Tag: State News

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FWA- California suspends Medicaid payments to Borrego Health for 2nd time in 2 years

[MM Curator Summary]: If it walks like a duck..

 
 

For the second time in two years, California health officials are suspending all Medicaid payments to federally qualified health center Borrego Health for “continued and unresolved inappropriate billings,” the San Diego Union-Tribune reported Aug. 30.

The California Department of Health Care Services’ decision comes after state and federal authorities launched a criminal investigation into millions of dollars of alleged improper billings, excessive salaries and above-market rent payments at Borrego Spring-based Borrego Health, according to the report. It also comes after Borrego Community Healthcare Foundation sued several past board members, executives and contractors over allegations of racketeering, fraud, nepotism, excessive compensation and self-dealing.

Borrego Health’s Medicaid reimbursements were first suspended in December 2020 after state and federal agents raided Borrego Health locations, seizing computers, taking medical records and interviewing employees. 

Regulators agreed to reinstate Medicaid reimbursements for medical services in early 2021, but not for dental work, which remains the focus of the criminal investigation, according to the report. The reinstatement came after Borrego Health agreed to an independent monitor and other conditions. 

In an Aug. 19 letter obtained by the San Diego Union-Tribune, state health officials said they would withdraw all Medicaid reimbursements by Sept. 29 because of Borrego Health’s alleged failure to meet its settlement obligations.  

A Borrego Health spokesperson told the San Diego Union-Tribune the decision was unwarranted and unexpected and will “significantly and abruptly reduce access to care for thousands of at-risk Californians.”

 
 

 
 

Clipped from: https://www.beckershospitalreview.com/finance/california-suspends-medicaid-payments-to-borrego-health-for-2nd-time-in-2-years.html

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FWA- Southwest Idaho woman gets jail, fines for Medicaid fraud

[MM Curator Summary]: Pretty pedestrian bogus claims fraud here. Nothing to see except another half a million or so of the taxes taken out of your W-2 going up in smoke.

 
 

 
 

BOISE, Idaho

A southwestern Idaho woman who pleaded guilty to defrauding the Idaho Department of Health and Welfare’s Medicaid program by falsely claiming services to participants with developmental disabilities has been sentenced to 180 days in the Ada County Jail and must repay more than $146,000 in criminal restitution.

Attorney General Lawrence Wasden announced Monday that 58-year-old Janna Lyn Miller of Kuna received the sentence Thursday in 4th District Court.

District Court Judge Samuel Hoagland also ordered Miller to pay $83,000 in criminal restitution as well as $2,000 in court costs. Officials recovered $64,000 in fraudulent payments before sentencing.

Miller also received a five-year suspended sentence with five years of probation. She will have to spend a minimum one year in state prison if she violates her probation.

In addition to the criminal restitution, Miller owes the state more than $234,000 in additional overpayments and related penalties. All told, she is responsible for paying more than $375,000 related to her company’s actions.

The attorney general’s office said that Miller owned and operated Inclusion, Inc., a Meridian-based company that provided home health, supervised employment, mental health counseling and social support services to Idaho Medicaid participants with developmental disabilities.

Besides the main office in Meridian, the company also had offices in Sandpoint, Coeur d’Alene and Twin Falls.

The attorney general’s office said Miller wrongfully obtained Medicaid funds by making false representations or directing workers to make false representations regarding services provided.

Miller’s prosecution resulted from a coordinated effort by the U.S. Department of Health and Welfare’s Medicaid Program Integrity Unit, the Idaho Branch of the Office of the Inspector General of the U.S. Department of Health and Human Services, and the state attorney general’s Medicaid Fraud Control Unit.

This story was originally published August 30, 2022 5:12 AM.

Clipped from: https://www.newsobserver.com/news/article265057249.html

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MCO- UPMC Health Plan adds more than 11,000 Philadelphia-area Medicaid members

[MM Curator Summary]: The PA MCO continues to have success; this time in a new region (for Medicaid anyway- they already had a strong duals presence there).

 
 

Enlarge

A billboard used to promote UPMC Health Plan’s Medicaid managed care product, UPMC for You, in the Philadelphia region.

UPMC Health Plan

Medicaid managed care companies serving the five-county Philadelphia region have new competition from western Pennsylvania.

During this year’s open enrollment period, Pittsburgh-based UPMC Health Plan signed up 11,142 Medicaid recipients in Southeastern Pennsylvania for its UPMC for You plan, which will operate statewide as of Sept. 1.

