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Iowa Medicaid providers fight former insurer for payment

September 10, 2019

DES MOINES, Iowa (AP) — An insurance company that pulled out of the Iowa Medicaid program nearly two years ago still has unpaid bills of as much as $1.4 million owed to Iowa hospitals, nursing homes and providers of mental health services, documents filed with the Iowa Insurance Division show.

AmeriHealth Caritas still owes money to some providers who say state officials won’t help them get paid and they are frustrated that the state through its privatization of Medicaid has set up a system in which they have to file costly lawsuits or go through arbitration just to get the money for services they long ago provided.

“Downright thievery,” is how Kim Weber described it on Tuesday. She’s the CEO of Iowa Home Care, a provider of in-home nursing, therapy and other services that allow Medicaid patients to stay in their homes.

AmeriHealth still owes the company $193,000.

“We have communicated excessively with the state of Iowa but with no real intervention to correct,” she said.

Iowa Department of Human Services spokesman Matt Highland would only say Monday that the agency has completed its review of all providers who sought help on AmeriHealth claims.

“Providers with any concerns should contact Iowa Medicaid,” he said.

AmeriHealth spokesman Jawanza Keita said Monday that the $1.4 million is an estimate of the potential liabilities for claims that may need to be paid based on historical information.

“As part of the transition, we have and continue to diligently work to resolve any outstanding items, and expect these will be addressed in the near term,” he said.

AmeriHealth pulled out of the Iowa program in October 2017 saying it couldn’t reach a new contract with the state. The Philadelphia-based company was one of three for-profit groups that Iowa hired in 2016 to take over management of the state’s $5 billion annual program that serves more than 638,000 poor and disabled people.

Rep. Ruth Ann Gaines, a member of the House Oversight Committee and a mother of an adult son with an autism spectrum disorder and other disabilities who uses Medicaid services, said she’s learned DHS distributed its last payment to AmeriHealth in August and now has no clout to push the company to pay service providers.

“They have to sue to get paid and that’s terrible,” said Gaines, a Democrat who has been critical of Medicaid privatization.

Recent court cases suggest some of the unpaid bills are significant.

ABCM Corp. in Hampton filed a lawsuit in July claiming AmeriHealth owes it $100,467 for services provided in 2016 and 2017 at its Indianola nursing home. A judge has scheduled a hearing for Sept. 12 to set a trial date.

The company’s lawyer, David Dutton also represents Virginia Gay Hospital in Vinton which sued AmeriHealth for unpaid emergency room services. Documents filed Monday indicate settlement discussions have begun.

Another lawsuit initiated in February indicates the Washington County Hospital recently settled a dispute with AmeriHealth over unpaid claims of more than $84,000.

Sen. Janet Petersen, the Iowa Senate Democratic leader, said delayed payment is an ongoing problem with privatized Medicaid in Iowa despite Reynolds’ assurances of improvements.

“I think that the Reynolds administration has been completely irresponsible in how they’re paying providers. Basically, they’re using Iowa health care providers as a bank is what one health care provider in particular said to me,” she said.

A spokesman for Reynolds did not immediately reply to a message.

The state, under Republican Gov. Terry Branstad’s direction, took the Medicaid program from state oversight and placed it under the management of private for-profit insurance companies in 2016. He promised the move would save millions of dollars and improve efficiency but since he departed in July 2017 to become U.S. ambassador to China, Reynolds has put millions more into Medicaid each year amid calls to reverse privatization and restore stability. She insists improvements have been made and she announced last week she’s hired a new DHS director and expects a new positive direction.

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