Federal Grand Jury Begins Investigation into Insolvent TennCare Health Plan
A federal grand jury is examining the findings of a task force investigation into Access MedPLUS, a now-insolvent health plan that had participated in TennCare, Tennessee's Medicaid managed care program, the Memphis Commercial Appeal reports. Under the investigation, officials from the FBI, IRS, Justice Department and Tennessee Bureau of Investigation interviewed former Access MedPLUS officials regarding the health plan's organization and how it handled the millions of state and federal dollars it received to manage care for TennCare beneficiaries. Despite years of criticism about the insurer's operations, including slow payment of providers, the health plan has not previously been involved in a potential criminal investigation (Wade, Memphis Commercial Appeal, 4/8). Tennessee officials seized control of Access MedPLUS last October, and in November, the state won a court order to take control of operations after financial reports indicated the health plan was insolvent (Kaiser Daily Health Policy Report, 2/15).
Better Regulation Needed
The investigation should also determine why Tennessee officials did not impose "regulatory accountability" before permitting Access MedPLUS to participate in TennCare, a Commercial Appeal editorial states, adding that it is "crucial" for the state to establish such accountability before giving money to TennCare health plans. Despite a "sea of red flags," the state failed to take action regarding the health plan's problems until last October, the editorial notes. The state's lack of action has helped make TennCare a "convenient scapegoat" for lawmakers, who are looking for reasons to explain the state's budget deficit and are considering proposals to reform TennCare, the editorial says. The editorial concludes, "Those who profess to want to 'save' TennCare might usefully work to prevent such failures from recurring, before they commence to kick hundreds of thousands of poor and sick Tennesseans off its rolls or deny them needed services" (Memphis Commercial Appeal, 4/11).
