Disappointed Medicaid Bidder Focuses on Inconsistencies


A Toledo-based company trying to prevent a cluster of billion-dollar contracts on Wednesday focused on what it saw as inconsistencies in how the Ohio Department of Medicaid handled them. purchased. And it again hinted at possible irregularities by Medicaid director Maureen Corcoran.

This was the second day of a trial to determine whether to stop the implementation of Medicaid managed care contracts worth a combined $ 22 billion – the largest public market in the history of the state.

Long-standing Medicaid managed care company Paramount Advantage was not among the six selected earlier this year, even though it had been a provider since the state’s managed care program began and had obtained good grades.

He says being excluded from the program would lead to more than 600 layoffs at Paramount and its parent company, ProMedica, based in Toledo.

But if he succeeds in stopping the implementation of the contracts, it at least delay a major overhaul Ohio’s $ 30 billion a year Medicaid program. The reforms aim to focus care on individual clients, provide a continuum of services to 60,000 children with complex behavioral needs, and bring transparency to how it spends billions on prescription drugs.

While the company selection process was meant to be competitive, it had a lot more ambiguities than when government officials accepted bids for items like asphalt or police cars. Through two days of testimonies, Supreme attorney Kirsten R. Fraser focused on ambiguities and inconsistencies as she tried to argue that her client had been wrongly ignored.

Managed care providers contract with the state to enroll clients, create networks of providers such as doctors and hospitals, help determine what care is covered, and ensure providers are paid. Managed care companies receive a set amount each month for each client they have.

One of the vagaries of the procurement process that Fraser pointed out is that interested companies were told they would be assessed against three criteria: “method of approach”, “capability” and “experience”. But when interviewed six of the seven Medicaid officials who evaluated the proposals, none could point to written definitions of those terms, either in the instructions for submitting a proposal or during the evaluation process.

Paramount contends that the process was skewed in favor of huge foreign companies, including Centene, a successful bidder who agreed this year to pay $ 88 million to settle allegations that it ripped off Ohio taxpayers.

Maureen Corcoran, Director of Ohio Medicaid. Official photo.

Despite Paramount’s long experience in Ohio, assessors felt this was a weakness the relatively small company had not operated out of state. Fraser asked deputy director of Medicaid, Patrick Beatty, if this did not conflict with Corcoran’s claim before a Senate committee that the procurement process would favor companies with extensive Ohio experience. Beatty responded that Corcoran was not on the panel that assessed the nominations.

Even so, Corcoran had the final say in who won the contracts.

Corcoran’s role in procurement is under scrutiny for other reasons.

All of the appraisers who have testified so far have said they have to fill out forms indicating whether they have a financial interest in companies trying to win contracts.

Corcoran declined to say whether it had filed such disclosures although it appears Required by law. Documents filed under a separate law show that at least since last year, Corcoran had shares in two of the companies that got managed care contracts and in the company that got the contract to create a system of services for children with behavioral problems complex.

Corcoran will also not say how many shares of these companies it owns. The law under which she disclosed her ownership only requires officials to say if they own at least $ 1,000 of stock in a company.

When Fraser asked Beatty if he was aware of Corcoran’s holdings, Medicaid Department attorneys objected and Franklin Common Pleas County Judge Julie M. Lynch supported the objection.

Fraser also asked Beatty whether Corcoran violated the “blackout period” by contacting or having staff contact the companies while their proposals were under consideration. Beatty said he was not aware of any of these inappropriate communications.

Repeatedly in his presentation on Wednesday, Fraser pointed out that as recently as last year, Paramount had a good lead on parts of Medicaid’s annual newsletter than UnitedHealth. This company, the fifth in the country, was successful in this year’s sourcing and Corcoran owned its shares from at least 2018 to 2020.

But Medicaid evaluators testified that they were given strict instructions to disregard their past experiences with the companies; they only had to consider what was in the business demands.

Mary Applegate, the department’s medical director, said it was about rethinking the program and achieving better health outcomes, such as reduced child mortality. She said that in their request and oral presentation, Paramount officials explained how they would do things under the current system.

“We wanted ingenuity,” said Applegate. “We wanted a patient-centered approach. We wanted a new paradigm of what “managed care” means.

The trial will resume on November 8.



Leave A Reply