Category Archives: Medicaid/Medicare

Luring Customers From Medicare

Source: By MILT FREUDENHEIM, New York Times, September 22, 2006

For years, private insurers have offered alternatives to the federal Medicare program that are meant to give patients lower-cost options than the government coverage provides. More than 7 million people now subscribe to such plans, out of a total Medicare population of 42.5 million. But suddenly a type of private insurance plan is gaining ground that looks very similar to the basic coverage long available to anyone with a federally issued Medicare card. And the government is paying the private insurance industry a subsidy of 11 percent per patient, on average, to provide it.

…….Critics see the trend as further evidence that the government is paying private industry to take Medicare off its hands.

John Young: Texas's privatization disaster

Source: Waco Tribune (TX), Sunday, May 14, 2006

It’s one of Texas’ biggest stories in years. Too bad few Texans know about it. It’s the great Texas Push-Button Bureaucracy-Eliminating Paper-Pusher Massacre (TPBBEPPM). I made that name up but not the debacle that state policymakers now face. It’s a mess they’re hoping will slide right past your nose. It came with an understated announcement last week: that 1,000 employees that the Texas Commission on Health and Human Services said it wouldn’t need are needed still. The state was prepared to send the jobs through a corporate shredder. It was part of a massive privatized effort to change how Texas grants food stamps, Medicaid, Temporary Assistance for Needy Families and the Children’s Health Insurance Program (CHIP).

State takes back aid task

Source: Guillermo X. Garcia, San Antonio Express-News (TX), 05/10/2006 12:00 AM CDT

Effective immediately, state workers again will be responsible for processing applications for assistance programs such as food stamps and Medicaid after myriad problems resulted with the private company hired to do the job. Bermuda-based Accenture LLP won an $899 million, five-year contract early last year to take over the state’s public assistance eligibility system. The switch comes about as state Health and Human Services officials acknowledge flaws with several components of the system, which is supposed to help applicants compile the information that’s used to determine eligibility for public assistance programs.

Federal inquiry targets Reston firm

Source: By Jim McElhatton, THE WASHINGTON TIMES, May 3, 2006

Federal authorities have begun a criminal investigation of Maximus Inc. in the wake of a lawsuit claiming that the Reston-based consulting giant overcharged the government tens of millions of dollars while working for the District’s foster care agency, unsealed court records and other official files show. The investigation follows a federal False Claims Act lawsuit that says Maximus lacked proper documentation for most of the more than $30 million in Medicaid claims the company prepared for the D.C. government, starting in 1999.

….. Maximus derives nearly 80 percent of its revenue from state and local contracts covering a broad range of government services, including tracking down deadbeat parents, managing child welfare programs and implementing public retirement benefit systems. The company finds itself in the wake of a management shake-up. It announced last week the firing of Chief Executive Lynn Davenport, citing unspecified conduct toward a former female employee.

Benefits call center plan put on hold / State officials want better training, data tracking before statewide rollout.

Source: By Corrie MacLaggan, AMERICAN-STATESMAN (TX), Thursday, April 06, 2006

…….. State officials have put on hold a controversial call-in system for Texans to apply for food stamps and Medicaid, Health and Human Services Executive Commissioner Albert Hawkins announced Wednesday. Hawkins is calling for better training for the system’s private-sector customer service representatives and improvements in how data from applications are tracked. Officials will re-evaluate the system’s readiness in 30 days, to ensure that call center employees are better able to resolve complicated cases, he said.

Better Review Urged For Medicare Complaints

Source: By Gilbert M. Gaul, Washington Post, Friday, March 10, 2006

Private contractors hired by Medicare to improve quality and investigate complaints have failed to promote patients’ rights, and face conflicts of interest that may lead them to favor doctors and hospitals over beneficiaries, a federal advisory group reported yesterday. The Institute of Medicine, which is the government’s key consultant on health care policy, concluded that while Quality Improvement Organizations play an important role in health care, responsibility for investigating patient complaints should be removed from them and shifted to other organizations.

Ted K slams Mitt for outsourcing jobs: Mass. work farmed out to India, Utah

Source: By Kevin Rothstein, Boston Herald (MA), Thursday, February 23, 2006

Under fire from U.S. Sen. Edward M. Kennedy, the Romney administration yesterday defended its policy of outsourcing state jobs, saying that Massachusetts work formerly done in India is now handled in the United States – albeit in Utah. …. “Even governments are part of the offshoring bandwagon,” Kennedy said. “The state of Massachusetts has hired a contractor that uses workers in Bangladesh to process Medicaid data. It’s hired another contractor using workers in India to answer questions about food stamps.” Kennedy’s staff later acknowledged the jobs were sent to India, not Bangladesh, but argued that the principle is the same. ….. JPMorgan Chase, the previous food stamp contractor, had farmed out the call center work to India. When that contract expired, though, the state Department of Transitional Assistance required the work be done in the United States. Call center giant ACS was awarded the $27 million, seven-year contract.

Legislators looking to save money on Medicaid services

Source: BY SUSAN K. LIVIO, Star-Ledger (NJ), Wednesday, February 22, 2006

A Senate panel yesterday dissected the state’s $4.5billion budget for Medicaid, the health insurance program for 1million New Jerseyans, mining it for savings that include limiting services and hiring a team of auditors to detect fraud and bookkeeping problems. ….. The state typically hires contractors to scour the budget in search of savings. Ann Kohler, director of the state Division of Medical Assistance and Health Services, said Maximus and the Public Consulting Group have identified more than $40million the program could earn through new funding and increased efficiency this year. In return, the contractors are paid about 5 percent of what the state ultimately collects from those recommendations.

Federal probe costly for firm

Source: By Jim McElhatton, THE WASHINGTON TIMES, February 22, 2006

A Reston-based company said it has spent $500,000 in legal costs for an internal review of its handling of Medicaid claims for the D.C. government in the face of an investigation by the U.S. Attorney’s Office. Maximus Inc. said the Criminal Division of the U.S. Department of Justice sought company records pertaining to the company’s work for the District, “primarily relating to the preparation and submission of federal Medicaid claims,” according to filings with the U.S. Securities and Exchange Commission. ….. The company first disclosed the investigation in 2004, saying in an SEC filing that it was confident the company had not broken any health care laws. ….. Maximus has contracted with the D.C. government for years. The company recently has won contracts to handle the District’s welfare-to-work program and to provide Medicaid billing services for the city’s public school system.

Medicaid to undergo 'the boldest reform' in HMO experiment

Source: MARC CAPUTO, Miami Herald (FL), Dec 9, 2005

From people with AIDS and diabetes to children and the seriously disabled, most of Broward County’s poorest and most fragile residents will be subjects of a nationally watched experiment to reshape Medicaid, after the Florida Legislature voted Thursday to turn over some control of the program to private companies. …… The plan, starting in Broward and Duval counties in July, puts the state on a five-year course to enroll nearly all of its Medicaid recipients into HMO-like managed-care companies. The firms will have unprecedented say in defining benefits that the government now decides.