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Iowa Medicaid bids include misleading or unverifiable data

cigaretteman

HR King
May 29, 2001
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Some of the claims made by the for-profit corporations chosen to manage Iowa’s $4.2 billion annual Medicaid program contain unverifiable data, misleading statements or half-truths, a Des Moines Register investigation has found.

The questionable information was provided to Iowa officials in public bid documents used to help the companies edge out competitors to win the lucrative contracts.

The Register could find nothing to suggest that the Iowa Department of Human Services, the agency that oversaw the selection process, did its own fact-checking of claims included in the winning bids.

Among the Register's findings:

  • Amerigroup claimed its Maryland affiliate has a pharmacy program that reduced hospitalizations by 36 percent, emergency room visits by 17 percent and prescriptions by 20 percent during an unspecified time frame. But the Maryland Department of Health and Hygiene says it can't verify these claims. The company declined to comment or provide data to substantiate the claims, citing an ongoing court challenge to Iowa’s bid selection process.
  • WellCare credited its Hawaii affiliate's care plan with reducing hospital admissions by 26 percent, and with cutting length of hospital stays by 37 percent overall and by 17 percent for acute patients. Officials from the Hawaii Department of Human Services said they were unable to confirm the accuracy of WellCare's calculations. The agency provided information that showed reductions in all three categories from 2013 to 2015, but not to levels cited by WellCare in its undated data. Asked to explain the discrepancy, WellCare said its analysis used 2006 data — four years before it began working with Hawaii — as the baseline for comparison. A spokeswoman said those data were the most current available and defended the comparison as fair and accurate.
  • UnitedHealthcare said its Kansas affiliate reduced premature births by 23 percent from 2013 to 2014 and some types of emergency room visits by more than 10 percent. Officials from the Kansas Department of Health and Environment said it could not verify the information. A UnitedHealthCare spokeswoman responded that the company remains confident in the data it provided.
  • AmeriHealth said its Pennsylvania programs reduced congestive heart failure admissions by 21 percent from 2013 to 2014. Pennsylvania officials said they couldn’t verify those numbers. AmeriHealth said the figure was the result of "internal medical management monitoring" but declined to share that data with the Register.
DHS officials declined to answer questions about those and other bid claims, citing ongoing litigation brought by three companies that competed unsuccessfully for the contracts. DHS spokeswoman Amy Lorentzen McCoy issued a statement saying the department had followed its bid request procedures, calling it a "a fair and thoughtful process."

But advocates for the poor and vulnerable who make up the majority of Americans relying on Medicaid for their health care needs say they find the unverified claims disturbing.

“In a situation like this, you would hope that they would have supporting data, but — if they’re unable or unwilling to produce it — that is really problematic,” said Eric Carlson, an attorney for Justice in Aging, a Washington, D.C.-based advocacy group.

The Register began fact-checking the bid claims after Iowa Department of Human Services staffers testified last month that the agency had no data to support its estimate that Gov. Terry Branstad's privatization plan — the largest ever in Iowa — would save $51 million within the first six months of its planned launch on Jan. 1.

DHS officials have said the companies will generate those savings by, for example, eliminating medical redundancies in care and focusing on prevention. But critics fear such savings could come from reduced or denied services to about 560,000 Iowans who are currently served by the program.

In their bids, the companies made dozens of claims that they had implemented measures that led to savings and program efficiencies in other states. The Register reviewed more than 6,000 pages of public bid documents, and selected two claims from each company for in-depth reviews.

Of the eight claims, the Register could confirm only one as fully accurate: WellCare's assertion that a behavioral health program linking coordinators with high-cost clients saved Missouri $38 million over 18 months.

A claim by Amerihealth boasted that state agencies in Pennsylvania and South Carolina rated its program “the best Medicaid plan for access.” In fact, the ratings were based on consumer surveys, not a data-driven ranking by the states.

The rest could not be verified. In each of those five cases, the states said they do not collect data supporting the assertions, and each company declined to provide the Register with its internal data to support the claims.

Costs for Medicaid are shared by the federal and state governments. To launch, Branstad's privatization plan must be approved by the federal Centers for Medicare & Medicaid Services.

