Policy: Entitlements

Feds investigate Idaho Medicaid contractor

News,Business,Watchdog,Idaho,Medicare and Medicaid,Entitlements

BOISE, Idaho (AP) — Federal officials are investigating a contractor Idaho selected to oversee its Medicaid behavioral health program for possibly violating patient-privacy laws.

In a collaborative report from the Idaho Statesman and Boise State Public Radio ( ), health care providers say Optum Idaho sent them patient information that should have gone to other providers.

"We have received multiple authorizations for clients that are not ours (were never ours)," a provider, whose identity was redacted by the Idaho Department of Health and Welfare, wrote in an email to Optum in January.

Another provider reported that "one of his competitors (said) they received five pages of patients' information and a sizable check from Optum."

Now the U.S. Department of Health and Human Services is investigating Optum for breaking federal patient protection laws because of the providers' growing complaints.

Optum officials said they have fixed the problem, adding that the 134 records sent erroneously make up less than 1 percent of the 1.3 million claims they process. They also said that none of the patient information went outside the network of providers.

"Consumer information was not compromised outside of the health system," said Becky diVittorio, executive director of Optum Idaho.

Meanwhile, Health and Welfare said in July it received six complaints related to possible Health Insurance Portability and Accountability Act violations, but officials decided they weren't reportable breaches.

Idaho hired Optum last year in an effort to reduce Medicaid's rising costs. The state pays Optum, a unit of United Behavioral Health, nearly $10.5 million a month to manage contracts with local mental health and substance-abuse treatment businesses to provide Medicaid patients with counseling, psychiatric care and other services.

However, dozens of providers have complained that Optum has created lengthy delays and cut services. Some say Optum hasn't paid them on time, which has put their business at risk.

Chris Culp, whose Boise-based behavioral health company has filed 25 federal complaints against Optum, said he has yet to receive responses on what the company is doing to address his concerns.

"And what typically happens is I'll send an email, I'll provide the information - exactly what happened - and then I will get a form letter back within 10 days that says 'I've received your complaint and we will do our investigation and we will let you know what the results of that are,'" Culp said.

"And if that's the organization that's in charge of our health care here in Idaho, that's kind of concerning to me," he said.

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