State Auditor: Managed Care companies not complying with contract obligations

Local News

DES MOINES – On Wednesday, State Auditor Rob Sand sent a letter to the interim director of the Department of Human Services, informing him two of the companies on Iowa’s privatized Medicaid system have violated parts of the contracts with the state.

“Clause 2.13.27 of the State of Iowa’s contracts with MCOs Amerigroup and United HealthCare allows the State Auditor, at the MCOs’ cost, to determine whether the MCOs have complied with their legal and/or contractual obligations. I write today to state that they have failed to comply, in the hope that their failures will be immediately remedied to save taxpayer money and protect the Iowans specifically harmed. The issues that I will note in this letter focus on the treatment of two quadriplegics who are currently experiencing service gaps and cuts. Staff at DHS are aware of their situations, and yet thus far their situations are unresolved. While progress has been in some areas of their cases, the facts appear to violate federal regulations at 42 C.F.R. § 441.710, in addition to violating the contract clauses specifically noted below. Not only that, but the violations would have been worse had these individuals and their families not spent hours doing what taxpayers already pay the MCOs to do ,” wrote Sand in a letter delivered on Wednesday.

In a one-on-one interview with Local 5 on Wednesday, Sand explained that two Iowans contacted him to look into their decreased care.

“And they failed to comply in a way that is both bad for the individuals that we’re talking about in these cases, but also bad for taxpayers in general. So there’s two quadriplegics in Iowa, who received notice from their provider that their provider was going to cease providing services, they got a 30-day notice. And I was contacted during that 30-day window,” said Sand. “And I decided that this would be a good opportunity for me to see what I could see and see what I can learn and see if I could help. What I saw in those 30 days was a total lack of action on the MCO’s part. And that, really, the situation for these individuals would be worse, if these individuals weren’t essentially doing what the MCO are being paid to do. These people have experienced cuts in their care, they’ve experienced cuts in their services, they’ve had a service gap, both of which should not happen. And that is an instance of non-compliance.”

Local 5 asked Sand the status of his Medicaid audit that he promised to do while campaigning in 2018.

“I don’t give out deadlines on things because I want to know that I am doing my job thoroughly. However, at the same time, I can tell you that we will have probably multiple Medicaid audits that are issued in advance of the 2020 elections,” said Sand.

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