'A reckless process'
The Register’s inquiries about bid accuracy coincided with last month's court hearings into claims made by the companies that failed to win bids. The hearings revealed that at least one company, WellCare, sought to obtain confidential information, including the identities of members of the committee that would be scoring the bids. A company official had suggested sending a third party to contact members in a effort to sway them in favor of the company's proposal.

The hearings also revealed an extensive network of communications — including some during a required blackout period in the bidding process — between the winning companies, former lawmakers, sitting legislators and the governor’s staff.

One lawmaker said the state should have spotted the apparent discrepancies in the claims before it awarded the contracts to the four companies.

“A basic Google search would have found some of the things that you found,” said Sen. Joe Bolkcom, D-Iowa City, and a member of an oversight committee reviewing the state’s privatization efforts. “This says to me that DHS has not done its job.”

Bolkcom continued: “This has been a reckless process and has resulted in reckless decisions. Frankly, I think it shows a real contempt for the people of this state that need and rely on these health care services.”

Rep. Ken Rizer, R-Cedar Rapids, oversaw contracts in his work as a former U.S. Air Force commander. He said his experience suggests that false statements in bid documents are rare. But he said that doesn't excuse the state for failing to check them for accuracy.

“Those who are reviewing those bids have to do their due diligence," Rizer said. But I will tell you, my experience of companies that bid on big contracts, they tend not to put things in their bids that are fictitious. Because if they do, they jeopardize future business.”

Julia Paradise, an associate director of the Kaiser Commission on Medicaid and the Uninsured, said she is unaware of specific cases of inaccuracies in Medicaid bids in other states. But she said it's important to know how bidders arrived at the numbers they included in their proposals.

“Certainly when you’re evaluating a contract that’s worth a lot of public dollars, you want to understand what the record is and the basis for the estimated potential savings,” Paradise said.

Carlson, the Justice in Aging attorney who reviewed some of the bid claims at the Register’s request, likened the public documents to academic research papers. The onus is on the companies to show the documentation or citations that support the facts they are including, Carlson said.

“If I put something out there as a fact that is specific enough to be reduced to a number, I would be expected to list a citation for that,” Carlson said. “I think that’s a fair expectation” for companies that seek the state’s Medicaid contracts.

Medicaid discussion Tuesday
Learn more about the largest government privatization effort in state history and how it affects Medicaid recipients and providers. The Des Moines Register Editorial Board will meet with Iowa Medicaid director Mikki Stier and representatives of four managed care organizations chosen to manage Iowa’s Medicaid program. Watch live video of the discussion at DesMoinesRegister.com at 11 a.m. Tuesday, Nov. 10.

http://www.press-citizen.com/story/...nclude-misleading-unverifiable-data/74233238/
 
UnitedHealthcare= obama
latest
 
I have posted it many times and I even posted it on freep one time before they booted me off of there. { Yes, I was booted from freep} But the Obama connections to united healthcare are more than likely criminal.
 
UnitedHealthcare= obama

UnitedHealth Group is the parent of UnitedHealthcare, the largest single health carrier in the United States.[7] It was created in 1977, as UnitedHealthCare Corporation (it was renamed in 1998), but traces its origin to a firm it acquired in 1977, Charter Med Incorporated, which was founded in 1974. More informally, it has its origins in the development of the HMO as a model for organized health care and in the work of spokesman Paul Ellwood.[8]

In 1979, it introduced the first network-based health plan for seniors. In 1984, it became a publicly traded company.

In 2011, J.D. Power and Associates gave UnitedHealthcare the highest employer satisfaction rating for self-insured health plans.[9] In a 2010 insurance industry publication, Business Insurance (magazine), UnitedHealthcare was named "Readers Choice" winner in 2010 for "Best health plan provider".[10] In contrast, a 2010 survey of hospital executives who have dealt with the company, United received a 65% unfavorable rating. While this marks a 33% improvement over the prior year's survey, UnitedHealthcare still ranked last among all listed.[11]

https://en.wikipedia.org/wiki/UnitedHealth_Group
 
You did not happen to mention the connections to Obama himself ciggy, and how Obama profits from united healthcare. Of course J. D. Powers and all the liberal commie organizations are gonna give them a number one ranking, to line the pockets of obama
 
Point out the specific laws being broken.
oh, ok, manipulating the entire healthcare system of the united states with dirty bribe money so that you get installed as a dictator or get your guy in there, is perfectly legal... ok,got it.
 
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