John Lovelace, president of UPMC Health Plan, said that enrollment number will likely rise in the days ahead because the state will be randomly assigning — in an equitable manner — any Medicaid beneficiaries who did not enroll in a Physical HealthChoices program plan to a program participant.

“We’re starting off our big push forward with about 130,000 new people across Pennsylvania on Thursday, and maybe more,” Lovelace said.

 
 

Enlarge

UPMC Health Plan President John Lovelace

UPMC Health Plan

The Pennsylvania Department of Health, after a process delayed by litigation for several years, this year changed its lineup of health insurers participating in the state’s Physical HealthChoices program. The program requires recipients of Medicaid, which covers health care costs for low-income families and individuals, to enroll in a choice of managed care plans.

The state has separate Medicaid manage cared programs for mental health services, for children and for people dually eligible for Medicaid and Medicare — the federal and state program that covers health care costs of the elderly.

UPMC was selected as a Physical HealthChoices program participant in all five geographic zones in the state including Southeastern Pennsylvania, where it will compete with Independence Health Group’s Keystone First and Health Partners Plans, both of which are based in Philadelphia, along with United Healthcare and Geisinger Health Plans.

The biggest change locally is Aetna will no longer be part of the program.

The five-county region has 1 million people who qualify for the Physical HealthChoices program. The two Philadelphia-based companies lead the market, with Keystone having about 524,000 Medicaid members and Health Partners Plans having about 273,000.

New enrollment numbers for all the plans, following open enrollment, are not yet available.

UPMC Health Plan already has a presence in the Philadelphia region, Lovelace said, covering about 32,000 people who are either dually Medicare and Medicaid eligible or Medicare special needs patients.

Lovelace said the plan is in the process of expanded its Children’s Health Insurance Program (CHIP) coverage in the Philadelphia region.

Prior to expanding into Southeastern Pennsylvania as well as Northeastern Pennsylvania, where it has picked up about 20,715 Medicaid members, UPMC had about 560,000 Medicaid plan members throughout the rest of the state.

Clipped from: https://www.bizjournals.com/philadelphia/news/2022/08/30/upmc-health-plan-medicaid-philadelphia-pittsburgh.html

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OP ED Grab-Bag: Medicaid work requirements aren’t inherently a bad thing

[MM Curator Summary]: The author suggests that the success of welfare reform- which got single mothers into the workforce- should be considered before we burn the Republican witches at the stake.

 
 

“Work requirements” are back in the news, after a federal judge ruled in favor of Georgia’s Medicaid “waiver.” It’s worth exploring what this means — and what it doesn’t.

You may recall this discussion from years past. Rather than expanding Medicaid as envisioned by Obamacare, Gov. Brian Kemp sought and received federal permission for a more limited expansion, including a work requirement. But within days of Joe Biden entering the White House, the federal government signaled it would rescind that approval, which it did late last year.

First things first: “work requirements” is a misnomer. In fact, the Georgia Pathways program offers several ways to meet the 80-hours-per-month qualification. Those include a job, job training, community service and some types of education.

 
 

But to the extent “work requirements” are fulfilled by actual work, they’re a proven way to help Americans better themselves financially. We can see this from the successful welfare reforms of the 1990s.

A 2016 study of the effects of the reforms by the Manhattan Institute found child poverty, for example, fell from 29% in 1993 — exactly where it stood back in 1967 — to 18% in 2000 and 17% in 2009. Even after the Great Recession, it was significantly lower than pre-reform, at 19% in 2012.

What changed? Single mothers joined the workforce. Before, they faced a choice between working and receiving benefits — a choice that skewed toward welfare because of the relatively high wages one would have to earn to replace those benefits. With greater latitude to work, single mothers began working at much higher rates: a 15-percentage-point increase between 1996 and 1999, compared with a 10-point increase between 1980 and 1996. The share of single mothers on welfare fell from 50% in 1996 to 17% in 2008.

How does that apply to Medicaid? It largely hasn’t. Courts ruled that adding work requirements for existing recipients in Arkansas and Kentucky was unlawful because it would cost some people their coverage. Opponents of Georgia’s waiver pointed to those rulings as a reason Kemp was wasting his time.

But Kemp’s program, called Georgia Pathways, essentially reverse-engineered the Arkansas and Kentucky rulings. Rather than adding work requirements for current beneficiaries, Georgia uses “qualifying activities” to determine eligibility for the new program. People can’t lose coverage they never had.

