Third Oklahoma Medicaid company

accused of wrongdoing

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Humana accused of overbilling Medicare

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OKLAHOMA CITY, April 27, 2021 – Three of the four insurance giants chosen to administer Oklahoma’s Medicaid program now face allegations of misconduct.

 

A U.S. Health and Human Services Office of Inspector General’s audit found Humana overcharged Medicare almost $200 million in 2015 by overstating how sick some Florida patients actually were, according to an audit released last week. 

 

The Oklahoma Health Care Authority (OHCA) selected Humana, along with Centene, UnitedHealthcare and Blue Cross and Blue Shield of Oklahoma, to administer the state’s Medicaid program beginning Oct. 1. Although the contracts involve more than $2 billion annually in state funds, the Legislature was bypassed in the decision-making process.

 

“While the allegations against Humana involve Medicare, not Medicaid, the fact remains that three of the four companies chosen to manage health care for some of Oklahoma’s most vulnerable residents face serious allegations of misconduct,” said Woody Jenkins, M.D., Stillwater-based physician and co-chair of the Oklahoma State Medical Association Rural Physician Section. “The governor and OHCA sidestepped the Legislature, but that doesn’t mean the Legislature can’t stop this disaster before it happens. The House of Representatives has already passed legislation to prevent outsourced Medicaid and we’re hopeful the State Senate will respond in kind. The Legislature can also refuse to fund this flawed plan through the appropriations process.”

 

Centene Corp. has been accused of fraud in Ohio and is under investigation for similar actions in Mississippi. Ohio Attorney General Mike Yost filed a federal lawsuit saying Centene devised an elaborate scheme to maximize company profits at the state’s expense. The Ohio lawsuit, filed March 11, alleges Centene created a web of subcontractors to inflate pharmacy costs for Medicaid recipients. Mississippi’s attorney general is investigating similar allegations, according to media reports from that state.

 

UnitedHealthcare has been sued in Colorado and Texas by U.S. Anesthesia Partners (USAP) for allegedly forcing USAP physicians out of UnitedHealthcare’s network and pushing hospitals to stop referring patients to USAP.

To learn more about the Oklahoma coalition urging legislators to reject outsourced Medicaid, go to www.healthcareholdup.com.