Coverage Denied: Medicaid Patients Suffer As Layers Of Private Companies Profit

https://khn.org/news/coverage-denied-medicaid-patients-suffer-as-layers-of-private-companies-profit/

Agilon’s June report depicts an operation that was often stretched thin: Nurses were handling 120 to 200 requests for care per day, on average, with no full-time medical director to review the findings.

From 2014 until May, the company relied on a family physician who was working 10 to 12 hours a day running his own medical practice, according to the report.

Ultimately, Agilon’s internal investigation found that patient care may have been denied 439 times since 2014 without a physician’s review of the medical records — a potential violation of state law. Under California law, only a licensed physician or health care professional who is “competent to evaluate the specific clinical issues involved” can determine medical necessity.

“These private entities get very little oversight,” said Linda Nguy, a policy advocate at the Western Center on Law & Poverty in Sacramento, “and there’s real harm being done to patients.”

Comment by Don McCanne of PNHP: Private Medicaid managed care companies using private subcontractors to appropriate to themselves our public funds by denying health care – need we say more?