 
 

Thus, Georgia Pathways can only increase coverage. That was central to the Aug. 19 decision by U.S. District Judge Lisa Godbey Wood, which set aside the Biden administration’s rescission of Georgia’s waiver.

Pending an appeal by CMS, we may finally get to see how work requirements fit with Medicaid. We can expect good things.

First and foremost, we can expect better health outcomes for recipients — even if federal judges have said health outcomes aren’t a priority for Medicaid waivers, because coverage is the program’s central objective. Why better outcomes? Research indicates employed people tend to remain healthier. Even if that isn’t a primary objective of Medicaid, it would be a worthy result.

Georgia Pathways also prioritizes private coverage for workers whose employers offer health insurance. That’s beneficial for them in two key ways. First, private insurance is much more widely accepted by providers than traditional Medicaid, so these workers are far more likely to gain access to care.

Then there’s continuity of coverage. The income limit for Georgia Pathways is 100% of the federal poverty line, or $13,590 for a single adult this year. A part-time worker earning $13.50 per hour would barely qualify. But if he got an hourly raise of even 10 cents, he might lose it.

With traditional Medicaid, that would mean losing his specific plan, with its specific network of doctors. But with Georgia Pathways, he would already be on his employer’s plan. Although he would have to pay more in premiums, he could stay on the same plan and keep the same doctors.

All of this is more complicated than our bumper-sticker politics prefers. But it’s clear that with this ruling, Georgians may finally get a plan that works.

 
 

Clipped from: https://thebrunswicknews.com/opinion/editorial_columns/medicaid-work-requirements-arent-inherently-a-bad-thing/article_809114f7-f637-51ec-96da-48b291302c98.html

 
 

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Federal Judge reinstates Georgia Medicaid work requirements

[MM Curator Summary]: Ruh-roh.

 
 

Photo: VisionsofAmerica/Joe Sohm/Getty Images

A federal judge has reinstated a Medicaid work requirement program in Georgia, saying that the Centers for Medicare and Medicaid Services, under the Biden administration, unfairly struck down the program that was first approved by the Trump administration.

CMS said last year it was revoking the work requirement, as well as a proposal to charge some Medicaid recipients monthly premiums. That prompted Georgia officials to sue, saying the agency lacked the authority to rescind the provision.

U.S. District Judge Lisa Godbey Wood issued the ruling on Friday, saying CMS’ decision was “arbitrary and capricious.” She said the agency measured pathways against a baseline of full Medicaid expansion rather than taking the demonstration on its own terms.

Wood also said CMS violated federal law by not engaging in reasoned decision-making, and failed to adequately explain why it changed course from the previous administration’s approval. She added that rescinding the approval may mean less Medicaid coverage in the state.

CMS does not comment on litigation as a matter of policy, but said last year that similar work requirements in other states had created confusion and hardship for Medicaid beneficiaries, with more than 18,000 losing coverage in Arkansas upon implementation of that state’s work program.

Georgia’s plan was to add an estimated 50,000 low-income and uninsured residents to the Medicaid rolls within two years, with the requirement that new Medicaid recipients would need a minimum number of qualifying hours through work, job training, education or volunteering.

Georgia Democrats have said full Medicaid expansion would cover hundreds of thousands of people at a much lower cost to the state, owing to expansion options under the Affordable Care Act, with the federal government picking up 90% of the cost of expanding the program to adults who make up to 138% of the federal poverty level.

In a recent Tweet, Georgia Governor Brian Kemp said the state’s plan “would better serve Georgians than a one-size-fits all Medicaid expansion.”

WHAT’S THE IMPACT

CMS began implementing work requirements for Medicaid coverage four years ago, a move opposed by those who said it would kick many receiving coverage off of Medicaid’s rolls.

In order to qualify for the program, individuals must comply with specific requirements, including participating in 80 hours of work monthly, or other qualifying activities. Most people with income between 50% and 100% of the FPL would be required to make initial and ongoing monthly premium payments.

Applicants and beneficiaries with disabilities who require reasonable accommodation will have options available to complete and report their qualifying activities and hours. The state is providing support to those not already working in order to encourage and enable those beneficiaries to obtain employment and take part in other education and job-supporting activities.

THE LARGER TREND

The Biden administration first began taking steps to roll back Medicaid work requirements in 2021, citing the economic and health impacts of the COVID-19 pandemic, which it said could make it more difficult for Medicaid recipients to fulfill the requirements.

