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* WBEZ…
Saint Anthony Hospital, a century-old, West Side fixture for poor and uninsured people, is suing the director of the Illinois Department of Healthcare and Family Services for at least $22 million as it grapples with treating COVID-19 patients.
Theresa Eagleson runs HFS, which oversees the state’s Medicaid health insurance program for low-income and disabled people. In its lawsuit, Saint Anthony said the hospital has less than two days of cash on hand — less than $500,000. That’s because HFS and private health insurers the state has contracts with are slow to pay back Saint Anthony for medical care its doctors provide. Sometimes, the hospital doesn’t get paid at all.
* Kristen has more on Twitter…
It's been a roller coaster ride in Illinois. Hospitals have complained ever since, mostly about private insurers not paying at time or denying other claims. This adds up to a lot of $$ for small hospitals in particular, esp during #COVID19. @WBEZ @WBEZpolitics @IHAhospitals
— Kristen Schorsch (@kschorsch) April 28, 2020
.@SaintAnthonyHos' lawsuit raises a lot of questions about how transparent IL Medicaid & the health insurers it contracts are when it comes to how much they actually owe hospitals & and how much they pay.
— Kristen Schorsch (@kschorsch) April 28, 2020
The Illinois Department of Healthcare and Family Services “has been working with the hospital for several weeks to address the hospital’s claim that it has not received all of the payments it is due,” DHFS Director of Communications and Public Affairs John Hoffman told Bloomberg Law. The hospital hasn’t yet provided the state with information demonstrating it’s due any payment, he said. “It is unfortunate that the hospital has chosen the path of litigation instead of continuing to discuss its concerns with” DHFS, he said.
posted by Rich Miller
Wednesday, Apr 29, 20 @ 10:21 am
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As if Covid wasn’t enough, you got to hit me with a picture of arguably the worst governor this state has ever endured?
Thanks, Rich.
Comment by efudd Wednesday, Apr 29, 20 @ 10:28 am
Ah, Gov. Rauner: The gift that keeps on taking. And taking.
Comment by Linus Wednesday, Apr 29, 20 @ 10:33 am
During hearings on MCOs a year or two past, Rep. Lilly, Rep. Flowers, and Rep. Ford hit the nail on the head. In Illinois, we don’t have managed “care,” we have managed “cost!” HFS has farmed this out, and they don’t manage the relationship between the MCOs and the providers. As a result, there are provider groups screaming for attention, which usually leads to meetings “overseen” by the department, and which lead to nothing. HFS continues to allow the MCOs to basically rob from the providers through utilization controls, payment denials or downgrades, or audits that lead to claw backs. The MCOs are paid a per patient per month captivated rate which is supposed to cover the total cost of care. What happens is that the MCOs deny and downgrade the provider reimbursements and they pocket the spread. Its a complete misappropriation of funds, and it should not be allowed to continue. But, for the administration and legislators to truly address the problem, they would need to acknowledge the true cost of care and account for that. They would also need to aggressively oversee the MCOs and impose strict accountability. Managed care is not good for patients, and its not good for providers. Maybe I’m wrong? If you are a provider, and your experience has improved after the migration from fee for service to managed care, please comment here under your true name and what provider group you represent. I’m sure the MCOs would LOVE you to come forward with your positive experience! I won’t hold my breath!
Comment by 32nd warder Wednesday, Apr 29, 20 @ 10:35 am
However, that is the perfect image of what the rich look like when they’re met with the stark realization that they can’t buy everything.
Comment by efudd Wednesday, Apr 29, 20 @ 10:37 am
Appears the hospital had really no choice other than to sue the state.
It appears that this has been going on for a long time and the administration has done nothing to correct a problem that has been around for at least a year.
“Poaching” nurses from this hospital is over the top. It seems the McCormick “hospital” has only had less than 10 patients.
Perhaps the Director of Communications should either get someone to write a check or be quiet.
Comment by Back to the Future Wednesday, Apr 29, 20 @ 10:43 am
===The hospital hasn’t yet provided the state with information demonstrating it’s due any payment, he said.===
My law firm contacts hospitals for medical bills daily with no problem, including the necessary coding requirements, except for the John F. Stroger (Cook County) Hospital, which usually ignores us or gets annoyed over the request. I find this statement by DHFS rather unbelievable under the circumstances.
