A Medicaid company that terminated its Iowa contract almost a year ago has yet to pay as much as $14.6 million for medical care provided to disabled, poor and elderly Iowans, a Des Moines Register investigation shows.
AmeriHealth Caritas’ outstanding bills include nearly 6,000 individual charges totaling more than $1 million at the University of Iowa Hospitals and Clinics and $541,000 at Broadlawns Medical Center, public records obtained by the Register show.
Several private and nonprofit medical groups told the Register they have tens of thousands of dollars in outstanding bills that they say are hamstringing their operations and efforts to provide medical care.
“I’ve talked with the governor and she said $1 unpaid is a $1 too much,” said Julie Tow, owner of Comfort Home Health Care in Cedar Rapids. “And she has tried to coordinate meetings with these people, and she does, but then nothing happens.”
At the directive of then-Gov. Terry Branstad, AmeriHealth was one of three for-profit businesses that Iowa hired in 2016 to take over management of the state’s $5 billion annual program.
Last year, after 18 months and multiple failed attempts to negotiate higher payments for its Medicaid work, AmeriHealth announced on Halloween that it would terminate its Iowa contract. Its services continued until Nov. 30.
Until the termination, AmeriHealth was Iowa’s largest Medicaid company, managing the care of more than a third of the 600,000 Iowans in the program.
One of AmeriHealth’s chief responsibilities was to pay medical professionals who provide services to their clients. Doctors have up to a year to submit claims for payment to the company.
AmeriHealth and other Medicaid managers generally are expected to make payment for legitimate and correctly filed claims within 30 days to meet the federal definition of “timely processing.”
But medical executives such as Tow — who says her company is owed at least $30,000 — say payments have languished for months, describing situations in which AmeriHealth has either lost claims or information crucial to resolving the unpaid disputes.
AmeriHealth’s latest report June 30 to the Iowa Insurance Division shows it has $14,624,276 in unpaid claims. A review of the report was first published by the community blog “Bleeding Heartland” earlier this week.
AmeriHealth spokesman Joshua Brett responded to a request for an interview with a written statement that said the company is complying with its Iowa contract.
“AmeriHealth Caritas Iowa continues to diligently work to adjudicate provider claims,” Brett said.
Kimberly Weber, an executive of Iowa Home Care in Des Moines, estimates her business is owed more than $222,000 by AmeriHealth.
She said she has reached out to Iowa Medicaid Director Mike Randol and Iowa Department of Human Services Director Jerry Foxhoven several times.
“What cannot happen is they act like they don’t know,” Weber said. “We’ve been forthright about the problem.”
Brenna Smith, a spokeswoman for Gov. Kim Reynolds, issued a one-sentence statement when asked what steps the governor may take to resolve the issue:
“The governor expects AmeriHealth to fulfill the contract, and that includes paying any providers who are entitled to be paid.”
Matt Highland, a spokesman for the Iowa Department of Human Services, said AmeriHealth’s final payments likely will not be made until 2020 because of filing standards.
Iowa has a payment “withhold” of 2 percent to Medicaid companies, which can amount to tens of millions of dollars should Human Services determine the company has not met goals or acted appropriately.
That decision will be made late this year, Highland said.
Before AmeriHealth terminated its work with the state last year, Iowa’s Human Services had assessed more than $1 million in penalties against the company.
AmeriHealth also was a subject of a Des Moines Register investigation published earlier this year about the denial of care to disabled Iowans.
AmeriHealth’s Dr. Brian Morley testified that it wasn’t necessary for an in-home care patient to receive daily assistance to clean himself after bowel movements. Read the full investigation: features.desmoinesregister.com/news/medicaid-denials/
Ed Brown, the CEO of the Iowa Clinic, said his staff is aggressive in challenging billing practices from the Medicaid companies it believes to be unfair.
AmeriHealth owes the Iowa Clinic less than $20,000, an amount he described as “not trivial but also not of a magnitude that I have to hold my nose.”
Brown said the state’s desire to better manage Medicaid and save money — the key reasons Iowa hired for-profit corporations to manage the program — is worthy, but continuing operational issues make it difficult to achieve that goal.
“It’s unfortunate, but this has turned into a political football,” Brown said. “And this is not something to play political football with.”
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