“Uncertainty regarding the current crisis and the pandemic’s aftermath, and the potential impact on economic opportunities (including job skills training and other activities used to satisfy community engagement requirements, i.e., work and other similar activities), access to transportation and to affordable child care have greatly increased the risk that implementation of the community engagement requirement approved in this demonstration will result in unintended coverage loss,” CMS said in letters to states at the time.

Hospitals in states that implement Medicaid work requirements could see their Medicaid revenues decrease by as much as 21%, their uncompensated care costs increase as much as 133% and their operating margins fall by upward of 2%, according to estimates by The Commonwealth Fund.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

 
 

Clipped from: https://www.healthcarefinancenews.com/news/federal-judge-reinstates-georgia-medicaid-work-requirements

In issuing the ruling, U.S. District Judge Lisa Godbey Wood said CMS’ decision was “arbitrary and capricious.”

 

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California county, three health systems pay $70.7 million for Medicaid fraud

[MM Curator Summary]: Who said county plans have to miss out on all the fraud fun? Sorry, I mean “alleged” fraud fun.

 
 

 
 

Justice Department: Federal health care money not a “blank check” to misuse.

 
 

The health system operated by Ventura County, California, and three health care providers will pay $70.7 million to settle allegations they defrauded California’s expanded Medicaid program.

The U.S. Department of Justice (DOJ) and the California Attorney General’s Office announced the settlement for false claims from January 2014 to May 2015. The time coincides with California’s expansion of its Medicaid program, known as Medi-Cal, to cover previously uninsured adults with incomes up to 133% of the federal poverty level.

That expansion was allowed under the federal Affordable Care Act and was reimbursed by the federal government for the first three years. If county organized health systems (COHSs) did not spend at least 85% of the money they received on allowed medical expenses, they were required to reimburse the state of California, which would return the money to the federal government, according to DOJ.

The settlement resolves allegations that the county and three health care systems knowingly submitted false claims to Medi-Cal for allowable expenses, according to DOJ. The billed services were duplicative of those already provided, and some services were never provided, Acting U.S. Attorney Stephanie S. Christensen said in a news release.

“Federal health care funds are not intended to serve as a blank check,” Principal Deputy Assistant Attorney General Brian M. Boynton said in a news release. Boynton serves as head of DOJ’s Civil Division.

 
 

Clipped from: https://www.medicaleconomics.com/view/california-county-three-health-systems-pay-70-7-million-for-medicaid-fraud

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TX- Two charged in $6M pediatric dental Medicaid fraud/kickback scheme

[MM Curator Summary]: Pretty large for a dental fraud. Its like a kick in the teeth for Medicaid bennies waiting on dental services.

 
 

 
 

HOUSTON – An operator and manager at a dental clinic have been charged for their roles in a health care fraud scheme involving $6 million in claims to Medicaid, announced U.S. Attorney Jennifer B. Lowery.

Authorities took Ifeanyi Ndubisi Ozoh, 51, Houston, into custody today. He is expected to make his initial appearance tomorrow before U.S. Magistrate Judge Sam Sheldon at 2 p.m. Also charged is Rene Fernandez Gaviola, 65, also of Houston. He had been previously arrested on similar charges Aug. 1. He is expected to appear on the new charges in the indictment in the near future.

On Aug. 16, a federal grand jury returned the 13-count indictment which was unsealed upon Ozoh’s arrest today.

According to the charges, Gaviola was the operator, while Ozoh was the manager of Floss Family Dental Care clinic located in Houston.   

The indictment alleges Gaviola and other employees submitted false and fraudulent claims to Medicaid for dental services such as cavity fillings that were never provided as billed. Gaviola and Ozoh also allegedly paid kickbacks to marketers and caregivers of children Medicare insures to bring them to Floss for dental services.

Gaviola also employed at least one individual to practice pediatric dentistry without a license and billed Medicaid for their services, according to the charges.

The indictment further alleges Gaviola laundered Medicaid monies from the Floss business bank account to his personal bank account in several transactions exceeding $100,000.

From 2019 to 2021, the dental company allegedly billed Medicaid for nearly $6.9 million for which Medicaid paid approximately $4.9 million. Many of the dental services were not provided or that unlicensed and non-enrolled individuals had administered.

If convicted,  Ozoh and Gaviola face up to five years in federal for conspiracy to pay and receive kickbacks. Gaviola also faces up to 10 years for conspiracy to commit health care fraud and each count of health care fraud and money laundering. All charges also carry a possible $250,000 maximum fine.

