FOR the past year, Mayor Muriel Bowser and her Deputy Mayor for Health and Human Services Wayne Turnage have presented a master class in government and financial mismanagement marked by political and self-centered motivations. They — and they alone — have introduced unnecessary chaos into the city’s Medicaid health care system. During a deadly pandemic, they shifted services for nearly 200,000 recipients, most of whom are poor and working-class residents.
Hoping to camouflage their flawed public policy architecture and implementation, indisputable contract-steering and efforts to circumvent a ruling from the DC Contract Appeals Board (CAB), Bowser and Turnage have violated multiple local laws. They also have engaged in an orchestrated campaign to misinform and misdirect members of the DC Council and the public.
Unsurprisingly, it now appears they may have brought the city’s $1.5 billion Medicaid Managed Care program to the brink of collapse.
Those facts are underscored, in part, by MedStar Health System’s recent notice that it intends to terminate all services currently provided to District-contracted Medicaid managed care organizations (MCOs), effective Nov. 21. MedStar Health is the parent company of MedStar Family Choice Inc., which currently has an MCO contract with DC.
Equally important, Amerigroup DC Inc., which until last summer held a city-financed MCO contract, has asked the CAB to sanction the District — specifically, the DC Office of Contracting and Procurement, the DC Department of Health Care Finance and Turnage — for multiple disclosure violations under the city’s Procurement Practices Reform Act of 2010 and CAB-related protective orders.
Those violations were discovered in documents received from the DC Council’s Office of the General Counsel in response to a Freedom of Information Act request filed by Amerigroup in January. Not only did the OCP and its technical evaluation team share confidential, proprietary information with Turnage; he then shared that information with Ward 7 Council member Vincent C. Gray, head of the Committee on Health. Neither was on the procurement team.
That was happening during the same period that Turnage was telling me and others in the press that he had no knowledge of the contracting process and how decisions had been made.
Amerigroup has asked the CAB to order a new reevaluation, which would be conducted by a different technical team. Further, it requested that “the CAB issue an order restricting [Turnage] from any further involvement in this solicitation, reevaluation and related award.”
It also has filed a complaint with the DC Board of Ethics and Government Accountability, requesting an investigation of Turnage’s actions.
Rather than hold themselves accountable for the crisis they created, Bowser and Turnage have pointed the finger at the council: “When the Council, by a 7-6 margin, refused to support a reasonable exemption that would have allowed MedStar’s managed care organization to complete the procurement process, circumstances were created that now threaten the very access to treatment for managed care enrollees at all MedStar hospitals, clinics, their specialty care physicians, and its rehabilitation hospital,” Bowser said earlier this week in a prepared statement.
Her comments mirror those previously made by Turnage. Who’s the puppet? Who’s the ventriloquist?
No matter. Don’t believe their propaganda.
Council members did the right thing, albeit by a narrow margin. They refused to violate District laws and further sully the city’s already dubious contracting and procurement reputation.
Permit me to unpack: MedStar’s Family Choice Inc. was selected last year as one of the MCOs for DC’s Medicaid program. Almost immediately, the losing bidders, including Amerigroup, filed protests with the CAB. Administrative Judge Nicholas Majett agreed the administration had violated procurement laws and the process was biased. He ordered the OCP to reevaluate the top offers. He also prohibited the Bowser administration from extending existing contracts beyond Sept. 30, the end of the current fiscal year.
A separate but related CAB ruling, regarding submission of minority subcontracting plans, imperiled MedStar’s potential for successfully getting through that mandated reevaluation. It turned out the company also had not provided to the city its subcontracting plan as required by law.
Considering the CAB’s order and the council’s refusal to become conspirators in the violation of local laws, MedStar’s MCO contract was expected to be terminated by Oct. 1.
Now, as an attempt to gain leverage in future negotiations, MedStar sent out its termination notice to AmeriHealth Caritas DC. Turnage sent an email to Gray and other legislators, trying to gain his own leverage.
In his Aug. 20 email, Turnage wrote that Karen Dale, the CEO of AmeriHealth, informed him that MedStar Health System indicated it will terminate “all medical services that the health plan currently purchases from MedStar,” effective Nov. 21.
Turnage also said a MedStar official confirmed “the veracity of that information”; he didn’t name the official. He added that the individual also “informed me that CareFirst will receive the same notice but with an earlier effective date.”
“What this means is that if the current contracts between the health plans and MedStar expire without renewal, no enrollee in DHCF’s managed care program will have access to any MedStar hospital, clinic, rehabilitation facility, or their expansive specialty care suite of physicians,” Turnage added.
