FILE - Aetna

The Aetna world headquarters in downtown Hartford, Conn.

Two of the losing bidders seeking to manage the care of Louisiana Medicaid patients are accusing the state Department of Health of bias in awarding the lucrative contracts.

Louisiana Healthcare Connections (or LHCC) says in its protest to state officials that the contract award process was “tainted with conflicts of interest and bias from the start.”

LHCC, which currently serves more than 200,000 Medicaid recipients in the state, says Louisiana Department of Health employees who were involved in a dispute with the company in a separate matter also were involved in evaluating its response to the department’s request for proposals. One of those employees even fell asleep during LHCC’s oral presentation to the LDH evaluation team, the company claims.

“To think that individuals involved in an active dispute with LHCC could at the same time give LHCC ‘fair and equitable treatment’ in the RFP process – as the Procurement Code requires – is to expect the impossible,” the protest argues.

LHCC says the department has only produced one page of evaluators’ handwritten notes in response to the company’s public records requests, even though Louisiana public records law requires such notes to be preserved, “suggesting that LDH personnel intentionally discarded or even destroyed their notes to avoid such discovery.”

In its protest, Aetna Better Health, also one of the current contractors, argues LDH didn’t follow the scoring method laid out in its request for proposals to grade the RFP responses.

“Rather, the bias in scoring is so obvious that one cannot help but believe that the outcome of the scoring of the RFP was preordained, and the scoring process was utilized to accomplish the desired outcome,” Aetna’s attorneys argue.

Aetna says LDH allowed Humana, one of the winning bidders, to identify providers as part of its Medicaid network without a binding agreement to opt into the company’s Medicaid network. The company says LDH discounted its Medicaid experience, even though it conducts Medicaid business in 16 states compared to only three for Humana.

Protests were filed with the Division of Administration’s chief procurement officer, whose decision can be appealed and potentially challenged in court.

Louisiana contracts with managed care organizations to oversee utilization, cost and quality of care for Medicaid recipients. The MCOs work much like private insurers, and the state pays them a flat fee for each recipient that signs up with their plan.

Medicaid made $7.6 billion in payments on behalf of 1.7 million enrollees to the five current managed care organizations during the 2018 fiscal year, the department says.

In response to lawmakers’ questions at a recent meeting, Department of Health Secretary Rebekah Gee said it would be unrealistic to expect Humana to have a Medicaid provider network in Louisiana when the company doesn’t yet have a Medicaid contract. She said only career staff, not political appointees, were involved in the scoring.

Department attorney Stephen Russo said officials used “consensus scoring” to head off “noise and rumors that there was some bias against the plans that did not win.” Scores are reviewed and agreed to with a Division of Administration monitor in the room, so that one person’s bias doesn’t drive the result, he said.

“It’s a complex deal,” Russo said. “A lot of the noise that y’all may or may not be hearing will be played out at DOA now and then in a court.”

Officials plan to begin open enrollment by Oct. 15, with the new contracts going into effect Jan. 1, although the pending protests could alter the timeline.

Staff Writer

David Jacobs is a Baton Rouge-based award-winning journalist who has written about government, politics, business and culture in Louisiana for almost 15 years. He joined The Center Square in 2018.