Government

Black Hawk County may sue over unpaid Country View Medicaid claims

Second potential suit in Eastern Iowa against Medicaid insurers

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WATERLOO — A second lawsuit could be in the works against the insurers who oversee Iowa’s Medicaid program.

Black Hawk County claims UnitedHealthcare, one of the private insurers that handle Medicaid in the state, has shorted the Country View care center by hundreds of thousands of dollars in Medicaid claims.

The Board of Supervisors voted unanimously Tuesday to hire outside legal counsel to attempt to collect between $511,000 and $584,000 in claims for residents at the county-operated nursing home’s unit for persistent mental illness.

Assistant County Attorney Michael Treinen said UnitedHealthcare only has offered roughly $144,000 to settle the issue.

“That is why further action has been authorized on this claim,” Treinen said. “The supervisors have concluded this is too much public money to ignore.”

The supervisors have retained Craig Sieverding, of the Davis Brown law firm in Des Moines, to help develop the county’s case for reimbursement.

“If that is not successful to your satisfaction, then we will proceed with the filing of a lawsuit in this matter and it would go on from there,” said Assistant County Attorney Pete Burk.

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Medicaid is a federal program, managed by the states, that provides care to poor and disabled residents. Iowa has privatized management of its $5 billion Medicaid program, covering more than 600,000 residents, to UnitedHealthcare and Amerigroup.

Iowa had a third Medicaid insurer, AmeriHealth Caritas of Iowa, until the organization left the state’s program at the end of November 2017.

UnitedHealthcare officials were unable to provide a statement on the Country View situation by Tuesday night.

Country View is a county operated nursing center, which at one point last year had more than 90 percent of its 140 residents covered through the Medicaid program.

County officials then said shortfalls in Medicaid funding contributed to staggering budget deficits at the nursing home.

The supervisors voted in October to sell Country View to Pritok Capital, a private company based in Skokie, Ill., for $4 million. Closing on that transaction is expected by the end of December.

Earlier this year, Virginia Gay Hospital, a 25-bed facility in Vinton, filed a lawsuit against Amerigroup, UnitedHealthcare and AmeriHealth for allegedly violating federal law by recouping patient revenue from the hospital’s emergency department.

Mike Riege, chief executive officer of Virginia Gay Hospital, said the unpaid claims by the three insurers between 2016 and 2017 resulted in a roughly $91,000 loss.

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“In our minds, in the minds of our board of directors and our legal advisers, we felt it was so clearly wrong that somebody had to do something,” Riege told The Gazette.

According to Virginia Gay’s suit, the insurers were using an outdated version of a medical classification list that providers use to code diagnoses, symptoms and procedures for insurance companies.

The three insurance companies recouped a portion of reimbursements for patient services in the hospital’s emergency department, claiming overpayments, but were payments hospital officials claim should have been theirs.

Some unpaid reimbursements include claims for emergency room visits for migraine headaches, bleeding, a kidney stone, Chronic Obstructive Pulmonary Disease and more.

That suit currently is in the U.S. District of Northern Iowa.

Iowa’s State Auditor Mary Mosiman announced in June her office would conduct an audit of Iowa’s Medicaid program to determine if there were cost savings from switching to privatized managed care from the previous fee-for-service program.

Officials from the Department of Human Services, the state department that oversees Medicaid, said Iowans should expect the report soon.

The Auditor’s Office declined to comment on whether the audit would be complete before Mosiman leaves office at the end of this year.

l Michaela Ramm contributed to this story.

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