Medicaid provider drops state lawsuit

An Ohio-based Medicaid managed care company is set to end its lawsuit against the state.

Last year, he accused the Ohio Department of Medicaid of bias and conflict in a $ 22 billion bidding process. Toledo-based Paramount Advantage now says if the department approves a deal for Anthem to take over patients from Paramount, it will drop plans to appeal a lower court ruling that rejected his attempt to arrest the huge supply.

“Ensuring quality member care and minimizing local job losses have been top priorities for Paramount since learning that we had not been awarded a contract for the new Ohio Department of Managed Care program. Medicaid (ODM), which begins July 1, 2022, “Paramount said in an emailed statement.” Closing this deal with Anthem will help address concerns related to these priorities. And, if the transaction ends as scheduled, Paramount will not take further legal action against ODM. ”

The plans were first reported by Hannah News.

If the deal is approved, it will end a bitter challenge by Paramount to a procurement undertaken by Medicaid last year.

Seeking to reshape the state’s Medicaid system, the department released a call for nominations by managed care providers to show how they would prioritize the health of individual Medicaid beneficiaries, who make up 25% of the population of the l ‘Ohio. With 22 billion dollars, it was the biggest public markets in Ohio history.

After years of claims that pharmaceutical intermediaries working for managed care providers are wrestling the state, the Medicaid department is removing this activity from those companies and hiring a single pharmaceutical intermediary who will work directly with the Medicaid department.

Also as part of the overhaul, the department is hiring a single company that will create a continuum of services for 60,000 Ohio children with complex behavioral health needs. The billion-dollar program will work closely with health care providers managed under the revamped system, Medicaid officials said.

Plans call for the new system to be implemented in July.

When the Medicaid department selected six companies to run managed care and one to run OhioRISEThe children’s program he switched to Paramount, a longtime managed care provider in the Ohio system. The department said the company’s request did not adequately explain how it would meet the new goals the state was setting for its Medicaid program.

Primordial continued on the decision, and in court in October and November, he presented evidence that he was penalized for being relatively small and operating only in Ohio.

He also said the procurement ignored the fact that some of the large companies selected had been accused of massive wrongdoing against Ohio taxpayers.

For example, the Medicaid department resumed talks with Centene-owned Buckeye Health Plan in August – just six months after the company announced it was paying $ 88 million to settle claims it had diverted tens of millions from the Ohio Medicaid program. The company also announced that it is setting aside an additional $ 1 billion to settle similar claims in other states.

Additionally, UnitedHealth Group’s United Healthcare Community Plan of Ohio was one of six companies selected for a multibillion-dollar managed care contract. He got the case even though the state is actively pursuing its pharmacy middleman, OptumRx, over allegations that it snatched $ 16 million from the Ohio Workers’ Compensation Board.

In addition, Optum and CVS pharmacy intermediary, CVS Caremark, were the companies accused of having badly inflated Medicaid drug prices – charges they deny. Despite the claims, CVS’s Aetna was awarded the billion dollar OhioRISE contract.

In court, Paramount also highlighted potential conflicts of interest.

Medicaid Director Maureen Corcoran revealed that in the past she owned at least $ 1,000 of shares in CVS and UnitedHealth Group, but She refused say how much she owned as she negotiated and signed huge contracts with their affiliates.

And Mercer, the $ 9 million consultant who facilitated the procurement, refuse to say if any of the selected clients also have consulting contracts with Mercer.

Franklin County Common Plea Judge Julie M. Lynch November 10 dismissed the Paramount case after rejecting the evidence of possible conflicts. Immediately after the dismissal, attorneys for Paramount announced that they would appeal.

But Paramount and its parent company, Toledo-based ProMedica, have given more thought to the strategy. He says he turns his business over to Anthem because he believes it is the best of the six companies newly selected to provide care to Paramount’s Medicaid clients.

The two companies are also researching landing points for hundreds of Paramount employees.

“Anthem and ProMedica are working to identify open roles within both organizations that may be of interest to affected Paramount employees,” Paramount said in a statement. “It would create opportunities for Paramount employees to join Anthem or continue with ProMedica in another capacity. “

For his part, Anthem has said he’s up to the task.

“Anthem has served the global health needs of Ohio residents for over 81 years, and we look forward to expanding access to comprehensive, high-quality health services for more of those eligible for Medicaid.” , Greg LaManna, President of Anthem Blue Cross and Blue Shield Medicaid. in Ohio, said in an emailed statement. “This transaction expands our commitment to advancing the next generation of Medicaid managed care in Ohio ahead of the new Medicaid contract. “


This story has been reposted from Ohio Capital Newspaper under a Creative Commons license.


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