Home Care Industry News

Alleged Failure of MCOs to Pay Home Care Agency Leads to Closure

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A home health care agency franchisee has shuttered its doors, but not due to any incompetence, failure to find clients, or to maintain quality caregivers. It has closed because, according to owner Bonnie Phillips, it wasn’t receiving Medicaid reimbursement payments from the state for services provided because the managed care organizations responsible for distributing those payments failed to do so.

Bonnie Phillips alleges that $185,000 in reimbursements were never received, with $168,000 from one MCO. The agency, Home Helpers had been serving clients throughout numerous regions in west-central Wisconsin. Inclusa is one of the MCOs that has allegedly failed to forward the reimbursements, and the one owing the largest amount which has evidently been enough to bankrupt the agency.

According to a Leader-Telegram article, All work, no play: Area home health care provider shuts down as payments for services rendered fail to come, written by Eric Lindquist:

Specifically, Phillips blames the managed care organizations hired by the state to arrange home care for Medicaid patients, who accounted for about half of the clients Home Helpers served in Chippewa, Eau Claire, Dunn, Pepin, Buffalo, Trempealeau, Jackson, Clark, Taylor, Rusk and Barron counties.

Those MCOs owe Home Helpers a total of $185,000, with one of them, Inclusa, accounting for about $168,000 of the uncollected bills, Phillips said, arguing that few small businesses could survive with such a high accounts receivable balance. Phillips provided a spreadsheet purporting to show hundreds of unpaid bills Home Helpers submitted to Inclusa over more than two years.

“If we had that money, we’d be fine. We would not be closing,” Phillips said. “It’s heart-wrenching.”

Inclusa vice president of community resources and provider relations Erin Smith declined to comment directly on the issue, but did make a statement: “What I can assure you is we are working with her [Bonnie Phillips] as we would with any provider to assure that any legitimate claims are being paid.”

A spokesperson for the Wisconsin Department of Health Services stated that Ms. Phillips has been encouraged to use the formal appeals process, but that she hasn’t yet taken that step.

It’s unclear why Bonnie Phillips has yet to push forth with a formal appeals process and is instead continuing with the informal process through the MCOs. There are specific guidelines and regulations that must be met in order to receive reimbursements. Ms. Phillips apparently has the full support of the Home Helpers franchise and a business consultant for the company wrote a scathing letter to Governor Scott Walker.

There was no immediate word on whether Ms. Phillips agency would be able to resume operations is reimbursements are finally made.

Summary
Alleged Failure of MCOs to Pay Home Care Agency Leads to Closure
Article Name
Alleged Failure of MCOs to Pay Home Care Agency Leads to Closure
Description
A home health care agency franchisee has shuttered its doors, but not due to any incompetence, failure to find clients, or to maintain quality caregivers. It has closed because, according to owner Bonnie Phillips, it wasn’t receiving Medicaid reimbursement payments from the state for services provided because the managed care organizations responsible for distributing those payments failed to do so.
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HomeCareDaily.com
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Valerie VanBooven, RN BSN, Editor in Chief of HomeCareDaily.com

Editor in Chief of HomeCareDaily.com at LTC Expert Publications
Valerie is a Registered Nurse, Author, and Co-Owner of LTC Expert Publications. Read More at http://www.LTCSocialMark.com
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