Make corporate medical insurance conglomerates accountable

BY DIANE J. PETERSON AND JOHN KOLSTAD

April 15 is our all-American date for financial accountability on our taxable income. Therefore, this is an appropriate time to consider the Minnesota corporations that are evading similar accountability. The IRS requires documented proof of our personal income and expenses. Currently the state of Minnesota pays $8 billion per year to a few corporate insurance conglomerates to provide care for Medical Assistance patients. In over 30 years of paying them, the state has never conducted an independent, comprehensive audit on those tax funds as required by state and federal law. The corporations are not compelled to account for how they spend our money.
In addition to requiring regular financial audits, there is also a need to ensure the quality of care: is it medically necessary and appropriate for the patients? A federal study issued in July 2023 confirms the dangerous nature of Minnesota’s lack of state government oversight and auditing of our Medical Assistance program. The study, by the Office of Inspector General, announced that corporate contractors controlling Medical Assistance patients imposed high rates of denying medically necessary care to those patients. (See https://oig.hhs.gov/oei/reports/OEI-09-19-00350.asp.) The frequent denials of necessary care by the contractors caused particular harm to people of color. Minnesota’s lack of accountability on the Medical Assistance program is both a taxpayer and patient safety issue.
Frequent and solemn proclamations by the contractors that they spend our money efficiently are insufficient assurance. Their claims that they have been audited do not withstand scrutiny.
The documents they cite as proof of being audited are produced according to the contractors’ own criteria and paid for by the contractors, then submitted to the state. These alleged audits are not done according to generally accepted accounting principles.
Legislators ought to be confronted with the fact that no independent audits are done to check how the billions of public tax dollars are spent by these private corporations, such as Blue Cross and Health Partners, two of the contractors Minnesota uses to administer the Medical Assistance program. The state prepays the corporations for patient care. How this money is used should be examined by independent auditors chosen by the state. Such audits would also allow medical professionals to review whether or not appropriate treatments are delivered, ones which conform to standard medical care according to actual patient needs. The contractors and their allies may raise concerns about patient privacy. However, any IT professional will attest that such quality control review can be done while masking individual patient identity. Protecting patient medical confidentiality should not be considered a valid contractor argument to evade independent auditing.
Since all 134 seats in the Minnesota House are up for reelection in November, this tax month of April is a good time for voters to confront the incumbents on how they will act to get accountability from the Medical Assistance contractors for the first – and long overdue – time. Legislators are responsible for making sure our dollars are spent for the benefit of low-income patients, and spent efficiently. With no reliable auditing authority overseeing how tax funds are spent, legislators put taxpayers at risk of the corporate contractors spending our money inappropriately or hoarding it for themselves. How well does that sit with taxpayers who are not given a pass to evade financial accountability every April?
How will legislators rectify the lack of proper accountability from Medical Assistance contractors? If your legislator cannot answer this question to your satisfaction, promote the election of a candidate who makes accountability on Medical Assistance funding an election goal by Nov. 5, seven months from now.

The authors are longtime members of Health Policy Advocates.

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