KanCare, Sam Brownback's attempt at privatizing medicaid expenditures faced a new concern last night, as former Vice President of Sunflower State Health Care Plan Jacqueline Leary took to Federal District Court to allege that corruption was afoot in the state's management of federal benefits.
http://www.bizjournals.com/...
In the lawsuit, filed in U.S. District Court of Kansas, Leary said company executives met in February 2013 to discuss Sunflower's poor financial performance.
At that meeting, according to Leary, Centene's vice president of health plans, Rob Hitchcock, asked which provider networks had contracted for reimbursement rates higher than 100 percent of the standard Kansas Medicaid rates.
When he learned that the University of Kansas Medical Center was among them, he requested that the team find a way to prevent new Medicaid patients from being assigned primary-care physicians associated with KU Med.
"Ms. Leary was forced at the same time to determine how to alter the online and hard-copy provider directories to make these changes appear ... benign because KUMED administrators had not requested the closing of the member panel," the lawsuit said.
That's right. According to Leary, she was told to change the list of doctors available to the patients online, so that new members of the Sunflower Group Healthcare plan under medicaid would not be referred to doctors who worked with University of Kansas Medcenter.
Leary continues that she was later told by the head of the agency to "Lie" to patients in order to move their care from more expensive doctors to doctors who charged at the rate card the state wanted to pay, as a way to 'boost the bottom line'
http://www.kansas.com/...
Then in July 2013, she was instructed by Jean Wilms, Sunflower’s CEO, to move KanCare patients receiving services from health care providers with higher rates to ones that charged the state’s standard Medicaid rate as a way of boosting the company’s finances, the complaint alleges.
When she resisted and asked how she could explain this move, Leary was told to lie to KanCare recipients, the complaint alleges.
Leary received a poor performance evaluation as a result and brought the matter to the company’s compliance officer in January 2014, the complaint states.
Leary informed the compliance officer “that she believed that the practice was contrary to both SSHP’s contract with the State of Kansas and SSHP’s contracts with its providers” and “explained also that she believed in good faith that the practice violated both the Centene Business Ethics and Conduct Policy and state or federal law, including federal anti-fraud statutes and/or federal law relating to fraud against shareholders.”
Jacqueline Leary, in her lawsuit Provided by
the Wichita Eagle, paints a story of an agency so eager to show profit they were willing to alter the schedules of patients by changing the rules of the game as time went along, in order to optimize profits over patient benefits.
In the notes of the lawsuit we discover that an internal review finds her suspicions were bolstered as it wasn't just KU MedCenter targeted as other facilities, including Topeka's Stormont Vail and Johnson County's St. Luke's Health System were also removed from access to patients.
http://www.kansas.com/...
A footnote in the suit states that Centene conducted an internal investigation that “confirmed that primary care physicians within four separate provider groups were removed from the auto-assignment process: (1) University of Kansas Medical Center; (2) Stormont-Vail HealthCare; (3) Saint Luke’s Health System; and (4) Via Christi Health.”
Brownback spokesperson Eileen Hawley referred to the matter as a "personal issue" between the former vice president and Sunflower health service. OSHA had reviewed her claim prior, but dismissed it stating that Sunflower provided witnesses who:
“described, for example, Complainant’s difficulty with completing assignments in a timely and acceptable manner and in resolving issues for internal and external stakeholders, both of which prompted complaints about SSHP and Complainant’s overall performance,”
I'm sure it must be difficult to complete assignments you feel are morally and ethically wrong.