The state has crashed one of its current Medicaid managed care organizations with a $3.7 million penalty for denying patients timely access to critical medical services.
The fine appears to have prompted a top-level shakeup at Peach State Health Plan. The massive penalty focused on Peach State’s failure to grant “prior authorization” for medical assistance within two weeks the national standard for the time a
healthcare plan should decide to grant or deny coverage to a patient.
Peach State was abandoning to meet that target approximately 20 percent of the time, possibly putting patients who needed coverage for medications, tests, or other critical medical services and equipment at risk, according to sources close to the situation.
In a prepared statement, Bowers said that all outstanding issues for the prior authorization process for services have been resolved.
This is not the first time Centene has sustained criticism over the way its subsidiaries do business. Year, 2005 the company agreed to pay $9.5 million to Milwaukee-based Aurora Health Care Inc. to settle a two-year-old lawsuit over recompenses. The conflict centered on Centene’s Wisconsin subsidiary, Centene-Medicaid also dropped one of the dental care providers.
Preparing to cancel contracts with dental care provider Kool Smiles, P.C., Peach State Health Plan, and WellCare within the week and a lawsuit filed against the state by parents of children insured by Medicaid and Peachcare, the Georgia Department of Community Health (DCH) has reported its investigation of allegations of inadequate care delivery from Kool Smiles, according to DCH Director of Communications Amanda Seals.
Seals announced. “No child in our Medicaid or PeachCare for Kids programs has lost dental benefits or been dropped from the program due to the contract disputes between Kool Smiles, P.C., and the CMOs,”
August 25 when a decision issued that Kool Smiles is going to be dropped from WellCare and Peach State on Aug. 31, demonstrations have been carried to oppose the judgment of the care management organizations (CMOs). Aug. 14 A save Our Smiles rally in Dalton attended together more than 100 parents and community leaders who are concerned that more than 70,000 children in the state may lose access to quality dental care if Kool Smiles signifies dropped. The Save Our Smiles campaign has supported Georgia citizens to present messages to Gov. Sonny Perdue in support that he will intervene. The organization estimates more than 10,000 letters have been sent within two weeks.
The reality that time was running out, parents of children insured by Peach care and Medicaid sued the State of Georgia Wednesday under claims that their children will be dismissed dental care after the contract with Kool Smiles is canceled. Seals responded to this suit by stating to assure parents that they would still be capable to find quality dental care for their children.
According to Seals, five percent of current WellCare members and seven percent of current Peach State Health Plan members are possible to have services from Kool Smiles, P.C., citing Georgia Families records. Grievances of parents, as well as other dentists, have led the DCH to investigate reported difficulties, such as over-utilization of services, lower use of preventive care, and unusual methods to control patients, according to Seals.
Some of the parents who use Kool Smiles say parents must have looked for alternative dental care for their children, yet were frustrated in finding a provider who accepts Peach care or Medicaid. Provided was dropped, parents are believing that through this lawsuit a federal authority can subdue their health plans to continue their contracts with Kool Smiles so that their children will have a better smile in the future.
Medicaid was never been fair to everyone especially to people who are poor and needy. Seals are still quiet regarding the pending litigation. “If included in the lawsuit, the State of Georgia will be represented by the attorney general’s office,” reported Seals. “All inquiries should be directed there,” they stated.
Meanwhile, the state stands behind its choice to convert to manage care, notwithstanding initial kinks in the policy.