The FBI, Texas Attorney General’s Medicaid Fraud Control Unit and the Department of Health and Human Services – Office of Inspector General conducted the investigation with assistance of Customs and Border Protection. Special Assistant U.S. Attorney Kathryn Olson is prosecuting the case.

An indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless convicted through due process of law.

 
 

Clipped from: https://www.justice.gov/usao-sdtx/pr/two-charged-6m-pediatric-dental-medicaid-fraudkickback-scheme

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Lawrence woman to pay $7K+ for fraudulent Medicaid claims

[MM Curator Summary]: She gave her son her login info so he could fill out fake timesheets for her saying that she was caring for him. Not making this up.

 
 

 
 

LAWRENCE, Kan. (WIBW) – A Lawrence woman will pay more than $7,000 to the AG’s Office and the state Medicaid program after she claimed she was caring for her beneficiary son while she was working as a nurse in an ER instead to fraudulently gather benefits.

Kansas Attorney General Derek Schmidt says on Tuesday, Aug. 23, Terri Lisa Schwager, 56, of Lawrence was ordered to repay the Kansas Medicaid program more than $5,000 for filing false billing claims.

AG Schmidt said Schwager agreed to a consent judgment approved by Douglas Co. District Judge Mark Simpson on Aug. 19. He said Schwager agreed to repay the program a total of $5,085.62, as well as $5,085.62 in fines and $2,700.35 for investigative costs incurred by the Medicaid Fraud and Abuse Division of the AG’s office.

Schmidt noted that investigators found Schwager served as a personal care attendant for her adult son, who is a Medicaid beneficiary. The investigation found between Jan. 1, 2018, and March 31, 2022, she had provided her confidential user information to her son who logged into the app 91 times to indicate his mother was giving him the help he needed.

However, investigators found that Schwager was instead working as an emergency room nurse in Olathe at the time the claims were logged.

Schmidt noted that the case was litigated by Senior Assistant Attorney General Eve Kemple of his office.

 
 

Clipped from: https://www.wibw.com/2022/08/23/lawrence-woman-pay-7k-fraudulent-medicaid-claims/

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Centene guilty of overcharging state Medicaid program, owes WA $19 million

[MM Curator Summary]: Planet Centene will pay out another 0.00019% of its revenue to WA state over PBM spread pricing allegations.

 
 

 

Attorney General Bob Ferguson and the Washington State Health Care Authority announced Centene, a publicly traded managed-care company, will pay $19 million to Washington state to resolve allegations of overcharging the state Medicaid program for pharmacy benefit management services.

The resolution is the second-largest Medicaid fraud recovery for Washington state in history. The amount goes back to the state through the state Medicaid Fraud Penalty Account.

As part of the resolution, an additional $13 million from Centene will be paid to the federal government for the administration of Medicaid in Washington state.

“Medicaid dollars are a precious resource meant to fund care for the most vulnerable among us,” Ferguson said. “My office works to ensure that these dollars go where they are intended — not toward fraud.”

Centene ranked No. 24 on 2021’s Fortune 500 list with its recorded revenue north of $100 billion, according to the Centene Corporation 2020 Annual Report.

Washington attorney general joins coalition challenging Idaho’s near-total abortion ban

The Attorney General’s Office and Health Care Authority’s Program Integrity Team began investigating pharmacy benefit managers in 2019 after a whistleblower provided information that they were failing to disclose true pharmacy benefits and services costs.

Centene allegedly failed to pass on discounts it received to the state Medicaid program and inflated dispensing fees.

Earlier this week, Centene Corporation canceled its plans to build an east coast headquarters in Charlotte’s University City in what was originally considered the largest job announcement in Charlotte’s history. In July 2020, the company announced they were planning to create 6,000 new jobs once the headquarters were constructed, investing approximately $1 billion into the expansion.

Ferguson’s resolution with Wyeth is the only Medicaid fraud recovery larger than Centene. In 2016, Ferguson and the Attorney General’s Office recovered $46.7 million for the state Medicaid program, as the pharmaceutical company owed more than $780 million to states and the federal government for overcharging.

Centene has resolved cases with 10 other states over the same conduct.

Follow @http://twitter.com/Mynorthwest

 
 

Clipped from: https://mynorthwest.com/3607059/centene-guilty-of-overcharging-state-medicaid-program-owes-wa-19-million/

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D.C. Medicaid Contract Remains in Limbo

[MM Curator Summary]: The city council and mayor’s office are now communicating their disagreements about the MCO contracting process over twitter.

