State regulators are reprimanding a Blue Cross and Blue Shield of Minnesota subsidiary after a federal report questioned whether the company failed to suspend payments to a health care provider as requested by the state.
The Minnesota Department of Human Services (DHS) outlined a corrective action plan for Blue Plus, the insurance company’s HMO division, in a May 22 letter obtained by the Star Tribune.
The state alleges Blue Plus for several years breached contract provisions related to monetary recovery in instances of fraud and abuse by HMO subcontractors.
In a statement, the Eagan-based health insurer says it’s talking with DHS to substantiate the accuracy of conclusions reached by the federal government and whether there was a misunderstanding over how the health plan handles payment suspensions.
“We have provided DHS with documentation on how our Blue Plus HMO did have appropriate policies and payment suspensions already implemented at the direction of the state in all instances where there was an active contract with the provider,” the health insurer said.
The letter followed a draft report from the federal Centers for Medicare and Medicaid Services (CMS) in March about program integrity and managed care oversight, which identified a risk to the Minnesota Medicaid Program. Neither state nor federal officials have provided the Star Tribune with a copy of the draft report.
CMS has also called on the state to make sure Blue Plus promptly notifies a Medicaid fraud control unit whenever it suspends payments to a health care provider.
Medicaid provides coverage for lower-income residents and certain elderly/disabled populations.
