Florida PIRG protests Medicaid plan, calls it a “rip-off”
WellCare is one of the insurance companies that could receive Medicaid recipients and taxpayer funds if the federal government approves Florida’s plans.
The protest is being led by Florida PIRG, a public interest group in the state that also released a report (.pdf) today that criticizes the state’s plans to expand the Medicaid Reform Pilot statewide. The current pilot exists only in a few counties.
“With insufficient new protections being put into place to change the behavior of bad actors,” the group’s report states, “this Medicaid reform plan is a recipe for a massive taxpayer rip-off.”
The group claims that HMOs have had a questionable past in the state. According to the report:
For-profit Medicaid managed care plans also have a horrific track record of defrauding the state and denying care in order to increase profits. This report looks critically at that track record while asking why the state is forging ahead to aggressively expand a pilot program that has not been proven to work.
According to Sean J. Hellien the corporate whistleblower that exposed Wellcare’s many Medicaid Fraud schemes, the company cheated the state out of $300 to $600 million dollars. It is clear that the HMO illegally pocketed well over $100 million in taxpayer dollars but the full extent of WellCare’s fraud has yet to be fully determined and documented.
The Medicaid Managed Care Pilot Program should not be expanded unless there is convincing evidence from an independent evaluation conducted by an organization with a reputation for unbiased research that an expansion would result in cost savings to the State of Florida and improve the health care services received by Medicaid enrollees. To date, all objective research and a great deal of anecdotal evidence suggest that the pilot projects have not been effective.
The group is asking that the federal government’s Centers for Medicare and Medicaid Services not approve the state’s plans “without changes to greater protect against fraud and abuse, and guarantees like a [medical loss ratio].”
The federal government is currently requesting that the state include a medical loss ratio in its plans, much to the dismay of GOP legislators. The rule would require that 85 percent of the money given by the state government to insurance companies be spent on health care services. While policy experts say medical loss ratios are a good way to provide accountability, GOP legislators have said they feel this is an example of the federal government strong-arming them.
More than 100 Florida-based organizations have already asked the federal government to not approve the state’s plan. Testimony given about the Medicaid Reform Pilot, so far, has not been positive. Groups such as Florida PIRG contend the state should not be building out the pilot program, considering all the current problems with them.
“It is essentially taking a failed five county experiment that was rife with fraud and expanding it to all sixty-seven Florida counties,” says Florida PIRG.
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