GMHCC <> News & Information

*  Healthcare Accountability Press Conference  *

GMHCC held a press conference on Wednesday March 27th at 11 a.m. in Room 125 of the State Capitol building.  The purpose of the press conference was to update the media about progess and updates in our investigative efforts on HMO and DHS accountability in healthcare.  It's a follow-up to the release of our 20 page Healthcare Accountability/Transparency report. It covers and documents over 15 years of HMO mismanagement of a $4 billion dollar per year income which is funded by your tax dollars.

The press conference summary report can also be viewed on the KSTP-TV site here: 

                    http://bit.ly/YVXkzA

AND you can...

CLICK HERE to view, print or download our exclusive investigative report-

"Who Was Minding The Store?"          >>>>>>>>>>>>>>>>>>>>>>>>>
A report on Minnesota’s problem with contracting out the state public health care programs to HMOs

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ALSO, you can...

CLICK HERE to read the GMHCC summary of recent private and

state audits of the HMOs and DHS -

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HHS Accountability Legislation Lacking…

 June 15, 2012

After many hours of debate and legislative wrangling over the provisions of what has become generically known as the Health & Human Services (HHS) Accountability Bill, the final version’s elements can now be revealed.

This information comes courtesy of a private researcher and ally of GMHCC and Seven County.

Audit language contained in HHS omnibus legislation
First introduced in various stand-alone bills, managed care audit requirements were folded into the 2012 Health and Human Services Omnibus bill, which emerged from conference committee on April 23rd.

The audit provisions alter Minnesota Statutes section 256B.69, by adding another subdivision, labeled (9d.). This subdivision allows that:

• The legislative auditor will contract with an outside audit firm to conduct a bi-annual, “independent, third-party financial audit” of managed care financial data.

• Audits will focus on data that HMOs and county-based purchasers already submit to DHS – including information on administrative expenses, revenues, reserves, reinsurance, and more.

• Audits will be conducted “in accordance with generally accepted government auditing standards issued by the United States Government Accountability Office.”

• The audits will determine if managed care programs are compliant with state and federal laws, as well as with the federal Medicaid rate certification process.

• Firms retained for the audit cannot have provided services to managed care or county-based purchasers during the time period for which the audit is being conducted.

• Future managed care contracts must include provisions that allow auditors access to relevant information, and stipulate cooperation with such auditors. Contracted firms will have the same powers as those of the legislative auditor, for the purposes of completing managed care audits.

• Managed care organizations must provide DHS with bi-weekly “encounter” and “claims” data on public health care programs.

• Audit results will be circulated to the Commissioner of DHS, the state auditor, the attorney general, and various members of the legislative leadership.

In summary…

The end result of these changes is one long-sought by transparency advocates. The bill adds an additional layer of oversight to the state’s managed care programs, by inserting an external auditor who is empowered by (and answerable) to Minnesota’s legislative auditor.

Previously, the oversight of managed care programs fell to DHS, and to a lesser extent, to MDH and the Department of Commerce. The underlying premise of the audit legislation clearly appears to be that an outside observer can find new perspectives on the efficacy of public health care plans, even though they will be using the same underlying data set as state agencies.

The legislation omits a key provision sought by Senator John Marty, in that audits will only extend to contracts beginning in 2014, and will not be retroactive to prior years. GMHCC has long contended that understanding what occurred in the past will be critical to managing public programs going forward – as well as discovering the scope and scale of any past improprieties.  There is some hope that language can be added or amended next session to move the audit window back at least to 2011 or before.    ~30~ 

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Whistleblower Fired....

December 2010

In a move that caught many people by surprise, the attorney for almost 30 years for the MHA (Minnesota Hospital Association) was abruptly terminated in response to a video that he helped produce. 

The video was authored and produced by Dr. David Feinwachs who has been the corporate attorney for  the MHA since 1980.  Feinwachs was “released” from responsibilities in late November in apparent response to vehement objections to its content by various HMOs in Minnesota.  Minnesota’s HMOs were the subject of the video along with the state healthcare programs that they have been allowed to run since 1983.

At issue in the video is the double-standard and lack of accountability that is now the rule for the non-profit HMOs in Minnesota (by law, all Minnesota HMOs are required to be organized as non-profit entities).  Feinwachs describes the accountability problem as a “black box.”  State “tax dollars go into the black box” of HMO accounting in the form of $3 billion dollars in tax money every biennium, and they are “never accounted for” in any meaningful way, according to Feinwachs.

Feinwachs considers the current system of handing over healthcare tax dollars to the HMOs fiscally irresponsible and something that needs fixing.

The video illustrates the lack of oversight in a simple and understandable fashion and asks viewers to consider  the question of why no accounting of funds has been demanded for these tax dollars, and why this *demonstration project has been allowed to continue unmonitored. 

The response to the video’s content from the HMOs through the MN Council of Health Plans (MCHP), the organization which is made up of HMOs in the state, has been that they are monitored and are accountable to the state.

Feinwachs addresses that by saying they (the HMOs) are allowed to self report their expenditures and they don’t follow the same standard as any other group receiving state tax dollars.  He goes on to say that they are also not subject to any competitive bidding process, which is also unique to organizations receive state money.

As a well known and highly respected member of the healthcare industry as part of the MHA, Feinwach’s firing has generated a huge amount of interest.  Related to that, KSTP-TV reporter Jay Kolls has done an investigative piece on the story and plans to follow legislative activity related to the issue of HMO accountability.

Seven County and the Greater Minnesota Health Care Coalition (GMHCC) has contended for years that turning over state run programs without regulations or accountable standards has always been a huge waste of state resources.  Efforts to urge accountability hearings have been an ongoing priority with GMHCC and its coalition partners for years. 

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State “tax dollars go into the black box” of HMO accounting in the form of $3 billion dollars in tax money every biennium, and they are “never accounted for...”

David Feinwachs

Echoes Senior News Now Online

Welcome to the Greater Minnesota Health Care Coalition.

GMHCC is a non-profit organization, grassroots organization. We seek to unite Greater Minnesota citizens and their organizations to create positive social change on healthcare and other issues. In particular, we advocate for affordable prescription drugs, a sustainable Medicare system, and healthcare for all citizens. We also offer related information and resources, including a prescription drug program.

Follow our links to learn more about our positions on issues such as Medicare, healthcare, and prescription drugs; our legislative outreach, and our prescription partnership program. If you want more information or would like to talk with someone at GMHCC, call us toll-free at 1-888-694-5055.