicare

Legislative panel delays prisons and Medicaid contracts

Source: Bob Johnson, Associated Press (AL), September 6, 2007

A legislative panel on Thursday delayed a massive $223 million, three-year prison health care contract with a Missouri firm after questions were raised about why the contract didn’t go to a company that offered to do the job for $9 million less.

The Legislature’s Contract Review Committee also delayed a contract for $3.7 million with a Texas company to consolidate medical information about state Medicaid patients in one computer file after lawmakers raised questions about the company’s performance in other states.

Lawmakers also questioned whether the Medicaid computer contract, to be paid from a federal grant, was the best use of resources for the cash-strapped agency whose commissioner has predicted it will need almost $200 million in additional funds next year.

Medicaid vendor has history of controversy

Source: By BRIAN LYMAN, Press Register (AL), Wednesday, August 22, 2007

The Alabama Medicaid Agency on Tuesday chose a subsidiary of Affiliated Computer Services, a Dallas-based database services company, to implement an electronic database for Medicaid clients around the state.

The Fortune 500 company, which hired a former aide to Gov. Bob Riley as a lobbyist days before the contract was awarded, has won projects throughout the world but has been followed by scandal in recent years, including the loss of millions of personal records in two states and allegations of bribery in securing a Canadian contract.

Bill threatens Medicare quality contractors

Source: By Jeffrey Young, The Hill, August 08, 2007

The private firms that contract with Medicare to handle beneficiary complaints and recommend quality improvements to hospitals and other providers could see their industry fundamentally shaken up by new Senate legislation.

The legislation would deprive the contractors of their current authority to conduct investigations of complaints about medical providers while acting as consultants to those same providers. Some lawmakers, consumer advocates and regulators view these dual roles as conflicts of interest, although the industry maintains they should go hand in hand.

Maximus settles Medicaid complaint

Source: By Jim McElhatton, Washington Times, July 24, 2007

The Reston-based Maximus consulting company agreed yesterday to pay $30.5 million to resolve a criminal investigation into whether it falsified tens of millions of dollars in Medicaid claims prepared for the D.C. government.

The overall settlement, announced by the Justice Department, also includes more than $12 million that federal authorities said they recovered from the D.C. government in connection with the investigation.

……. The District hired Maximus, one of the country’s largest government consulting companies, to help recoup Medicaid funds for services that the agency provided to foster children.

However, Mr. Turner’s lawsuit charged the company’s work was “grounded in fraud.”

Medicaid Funding At Risk In D.C. / City Has Overpaid Firms $97 Million, According to Audit

Source: By Yolanda Woodlee, Washington Post, Friday, July 20, 2007

The District wasted nearly $100 million over the past five years overpaying health care contractors for services that many Medicaid patients did not receive, a situation that puts the city in danger of losing federal funding, the D.C. Office of the Inspector General said (.pdf) yesterday.

Auditors found that three contractors — Amerigroup Maryland, D.C. Chartered Health Plan and Health Right — that coordinate medical services for about 90,000 low-income residents received a total of $96.6 million in “excess payments.”

Computer cost rises 28.8% / Changes in laws help push overrun to $9.3 million for behind-schedule Medicaid system, officials say

Source: By PATRICK MARLEY, Journal Sentinel (WI), July 20, 2007

Madison – A major overhaul of the state’s Medicaid computer system will cost at least $9.3 million – or 28.8% – more than originally planned, largely because of changes to state and federal laws and rules, officials said.

……. Hayden said the state has an airtight contract with EDS Corp. of Plano, Texas, to finish the job. “We don’t pay EDS until they do their work,” he said.

Firm seeks settlement of Medicaid claims probe

Source: By Jim McElhatton, THE WASHINGTON TIMES, February 12, 2007

U.S. Department of Justice criminal division lawyers say a Reston-based government consulting company either “willfully or recklessly” submitted inaccurate Medicaid claims on behalf of the D.C. government, the company recently disclosed.

Officials with Maximus Inc. said in a recent Securities and Exchange Commission (SEC) filing that they disagree with the criminal division lawyers’ assessment. The company also said it is engaged in ongoing talks with the Justice Department concerning a potential civil settlement, the SEC filing states.

Study: Private Medicare costs $5.2B more

Source: By THERESA AGOVINO, Associated Press, Wednesday, November 29, 2006 · Last updated 9:15 p.m. PT

NEW YORK — Medicare beneficiaries enrolled in private, managed care plans cost the government 12.4 percent more than those in the traditional program last year, for a total cost of more than $5.2 billion, according to a study released Thursday.

Payments to what are called Medicare Advantage plans amounted to $922 per beneficiary over what a comparable enrollee would have spent in the traditional fee-for-service program, said a study by the Commonwealth Fund, a private foundation supporting independent research on health and social issues. There are 5.6 million Medicare beneficiaries enrolled in the Advantage plans.

In Medicaid, Private HMOs Take a Big, and Profitable, Role Managing Care for the Poor, They Prosper by Cutting Beleaguered States' Costs

Source: By BARBARA MARTINEZ, Wall Street Journal (subscriptin req.), November 15, 2006

Some 55 million poor and disabled Americans are covered by Medicaid. With an annual price tag topping $300 billion, it’s among the biggest government programs around. It’s also a lucrative business for some private companies that act as middlemen between the government and patients. Instead of directly paying the bills when a Medicaid patient goes to the doctor, state governments increasingly outsource the job to private contractors. More than one in three Medicaid beneficiaries now receive care through a private insurer. …… With the growth has come criticism from some doctors and patients who accuse Medicaid HMOs of scrimping on care. Even as they restrict medical tests and use of prescription drugs, the companies spend the money they get from states on items that don’t have an obvious connection to patients. Centene has funded a multimillion-dollar arts center in St. Louis and paid to put its name on stadiums in Montana and Missouri. The HMOs are also big donors to political campaigns.

GAO Report: Information Security: The Centers for Medicare & Medicaid Services Needs to Improve Controls over Key Communication Network

Source: GAO-06-750, August 30, 2006

The Centers for Medicare & Medicaid Services (CMS), a component within the Department of Health and Human Services (HHS), is responsible for overseeing the Medicare and Medicaid programs–the nation’s largest health insurance programs–which benefit about one in every four Americans. CMS relies on a contractor-owned and operated network to facilitate communication and data transmission among CMS business related entities. Effective information security controls are essential to protecting the confidentiality, integrity, and availability of this sensitive information.

……. CMS did not always ensure that its contractor effectively implemented electronic access controls designed to prevent, limit, and detect unauthorized access to sensitive computing resources and devices used to support the communication network.