Connecticut Attorney General Calls For Sanctions Against Medicaid Provider

Main Category: Medicare / Medicaid / SCHIP
Article Date: 19 Nov 2007 - 8:00 PDT

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Connecticut Attorney General Richard Blumenthal (D) on Wednesday called for sanctions against Health Net of Connecticut for sending fraudulent computer messages to pharmacies to deny coverage of certain prescription drugs for children enrolled in Medicaid, the Hartford Courant reports. Health Net, one of four managed care organizations in the state that contracts with Medicaid, uses a "not covered" computer message that falsely leads some pharmacists to believe that certain medications are not covered, when instead, they require prior authorization.

The state Department of Social Services earlier this year conducted an investigation into the computer message practices of the managed care organizations, during which Health Net misled the state into thinking its primary message was not a "not covered" message, according to Randi Mezzy, an attorney with Connecticut Legal Services. Blumenthal said, "The claims are credible and compelling, and so serious and significant and so egregious it could require very strong remedies and sanctions."

Alice Ferreira, spokesperson for Health Net, said that the company did not intentionally mislead the state with its "not covered" message and said Health Net will correct the problem immediately. Ferreira said, "The (not covered) code needs to disappear. We will work with our vendor to see how we could expedite and rectify it as soon as possible," adding, "The intent was to be always in compliance, and that's what we were going to do immediately" (Somma, Hartford Courant, 11/15).

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