Investigate Patient-dumping Claims

January 6, 2001

Patient dumping by Medicaid HMOs might not be a problem in Florida, but state residents may never know for sure. That's because the Florida agency that regulates managed care never bothered to complete its probe into allegations that the illegal practice is taking place.

Instead, officials at the Agency for Health Care Administration closed the cases. This left more questions than answers regarding the 15 HMOs in Florida that were once suspected of improperly dropping patients who had become pregnant or developed serious illnesses.

AHCA's current boss, Ruben King-Shaw, once ran two of the HMOs targeted by regulators.

Shaw says that when he arrived at the agency, "there was a shift in focus. It was not driven by me." Nevertheless, his explanation is troubling, considering the seriousness of the charges. King-Shaw needs to order AHCA investigators to complete the job they started more than two years ago when the agency began hearing horror stories about how some HMOs were mistreating Medicaid patients.

The federal and state-funded Medicaid program costs Florida at least $6 billion annually. Federal health officials, however, say about 10 percent of the money is lost to fraud. This is taxpayer money -- your money -- and this year Florida could face a billion dollar Medicaid shortfall. AHCA has an obligation to make sure taxpayers are getting their money's worth, and to recoup losses whenever possible.

Patient dumping is illegal. HMOs are allowed to "disenroll" unruly and uncooperative patients, but the health organizations can't dump clients because of a change in their health or a pre-existing medical condition.

AHCA is supposed to monitor Medicaid funds, and it did so responsibly in 1998 when it requested a computer report of patients who had been disenrolled by the HMOs and had accumulated at least $2,000 in medical bills three months after their discharge.

According to agency records, the computer report found more than 3,400 patients, with medical bills totaling more than $7 million. That was enough to prompt AHCA to probe further, and in January 1999 investigators decided to move forward aggressively to determine if any HMOs had violated their contracts.

Then the agency shifted gears. AHCA administrators say they switched resources to more important investigations, such as finding fraud in prescription drug programs for Medicaid patients. Consequently, the patient dumping probe was set aside.

AHCA has a lot to do, and limited resources with which to do it, but the patient dumping investigation needs to reinstated as a priority.

Indeed, if patients are being dropped from HMOs because of their medical conditions, the investigation becomes a matter of life and death.

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