COMPTROLLER MENDOZA SEES FIRST-HAND HOW MCOS SHORT-CHANGE HOSPITALS
Visit to Loretto the first of a series to hear about the impact delayed and withheld payments by MCOs are having on Illinois’ safety-net hospitals and other health care providers
May 16, 2019
CHICAGO — As she toured The Loretto Hospital, State Comptroller Susana A. Mendoza heard agonizing tales of how Illinois hospitals are suffering because the managed care organizations (MCOs) delay or deny coverage of medical procedures.
“We had the medical director of one of the MCOs tell our physician, a board-certified ER physician who saw the patient have two – not one but two seizures – they still didn’t need to be in the emergency room,” Loretto CEO George Miller told Mendoza. “They said the patient did not need to be admitted. They denied our claim.”
Miller pointed to the Intensive Care Unit the hospital is shrinking because of declining reimbursements.
“Our ICU is closing because we’re not getting enough reimbursements,” Miller said. “We’re owed $13.2 million from all the seven MCOs. We can’t have multiple units open and provide care and not get reimbursed. Until we get money, we have to consolidate our services. We’re going to retrench the treatments we provide.”
Mendoza warned Gov. Rauner’s administration two years ago against granting the largest procurement in the history of the state – $63 billion over four years – with less transparency than the state uses to buy paper clips. In just the last 10 years, the state has shifted from a practice of paying health care providers directly to one in which just about all Medicaid payments go through MCOs – $14 billion a year. Recent audits have blasted the MCOs for not documenting their spending.
“When the providers call our office and say, ‘Where is our money? We haven’t been paid in months,’ we respond ‘We have already paid it out -- $1.5 billion last week.’ Where’s the money going? The MCOs are
essentially holding on to these funds,” Mendoza told Miller and other health care providers at Loretto. “My suspicion is that they are taking their profits off the top and very little is being parceled out to the front-line providers.”
Mendoza has introduced a bill, HB 2117/SB 1238, the MCO Transparency Act, that would require the MCOs to report quarterly how many payments they sent out. It is one of several bills the General Assembly is considering this session to hold MCOs accountable.
In the meantime, hospitals like Loretto will just have to keep cutting services, Miller said.
“A patient that stayed here in the ICU had a $61,000 dollar bill,” Miller said. “She was intubated, with a tube down her throat, and was here for 12 days, and on a ventilator. And we got paid $222 dollars for a $61,000 bill/ They said she didn’t need to be in the ICU.”
WBEZ’s story about Comptroller Mendoza’s visit to Loretto: https://www.wbez.org/shows/wbez-news/cutbacks-at-loretto-hospital-as-insurers-delay-reject-payments/a9eb9fde-7a78-47f6-84ab-2dce808325d2?fbclid=IwAR2QGL8XACfPnR6P8GT6yWesQ4oL_216_Xmr4dIvJUfAhi8etQ4v7kl7wpk
The Comptroller’s office Fiscal Focus article about the explosive growth of the state’s MCO program: https://illinoiscomptroller.gov/news/fiscal-focus/illinois-massive-shift-to-managed-care/
For follow-up at The Loretto Hospital, please contact Marnie Robinson at 773-854-5485.
For notice of Comptroller Mendoza’s upcoming visits to other health care providers, please stay tuned.