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Medicaid Managed Care Audit
After months of mounting problems, State Auditor Adam Edelen says he will launch a full investigation into Kentucky’s statewide Medicaid Managed Care system. Edelen created a Medicaid task force in February after taking a first look at the managed care system. He also gave recommendations to managed care companies, health care providers and the state on how to make the system run better in the future.
But with clashes between private Medicaid companies and healthcare providers ongoing, Edelen wants to take a stronger look into the system.
“We will launch a full blown audit of the managed care companies based on the information that’s being gathered right now, we’re going to launch that investigation by the end of the year," he says.
The most recent problems with the system involve one operator, Coventry Cares, telling providers it wants to either re-negotiate contracts early or end them altogether. That has lead to lawsuits and it has threatened coverage in parts of the state.
“You’ve got a financial obligation and a moral obligation to making sure that the deal is indeed square for patients, providers and taxpayers,” Edelen says.
The state privatized Medicaid to save money last year. But a rushed start has led to the myriad problems the state is seeing now. Members of the General Assembly also plan to look into the Medicaid system during next year's legislative session.
But before that audit, Edelen will take a look at special taxing districts across Kentucky.
Kentucky has roughly 1,800 quasi-governmental taxing districts, the most recognizable being Louisville’s Metropolitan Sewer District, Lexington’s Airport Board and Sanitation District 1 in Northern Kentucky. All three of those districts were audited separately by Edelen's predecessor Crit Luallen. But Edelen says there are many more districts to look at.
“So what we’re gonna do on behalf of the Kentucky taxpayer is answer the question, how many are there? How much money floats through the system and how many are compliant with state law?” he says.
Edelen says history shows when groups use taxpayer money without being watched, that money is often abused. He predicts the various taxing districts handle more than one billion dollars each year.
“What we have found is, these government entities that operate in the shadows tend to get in trouble. They tend to misuse state taxpayer’s dollars. So what we know is, we have got to shine the light on these entities that have the ability to tax you the public. But they’re not just operating in the shadows, they’re operating in the pitch black dark and I intend to turn the lights on,” he says.
Edelen plans to start the audit next month.