Comment by Louis G Atsaves Wednesday, Apr 29, 20 @ 11:11 am
This has been a known issue for some time and has created major issues in smaller markets with smaller healthcare providers — which has allowed for easier concentration of the industry by larger entities that have deeper pockets and caused some well intended organizations to have to fold or reduce their activities because they were waiting on payment for services for so long.
This is a feature of the decision, not a bug.
I don’t do official communications for a living, but would love to have the opportunity to as clearly publicly commenting about on going litigation is bad — but the certainty of this statement is difficult to determine — “The hospital hasn’t yet provided the state with information demonstrating it’s due any payment”
“The State” is a big place. Providing the vendor the state hired to perform the duties the state is required to perform under statute probably still counts ans providing the state information to determine it’s due any payment. It’s an operating hospital. Of course it’s due payments. The question is how late are the state’s payments. There’s no way this person’s statement is true or authentic, and that’s without getting into whether or not during communications with this healthcare provider people who did not have a basis for requesting the information were requesting to have patient billing records transmitted to them via insecure methods so they could look at them and go “yep, y’all aren’t getting paid on time.”
I’m not saying this person should lose their job, but the agency’s press people should be able to do better than an anonymous poster on a niche political blog.
Comment by Candy Dogood Wednesday, Apr 29, 20 @ 11:12 am
I had a flashback to this: https://capitolfax.com/2017/11/27/medicaid-managed-care-contract-cost-skyrockets-more-than-50-percent/
Large contracts to multi-state corporations where the work could instead be done by hiring cost-effective Tier 2 state employees who work and pay taxes in our local communities.
Comment by Earnest Wednesday, Apr 29, 20 @ 11:14 am
Trust me - I ran a major hospital in Chicago and 32nd Warder has it right.
Comment by Dr. Pepper Wednesday, Apr 29, 20 @ 11:57 am
I wouldn’t be surprised if slow payments were a factor, but everyone is being hit hard by the pandemic. Not being able to do “elective” surgeries hits hospitals hard. But it’s questionable to say everything is the MCOs fault and the hospital is blameless and has perfectly done everything it should. Life is seldom so simple or one sided.
There are still 6 different MCOs around that serve medicaid recipients in Cook County I believe, though I think 2 might be merging. Does the hospital have the exact same problems with all 6 different MCOs? I would find that hard to believe, but all we hear with the headlines is that the program as a whole is evil incarnate.
Comment by Perrid Wednesday, Apr 29, 20 @ 12:01 pm
What I read is that this hospital is having severe financial problems and had to sue because the current administration is not doing anything. The administration’s response confirms that the decision to seek a court mandated solution is the right way to go.
The callousness and tone deaf response by this administration is inappropriate.
I did not see a response to the “poaching” allegation to hire the hospital’s nurses to work in the Governor’s “hospital”. I read this “hospital” had 5 patients.
A little less arrogance and a little more appropriate governing work is required now more than ever.
Of course, people are going to make mistakes. Just acknowledge that this is a problem and someone cares enough to address the problem.
Comment by Back to the Future Wednesday, Apr 29, 20 @ 12:42 pm
Insurance and medical billing has been a mess in this country for some time. The pandemic is just amplifying the symptoms. It would be nice if the two major parties could come together and devise a better system. Unfortunately, that appears unlikely until the system actually collapses.
Comment by Pelonski Wednesday, Apr 29, 20 @ 1:22 pm
The Managed Care Organization’s (MCO’s) are a disaster. They do not manage any care, and are simply a human rain delay for providers to be paid.
The MCO dynamic is broken . . . . WAY broken.
Comment by Say What? Wednesday, Apr 29, 20 @ 1:33 pm
that hospital is right down the block from Sinai hospital, which does very good work===and has forever, especially on gunshot victims== and does the same thing, serve a poor community.
Comment by Amalia Wednesday, Apr 29, 20 @ 2:38 pm
My grandparents were born there. I have been aware of this hospital and the neighborhood. Hope it survives.
Comment by Southwest Sider Wednesday, Apr 29, 20 @ 4:13 pm