Managed Care Organizations testify at committee meeting in response to “Pain and Profit” reporting

The House Human Services Committee held a committee meeting for over five hours on Wednesday to discuss the findings reported in the Dallas Morning News’s five-part series, “Pain and Profit.” The series sheds a light on problems in Texas’s Medicaid managed care program, including claims of withholding medical care and equipment, lack of available services, and insufficient HHSC oversight.

According to committee Chair Rep. Richard Raymond, the purpose of the committee hearing was to hear from the managed care companies mentioned in “Pain and Profit,” as well as some of the individuals featured in the series to address the investigation’s allegations.

The Human Services Committee first heard from representatives of Superior HealthPlan, which faced several serious accusations of failing to provide proper care in the “Pain and Profit” reporting. Mark Sanders, CEO of Superior, and David Harmon, Superior’s chief medical director, discussed several of the claims made against them and went into the details of the cases of D’ashon Morris and a foster child in need of psychiatric care.

During testimony, Sanders defended Superior’s actions and claimed “the articles make numerous, incorrect, and misleading assertions.” Sanders told the committee that Superior had conducted an internal review of the assertions in the article and that “almost all of those assertions are unsubstantiated.” In both D’ashon’s and the foster child’s case, the two Superior representatives said they acted appropriately and according to the typical “standard of care.”

D’ashon Morris’s mother also spoke at the hearing where she told the story of her son and the series of events that ultimately lead to an incident where he pulled out his tracheostomy tube, putting him into a “persistent vegetative state.”

Linda Badawo, D’ashon’s mother, had been directed to use a soft splint to prevent D’ashon from pulling out the trach tube. Badawo says D’ashon’s doctor warned that using restraints would negatively impact her son’s development. She also said she couldn’t legally restrain her son without a doctor’s order. During his testimony, Harmon maintained that a soft splint is in “no way, shape, or form” a restraint.

Also speaking at the committee hearing were managed care organizations Amerigroup, Cigna, and UnitedHealthcare.

LeAnn Behrens, west region president of Amerigroup Medicaid, addressed claims made against Amerigroup saying, “I don’t necessarily agree with everything and I do believe they missed many of the good things that we do.”

Behrens took particular issue with how the articles portray Amerigroup’s failings in regards to encounter data.

“If you were to read the Dallas Morning News article, you would come away from that thinking that somehow I had managed to get an additional $18 million. When in reality, I paid out $18 million to providers in this state that I should not have paid.”

An overarching theme of the “Pain and Profit” series is the idea that managed care organizations withhold necessary medical care in order to increase their profits. In response to this, Behrens said,

“As you all know, the state of Texas has set up a system that restricts the amount of profits that a managed care can make,” said Behrens. “Members get the best care, they get the right care at the right place — and you have confidence that I am being wise with taxpayer money.”

You can watch the entire 5-hour 28-minute hearing here.

Lawmakers will hear more on this case next week in the House General Investigating and Ethics Committee and in a subcommittee of the House Appropriations Committee.