Feds to Investigate Whether Managed Care Providers Deny Services to People with Disabilities

The U.S. Department of Health and Human Services are set to undergo an investigation into whether companies, that states have turned to take over the administration of Medicaid, have wrongly denied people with disabilities the services they are entitled to.

Bob Casey of Pennsylvania was the Senator who requested that the inspector general investigate.

“It is the duty of MCOs, as a steward of taxpayer dollars, to spend Medicaid funds responsibly in pursuit of the health of our families,” Casey wrote in a letter to HHS Inspector General Daniel R. Levinson. “What the Dallas Morning News and Des Moines Register uncovered, however, were actions taken by MCOs focused squarely on delivering profits to wealthy shareholders at the expense of those most in need of medical care.”

He cited some cases where treatments were denied and some routine cases turned into life-threatening diseases. He tells the story of a boy who was prone to unhooking his breathing machine. The boy’s doctor suggested hire around the clock nurse but Superior Health Plan denied the family’s request.

This forced their child’s health to deteriorate. On top of that, the healthcare provider failed to notify the family they have the option to challenge the decision.

In another tragic situation a woman with pancreatic cancer, Betty Frink, was denied access to regularly scheduled at home healthcare.

“A District Court judge finally found that Amerigroup’s decision to deny Betty’s care was ‘unreasonable, arbitrary, capricious or an abuse of discretion.’”

In his letter, Senator Casey outlined four questions he wanted to be answered. The first question centered around if people have ever been denied healthcare that they were entitled to. The rest of the questions were targeting how easy the process is for patients to navigate.

A full report is expected to be released within the next year.


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