[Vision2020] Medicaid claims malfunction could cost Idaho

Saundra Lund v2020 at ssl1.fastmail.fm
Tue Mar 29 21:02:45 PDT 2011


This makes me absolutely spitting mad.  These problems with Molina Medicaid
Solutions' (MMS) processing of Idaho's Medicaid claims has been totally
FUBAR for almost a YEAR now, yet:

 

Department of Health and Welfare officials are in talks with the Idaho
attorney general's office over how to address these issues - and how to hold
Molina accountable.

That finger-pointing phase has been put on hold, for now, while Molina and
state officials concentrate on working all the bugs out of the system, said
Dick Schultz, a Health and Welfare deputy director who is managing the
project.

"When the system is stable and there's no more harm being done, that's when
we'll start taking that comprehensive approach to looking at what happened,"
Schultz said.


In any case, I recommend reading the full article for the details of the
disgusting waste at a time when Medicaid is being cut.  No reasonable person
can help but think that there needs to be accountability NOW, and if the
contract wasn't written to protect our taxpayer dollars in this idiotic
contract with a clearly inept & irresponsible private contractor, there
needs to be a serious house-cleaning.  I suspect the cost to Idaho will be
well over (as in at least double) the $2 million mentioned in this article.

 

http://www.idahostatesman.com/2011/03/29/1584863/medicaid-claims-malfunction
-could.html

 

March 29, 2011

Medicaid claims malfunction could cost Idaho

JOHN MILLER - Associated Press

 

Idaho's new, problem-plagued Medicaid claims processing system may cost
taxpayers millions, according to a report released Tuesday by legislative
auditors who concluded that neither Idaho health officials, the software
company nor Medicaid providers were adequately prepared for the switch last
year. 

After California-based Molina Medicaid Solutions took over the $106 million
contract in May 2010, problems handling Idaho's roughly $1.4 billion in
annual Medicaid claims emerged almost immediately. That delayed thousands of
payments to private providers who rely on the payments to provide services
to the poor and disabled. 

To help keep them in business, the Department of Health and Welfare advanced
these providers a total of $117 million in interim payments in July and
August. 

These companies were paid again once their original claims were processed
late. 

Now, however, only about half these double payments have been recouped by
the state. And because some of those providers did eventually fold, an
estimated $2 million is now at risk of never being recovered, wrote the
Legislature's Office of Performance Evaluations. 

"That's a rough estimate," said Health and Welfare spokesman Tom Shanahan.
"It may be more, it may be less. Some of them (the providers) are not
billing anymore. We believe some of them have gone out of business." 

There are more issues, too, that are costing Idaho money. For instance,
federal matching rates for Medicaid are going from nearly 80 percent to 69
percent come July 1. With so many claims delayed, that means the state is
likely losing hundreds of thousands in federal matching funds, money Idaho
has to make up in state taxpayer dollars. 

Department of Health and Welfare officials are in talks with the Idaho
attorney general's office over how to address these issues - and how to hold
Molina accountable. 

That finger-pointing phase has been put on hold, for now, while Molina and
state officials concentrate on working all the bugs out of the system, said
Dick Schultz, a Health and Welfare deputy director who is managing the
project. 

"When the system is stable and there's no more harm being done, that's when
we'll start taking that comprehensive approach to looking at what happened,"
Schultz said. 

In February, the Legislature's Joint Legislative Oversight Committee voted
to conduct a performance audit to examine just why Molina's claims
processing system went so awry. Tuesday's report was the result. 

Auditors found improvements in the interim, including when Molina doubled
its support staff and enacted other remedies to reduce pending Medicaid
claims to fewer than 40,000 in February, from more than 120,000 last
September. But more work is needed, they wrote. 

"Providers continue to express concerns that progress is not being made
quickly enough," the auditors said, likening the failure of Molina's system
to the 2005 collapse of Idaho's proposed computer system meant to track
public school students' academic progress after $21 million had already been
spent on that project. 

Lessons learned by that financial flop weren't applied when Idaho brought
Molina on line, auditors wrote - despite the obvious importance of a
seamless transition for a system that handles 150,000 claims or more every
week. 

"The challenges associated with the transition were not simply a series of
unpredictable events," according to their report. "Instead, we found these
challenges were the result of unclear contract requirements, a lack of
system readiness and the absence of adequate end user participation
throughout the enrollment and testing phases." 

Dell Bell, Molina's Idaho account manager, spoke only briefly at Tuesday's
session, indicating the company agreed with auditors' findings. 

Lawmakers, meanwhile, reserved harsh words for Health and Welfare officials
in charge of getting the matter under control. Sen. Dean Mortimer offered
this tongue lashing when Health and Welfare's Schultz expressed "anxiety"
over collecting the outstanding interim payments: 

"The taxpayer expects us to go beyond that, and actually fix it," said
Mortimer, R-Idaho Falls. "To me, anxiety is not the right answer in this
situation." 

_________

Saundra Lund

Moscow, ID

 

The only thing necessary for the triumph of evil is for good people to do
nothing.

~ Edmund Burke

 

***** Original material contained herein is Copyright 2011 through life plus
70 years, Saundra Lund.  Do not copy, forward, excerpt, or reproduce outside
the Vision 2020 forum without the express written permission of the
author.*****

 

 

 

 

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