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Sen. Torrey Westrom: Oversight and accountability needed for HMOs

Last Tuesday, April 9, a press conference was held to expose a medical assistance (MA) audit that shows Minnesotan's have overpaid health care maintenance organizations (HMOs) $207 million.

Minnesota U.S. Congresswoman Michele Bachmann (Sixth District), State Senator Sean Nienow (R-Cambridge), and myself held a press conference to address the MA audit report produced by The Segal Company. The company was contracted by the Minnesota Department of Human Services. 

The Segal Report showed that Minnesota overpaid at least $207 million to the state’s Health Maintenance Organizations (HMOs): Blue Cross/Blue Shield, Health Partners, Medica and UCare. The state was unaware of the overpayments because these companies self-audit and self-report their claims and payment data.

Testimony was heard at the press conference from physicians and patients about how inadequate reimbursements from HMOs negatively affected individuals who are in desperate need of care. Examples were given how health care providers sometimes had to turn away people who were on Medicaid because the provider could not afford to treat those individuals due to the HMOs low reimbursement rates. Dentists spoke about how they currently receive reimbursements rates from 1989 and have recently had to shut their doors. Because of this, people are not able to get sufficient care and are suffering. 

This issue needs to be addressed by correcting the reimbursement rates to our providers so patients can get the care they need. In addition, Minnesota needs to recover the overcharged amounts for the taxpayers. Legislation is being created by Senator Nienow and myself to recover these funds, and restore oversight and accountability of these HMOs. The federal government is continuing to look into this in Minnesota and now other states.

A large portion of the state’s budget goes towards these companies and we need to find ways to make them more accountable and efficient so that individuals receive the care they need and deserve. This problem has gone on for up to twenty years. Given the budget deficits, multiple inquiries have been made into this expensive program which ultimately uncovered a huge amount of wasteful government spending.