Medicaid contract awarded to company with $23M in fines

DES MOINES — A newspaper investigation found that a company chosen to manage Iowa’s newly privatized Medicaid system has a history of alleged mismanagement and at least $23 million in fines in more than a dozen states.

Iowa Total Care was awarded a state Medicaid contract in May despite public records showing its evaluation score dropped 14 points since Iowa officials rejected its application in 2015, the Des Moines Register reported. The Centene subsidiary is replacing AmeriHealth Caritas, which left Iowa’s annual $4.8 billion Medicaid program after losing too much money.

The newspaper found that at least 300 sanctions have been levied against Centene and its subsidiaries since 2013, including failing to promptly pay medical claims. The company’s Iowa subsidiary self-reported $23.6 million in penalties or lost incentives to the company and its subsidiaries.

“If history teaches us anything, then this is an indication that we’re in more trouble,” said Democratic Sen. Pam Jochum of Dubuque.

Centene settled two court challenges in 2016. One was for $7.5 million in a Kentucky breach of contract lawsuit, while the other was for $4.5 million in a lawsuit alleging it failed to pay nurses overtime in several states. Separately, a federal lawsuit filed this year alleges Centene has failed to provide adequate access to doctors in at least 15 states.

“We know every day we must prove ourselves and earn the trust of the citizens of Iowa, and develop partnerships with providers and the community,” said Centene spokeswoman Marcela Hawn in response to questions about past sanctions.

Iowa Total Care is expected to launch its Medicaid work in July 2019. Iowa’s Medicaid program provides health care to 680,000 poor or disabled residents, which comprises more than one-fifth of the state’s population.

Iowa Human Services spokesman Matt Highland said the agency will be working closely with Iowa Total Care over the next year to get to operational readiness.