JohnMorrissey

Sedgwick landed six-year, $7.9 million state contract with also-ran cost proposal

Des Moines freelance writer John Morrissey digs into how a well-connected company landed a lucrative state contract. Laura Belin contributed reporting to this story.

Four months after being awarded a contract to administer Iowa’s worker’s compensation program for state employees, a politically connected West Des Moines company has apparently not come to terms with the state to continue its work.

Sedgwick Claims Management Services LLC was selected in early March to keep handling the program, even though a competitor achieved a better score on three cost proposal items. The state will pay Sedgwick $7.9 million in administrative costs over six years. Runner-up bidder TRISTAR Risk Enterprise Management LLC offered to do the work for a little more than $6 million, a potential savings of nearly $1.9 million over the contract period.

The Iowa Department of Administrative Services (DAS) provided copies of all submitted bids for the current and previous bid cycles upon receiving John Morrissey’s public records request. But the department has declined further comment about the award and refused to clarify the scoring system or other matters related to this bid process. The new DAS director Jim Kurtenbach did not respond to a request for an interview about this matter.

Sedgwick’s bid contact officer referred questions to several state officials and the company’s public relations office. That office also did not respond to Bleeding Heartland’s inquiry.

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An army of misery forced to decamp with UnitedHealthcare's departure

John Morrissey is a longtime Des Moines resident who has investigated state spending increases, financial anomalies, and payment disruptions associated with Medicaid privatization in Iowa. -promoted by Laura Belin

The “he said/she said” controversy between an insurance company CEO and Iowa’s governor about why UnitedHealthcare decided to leave the state’s Medicaid program might make entertaining copy, but it doesn’t address who is going to manage the care of 420,000 Iowans left in the lurch.

Nor does it address whether the remaining company (Amerigroup) is adequately prepared to handle more members, and whether a new player poised to enter our state’s Medicaid market (Iowa Total Care) has the expertise to handle special populations in Iowa such as the elderly, disabled, and very ill.

It also doesn’t consider whether the state’s traditional fee-for-service Medicaid offering has the financial wherewithal to shoulder an even larger share of the enrollment and cost. Fee-for-service was held over from the old state-run program when most of the Medicaid program was privatized in 2016. The fee-for-service program pays the claims of Iowa’s sickest and most frail Medicaid members, which the for-profit managed care organizations (MCOs) don’t want or can’t handle.

The Iowa Deparment of Human Services (DHS) did not respond to a request for comment on these issues.

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College admissions bribery case should kill sports betting bill

Two bills on sports betting, House File 648 and Senate File 366, made it through the legislature’s first “funnel.” John Morrissey wonders, “What assurance do any of us have that the colleges and universities can police themselves in light of today’s revelations?” -promoted by Laura Belin

The Associated Press is reporting today that 50 people, including several television celebrities, have been charged in connection with a scheme to get their children accepted to college athletic teams after offering bribes to college coaches and other collegiate insiders.

While not directly on point, this is very concerning in light of the state legislature’s apparent desire to legalize sports betting in Iowa casinos, not to mention the extremely arrogant position taken by Prairie Meadows to construct a facility before the enabling legislation was even introduced.

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Former Iowa Medicaid carrier's financial sleight of hand

John Morrissey investigates anomalies in financial reports filed by AmeriHealth Caritas, which left Iowa’s Medicaid program last year. -promoted by desmoinesdem

A managed care company that left the Iowa Medicaid program last November financially engineered its first quarter report to state regulators this year, even as it dragged its feet in paying Iowa medical providers for claims that were then more than 90 days old.

AmeriHealth Caritas Iowa, Inc. claimed in its calendar first quarter filing with the Iowa Insurance Division (IID) that general administrative costs to run its Iowa operation totaled $20 million. But at the end of June, the company reduced that expense to $6 million without explanation.

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Former Iowa Medicaid carrier owes millions in unpaid claims

John Morrissey delved into a little-noticed financial report by AmeriHealth Caritas. -promoted by desmoinesdem

Although it left the Iowa Medicaid program more than seven months ago, AmeriHealth Caritas Iowa, Inc. continues to string along claims payments due to Iowa providers.

AmeriHealth – which is owned by Independence Blue Cross of Philadelphia – reported $14.6 million in unpaid liability for claims submitted last year by Iowa Medicaid providers, according to the company’s most recent quarterly financial filing with the Iowa Insurance Division. Meanwhile, the managed-care organization has racked up more than $6 million in administrative costs so far this year to manage the now-closed operation.

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