 
 

 
 

The awarding of the District’s nearly $3 billion Medicaid contract remains in limbo until D.C. Mayor Muriel Bowser formally submits her recommendations for D.C.’s selected managed care organizations to the D.C. Council for approval.

Managed care organizations (MCO) CareFirst BlueCross Blue Shield, Amerigroup DC, AmeriHealth Caritas and MedStar Family Choice District of Columbia each hope to be awarded the contract to serve the 230,000 residents who count as Medicaid patients. 

Medicaid, a federal government health insurance program, services poor and low-income Americans, with seniors and those with disabilities included in some cases. The council selects the managed care organizations that will service the recipients due to its responsibility to approve District government contracts over $1 million. Ultimately, three of the four MCOs will be chosen for the Medicaid contract. And while a final decision has not been made of who be chosen, observers note Amerigroup and AmeriHealth appear to be favored with Med Star and CareFirst vying for the third position.

The D.C. Medicaid process for this year’s contract which will remain in place for five years, has been mired in contention for nearly a year due to complaints lodged by MCOs about being treated unfairly during the process. Their complaints include technical errors faced when submitting their paperwork for approval. 

Three MCOs, CareFirst, MedStar and AmeriHealth, have taken the procurement process to the Contract Appeals Board for review. Meanwhile, Bowser missed a June 28 deadline to submit the new contract to the council. 

In a July 21 letter, D.C. Council Chairman Phil Mendelson (D), along with Council members Robert White (D-At Large), Brianne K. Nadeau (D-Ward 1), Janeese Lewis George (D-Ward 4) and Elissa Silverman (I-At Large) questioned why the contract hadn’t been submitted. In a response via Twitter, Deputy Mayor for Health and Human Services Wayne Turnage wrote, “to be clear, the results of the current procurement are under protest with the Contract Appeals Board (CAB), so without special permission from the CAB, the Department of Health Care Finance cannot move forward with the new contracts until the protests are resolved.” 

In his July 29 letter responding to the council members’ concerns, George Schutter, who leads the D.C. Office of Contracting and Procurement, backed Turnage, saying, “in partnership with the program agency and District leadership, [we] determined it was in the best interest of the District and the beneficiaries to await the results of these three CAB decisions to minimize disruption to the beneficiaries resulting from any possible change in provider plans.”

Bowser said she agrees with the agency leaders’ stance regarding the contract.

“The fact that there is this delay isn’t unusual,” Bowser said. “This is a difficult contract to execute. We support waiting until there is a ruling by the Contract Appeals Board before we send the contract to the council.”

Bowser said Medicaid recipients should have a clear sense of who will be serving them and that can be best facilitated after the appeals process. She said she doesn’t know which MCOs will get the contract or the council submission timeline.

White serves as the chairman of the Committee on Government Operations and Facilities and will play a major role in the eventual awarding of the MCO contract. He said, “the executive can’t execute or implement the contract before the Contract Appeals Board ruling. But by law, the executive is able to send contracts to the council for review and doesn’t have to wait until the CAB issues a decision.”

“In fact, the executive used that process last year for existing MCO contracts, which [Schutter] recognized in the letter he sent to me and other council members on Aug. 11,” he added. 

White said he doesn’t have a favored MCO provider but has problems with the present procurement process. 

“My goal with procurement, as with all procurements, is to ensure that decisions are made through an independent, fair, transparent, legal and expeditious process,” he said. “Unfortunately, the MCO procurement has repeatedly failed to meet that standard over a period of years. Most recently, the administration agreed to send contracts to the council for review by June 2022 to avoid further extensions and that has not yet happened.”

White said the MCO procurement process needs reform or at least further investigation.

“The administration’s lack of transparency means that, at this point, the council doesn’t know what the issue is,” he said. “If the executive didn’t follow the legal procurement process, that would likely be a valid basis for a protest or appeal. But currently, we don’t have anything of substance that we can rely on to say they didn’t.”

White said alternatively, the process functions the way it should within the law and if a problem arises with the way it operates, reform might be needed. He said if the administration disagrees with the outcome, then “that is not a valid reason to hold up the legal procurement process.”

“Our residents see what happens when we disregard the legal process and it is those with the least resources who stand to lose the most in this situation with the MCOs,” he said.

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Clipped from: https://www.washingtoninformer.com/d-c-medicaid-contract-remains-in-limbo/