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Lombardi Law Firm

Medicaid Mismanagement Firms

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Iowa's $4.2 billion Medicaid services program is now governed by four companies with history of fraud and mismanagement.  The companies are as follows:

1) Amerigroup: paid $225 million to settle charges that it engaged in fraudulent practices within the Illinois Medicaid program by purposely not enrolling pregnant women and unhealthy patients in the managed care program.

2) WellCare paid $80 million for charges that they inflated expenses and skimped on health care to Medicaid patients in order to make a profit.

3) UnitedHealthcare was charged a $173.6 million fine for failing to make timely payments and responde to provider disputes. They are disputing the fine.

4) AmeriHealth paid $2 million in damages in Kentucky for falsely reporting procedures for Medicaid recipients that they did not actually receive - giving the company huge monetary bonuses.

Each company maintains that they comply with all federal and state regulations and that the culprits were removed from employment with the companies.

Governor Terry Branstad spurred the new movement to have these companies manage Iowa's Medicaid system instead of Iowa paying Medicaid providers directly as has been done in the past.  The supposed savings by implementing this system is estimated at $51 million, although critics believe this is an unfounded estimate.  Only time will tell.

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