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Fox is Watching Health Care Henhouse; Nobody’s Watching $$$

by Barbarara on February 16, 2013

Hi MPPers,
I’m Barbara Mahowald and I’m a supporter of a Public Option in the Minnesota Health Care Exchange.  This week I attended an info session and learned about the fraud that’s going on with Minnesota’s HMOs and Medicaid. Even though it’s been in the news over the last couple of years, there is so much I didn’t know. Here are points that I’d like to share with you.
1.  DHS cost-plus contracts with HMOs are illegal and constitute fraud. Cost-plus contracts allow the insurer/payer HMOs the ability to never lose money.  

2.  Our state actuary, Milliman, says an audit of Medicaid spending for 10+ years is NOT possible because there is no data. No data at DHS or DoCommerce. No data from HMOs. What?!? Really?!?  Yes, it’s true.  We cannot tell if we have spent too much, too little, or just the right amount.

3. Most of fraud focus of DHS is on catching providers or recipients who scam the system. Of course, this is not right. However, there is never any attention on HMOs and their actual costs.

4.  Wendell Potter has written Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans (Bloomsbury Press hardcover, November 2010)…

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