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Rauner says state audit of managed care program was “fundamentally inaccurate” and “misinformation”

Friday, Feb 2, 2018

* January 24th Chicago Tribune

The state agency responsible for overseeing Medicaid in Illinois failed to properly monitor $7.11 billion in payments made to and by managed care organizations, according to a report issued Tuesday by the Illinois auditor general. […]

According to the report, the Department of Healthcare and Family Services could not provide auditors with complete or reliable data that the agency was required to collect under its agreements with the 12 [Managed Care Organizations] it contracted with in 2016. The agency wasn’t able to provide data on paid claims MCOs made to providers; the claims denied by MCOs; administrative costs and coordinated care costs incurred by MCOs; and what percentage of each MCO’s premium income goes to health care and quality improvement as opposed to marketing and other costs, which is information required by federal law.

The report also found that the agency may have made duplicate payments to the MCOs to the tune of $590,237.

* Today…



Raw audio is here.

* Transcript

I think those are fundamentally inaccurate. Those are erroneous. I don’t believe that those, uh, those figures or the, the concerns are valid and we’ll have the truth come out with you guys and others here in the near future… I think there’s misinformation and misunderstandings. I think our teams in these departments are handling our, our managed care program and our Medicaid program very well. There’s been a lot of fraud and abuse and mismanagement in the past, we’re correcting it. And I think the teams are doing a fantastic job. And I think these concerns that somehow there’s not oversight or that there are some missing dollars or whatever, I think, I just don’t think that’s right, that’s erroneous.

* Except, if you click here, you’ll see the Department of Healthcare and Family Services concurred with five out of six of the auditor general’s recommendations. And while DHFS only partially concurred with a sixth recommendation, it said it was addressing the problem a different way.

And this is how the department responded to reporters’ questions

According to DHFS spokesperson John Hoffman, the department is already implementing changes suggested in the audit. Hoffman says many of these adjustments were made prior to the audit being issued.

“We are confident that HealthChoice Illinois will provide quality, whole-person care for millions of residents while saving taxpayer dollars and operating with vigorous accountability throughout. In addition, the Department contracts with an independent, third party, nationally recognized actuary to assist in this process. We will continually work to improve this program, fiscally and programmatically,” says Hoffman.

- Posted by Rich Miller        

20 Comments
  1. - Highland Il - Friday, Feb 2, 18 @ 2:05 pm:

    Bruce just called this fake news…..


  2. - Anonymous - Friday, Feb 2, 18 @ 2:05 pm:

    Asked for evidence, Rauner said “I just strongly believe their numbers are wrong.”


  3. - Anonymous - Friday, Feb 2, 18 @ 2:11 pm:

    “Misinformation” is Rauner-speak for “fake news”


  4. - Norseman - Friday, Feb 2, 18 @ 2:15 pm:

    Sounds like the same attack Blago made when the Auditor’s dinged CMS.


  5. - Henry Francis - Friday, Feb 2, 18 @ 2:17 pm:

    Yah, I “heard” something about $7B of tax payers funds not being managed properly. But I didn’t ask any questions about it. I was too busy trying to squeeze more than a 300% return on a $5M personal investment.

    -Honest Bruce Rauner (fictional of course)


  6. - Oswego Willy - Friday, Feb 2, 18 @ 2:18 pm:

    My favorite “Raunerite” fall back word…

    … after baloney, corrupt, broken/pineapple…

    … fundamental(ly)

    Man, Rauner and Raunerites love that.

    If Rauner knew “fundamentals” of governing or politics, he’d never have half of the messes he created.

    Maybe the Rauner Word Jumble is fixed, I dunno…


  7. - IllinoisBoi - Friday, Feb 2, 18 @ 2:19 pm:

    Yes, Bruce, if you deny it often enough it’ll all just go away.


  8. - BIG R. Ph. - Friday, Feb 2, 18 @ 2:27 pm:

    Here is this weeks example of what a sham this “Managed Medicaid” is:

    6 year old with Leukemia. Rx for an oral anti-fungal. Cost to the pharmacy $600. Reimbursement by the MCO $150.

    They expect me to take a loss of $450 and stay in business??


  9. - Gruntled University Employee - Friday, Feb 2, 18 @ 2:27 pm:

    This must be the waste, fraud and abuse that Bruce keeps harping about. Sheesh


  10. - Sense of a Goose - Friday, Feb 2, 18 @ 2:27 pm:

    Nothing is true anymore unless you hear it from me. Can’t deal.


  11. - Anonymous - Friday, Feb 2, 18 @ 2:32 pm:

    If you’re going to run the government like a business, you’d think that you’d start with bringing out of control vendors to heal. Just impossible to understand why Rauner keeps carrying the MCOs’ water, even though lives are at stake.


  12. - Prairiedog13 - Friday, Feb 2, 18 @ 2:34 pm:

    This guy is clueless. November can’t come soon enough.


  13. - 360 Degree TurnAround - Friday, Feb 2, 18 @ 2:35 pm:

    “Misinformation”=Facts


  14. - Anon221 - Friday, Feb 2, 18 @ 2:39 pm:

    For Immediate Release

    Governor Rauner’s Office Presents the First Ever “This I Don’t Believe” Essay Contest. Bonus points will be given to essayists who use the terms “outrageous”, “frustrating”, “erroneous”, “corrupt”, and “Madigan” more than five each times in their 500 word submission. Waste, fraud, and abuse are highly encouraged. Winners will receive a free upgrade of their home and school computer systems by DoIT. Judging will be done by DeLoitte.

    (snark, people, snark)


  15. - Arthur Andersen - Friday, Feb 2, 18 @ 2:46 pm:

    He fills his messkit every time he goes to Decatur, I swear.


  16. - Hoping for Rational Thought - Friday, Feb 2, 18 @ 3:02 pm:

    Wow the Governor sinks lower still. Misinformation? HFS agreed with the findings! I guess its a nice change from “It’s Madigan’s fault!” HFS is not doing its job and not collecting the data to monitor MCOs. How does that square with Gov saying they are going after fraud and mismanagement? How do you know there is fraud if you don’t have data? How do you know there are savings if there is no data?


  17. - Worse than Blago - Friday, Feb 2, 18 @ 3:14 pm:

    Our Governor is more like Blago every day - except Rauner has brought the fiscal damage to greater scope and scale.


  18. - Anonymous - Friday, Feb 2, 18 @ 3:14 pm:

    Hoping for Rational Thought, statements like yours give him wriggle room, because you make it sound even worse than it is. You said repeatedly there is no data, instead of saying the data is incomplete and much of what came in in FY 2016 was suspect. I agree HFS was deficient, HFS agrees it was deficient, but I’ve seen articles that say HFS has no idea what MCOs spent, that HFS can’t account for ANY of the $7 billion, which is not what the audit says. Incomplete data is not “no data”. And HFS has started fining MCOs for not sending in good, complete encounter data, here’s the sanctions against FHN: https://www.illinois.gov/hfs/MedicalProviders/cc/Pages/FamilyHealthNetwork.aspx

    That being said, I have no idea what the gov is talking about here. They were deficient.


  19. - CCP Hostage - Friday, Feb 2, 18 @ 4:59 pm:

    Those of us working within this system know well that the findings are accurate, but we’re all too busy trying to survive it to make much noise about it. The details in the media are boring and murky and not sound byte worthy for the general public. Meanwhile, lying Governor Junk has a rapt audience that publishes whatever he says. Guess what’s going to be believed.


  20. - Smitty Irving - Friday, Feb 2, 18 @ 5:15 pm:

    Didn’t Blago make similar comments about Bill Holland after the CMS Audit?


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