Turnage’s email had the intended effect: It instigated hysteria, which he undoubtedly hopes will move council members to reverse their previous vote. (The council is on vacation until Oct. 1, meaning that a special session would have to be convened by Chairman Phil Mendelson for that to happen. Mendelson did not respond to my telephone call requesting a comment.)
Bowser and Turnage jointly deserve the Shameless Public Official of the Year Award for using vulnerable residents in their petty political games.
As for MedStar, this is not the first time it has served as disrupter of health care services for poor, working-class and disabled Medicaid recipients in the District. During a previous stint as an MCO, it refused to sign agreements with DC’s other MCOs for services. Instead, it engaged in what seemed to be self-dealing.
In June 2017, during an appearance before the council, Turnage offered several facts that revealed the motivations of the health care giant: “Compared to other plans, MedStar Family Choice members rely heavily on MedStar Hospitals’ inpatient services.” MedStar has a “higher rate of hospital admissions.” Its “in-patient costs [are] higher than those of two other MCOs.” Its plan aggravates “the cost problem in the MCO program.”
That same year, Turnage rebid the MCO contract. MedStar was not selected. However, in 2020, when he suddenly rebid the contract, yet again, MedStar was back in. A company he had called a “bad actor” became a favored contractor.
Advocates and services providers have asserted that MedStar cannot simply walk away from providing services to Medicaid beneficiaries. Like other health care organizations operating in DC, MedStar signed an agreement with the District’s agency indicating it will abide by the requirements of Medicaid as a condition of receiving reimbursements under the program. After reviewing that agreement, I saw nothing that indicates the hospital must also be awarded an MCO contract.
Has Turnage reminded MedStar of this signed agreement? If MedStar is allowed to walk away, will other hospitals be allowed to do the same?
Ambrose Lane, the chair of the Health Alliance Network, one of the largest citizen advocacy groups working on health care issues in DC, said he believes that what MedStar has threatened is a violation of Title 6 of the federal civil rights code. “We are also looking into filing a complaint with the Department of Health and Human Services Office of Civil Rights,” he added in a prepared statement.
“Why is Medstar doing this in the middle of a pandemic when Black and brown District residents are already suffering from disproportionately high rates of death and infection from COVID-19, when Black and brown mothers experience higher rates of maternal death and infant mortality, and where life expectancy in Ward 7 and 8, which are predominately Black and brown communities, is nearly 20 years shorter than life expectancy in predominantly white Ward 3?” asked Lane.
Good question. Given how Turnage and Bowser have behaved, I wouldn’t be surprised to learn they invited MedStar’s termination threat.
Certainly, no one should think that Gray received Turnage’s email without any prior warning. The two have seemed to be a disingenuous tag team since the CAB’s December ruling.
In its CAB sanctions filing, Amerigroup’s lawyer, Lawrence S. Sher of Reed Smith LLP, documented the exchanges between Turnage, Gray and Gray’s staff about the Medicaid managed care procurement — exchanges that allegedly violated disclosure laws.
Prior to their filing, Sher alerted Robert Schildkraut, an attorney with the DC Office of the Attorney General, to Amerigroup’s discovery. In a letter dated Aug. 16, Sher wrote, “We have re-reviewed the material from pages 13-15 of the District of Columbia (‘D.C.’) Council’s response to the [FOIA] request that was attached to our August 5, 2021 letter.
“This review confirmed that protected, confidential proposal and evaluation information unlawfully was released by the Technical Evaluation Team or by the Contracting Officer to Mr. Turnage in violation of various sections of the Procurement Practices Reform Act of 2010 as well as the protective order entered by Judge Majett in the subject Protest of Amerigroup DC, CAB No. P1128.
“There are likely many other similar disclosure violations that have not yet been revealed,” Sher added in his letter.
In the CAB filing, Sher argued that the “District’s unlawful disclosure and ethical violations have prejudiced Amerigroup DC, clearly demonstrated Deputy Mayor Turnage’s bias against Amerigroup DC, and have prevented Amerigroup DC from receiving the fair and impartial reevaluation ordered by the CAB.”
Absurdly, Turnage has suggested that he — and he alone — can fix things. “I have the discretionary authority to rescind the health system’s entire Medicaid agreement and terminate the contract of both health plans,” he said in his email to Gray.
That sounds like a threat to terminate all MCO agreements and rebid the contract without conducting the reevaluation ordered by the CAB. Actually taking such a step could advantage MedStar, but it would wreak havoc in the lives of nearly 200,000 vulnerable Medicaid recipients.
Enough. The council should step in to stop Bowser and Turnage before they further jeopardize the health care of District residents.