The Family Care Program, which has come under much scrutiny over the last two years, may be in need of some serious reform. There are nine Managed Care Organizations contracted with the WI Department of Health Services to administer the Family Care Program in Wisconsin. Community Care Inc. which is the largest Managed Care Organization in Wisconsin, has come under fire lately from members of its program as well as service providers that are contracted with Community Care Inc. to provide services to their members.
Local vendors such as medical supply companies and pharmacies have severed ties with Community Care due to reimbursement issues. Community Care Inc. has been accused of delaying filling physicians orders for their members who reside in community based settings. These delays, according to service providers, have lasted anywhere from thirty days to over a year. Service providers have been forced to pay for costly medical equipment and supplies that are the responsibility of the Managed Care Organization. Ed Kohl who is program director for Community Care stated that, "Providers who accept individuals with limitations are expected to have the equipment and supplies necessary to meet their needs". Community Care has also been accused of violating its members rights to choose the in network provider of his or her liking. Recently Matt Moen, who is Director Of Provider Management for Community Care, conceded that "members can choose to live where ever they desire". Mr. Moen went on to say, "however providers under contract with Community Care remain subject to the terms of that contract". In other words the members can live where ever they want, but Community Care reserves the right to deny payment for services without prior authorization.
According to sources close to this story, the WI Department of Health Services have been aware of numerous complaints reported against Community Care ranging from member rights violations to Medicaid Fraud. State Representatives Robin Vos and Cory Mason have both also been made aware of consumer issues regarding Community Cares seemingly lack of regard for the program rules and the law. A major concern for one provider is the recent hiring of Kenneth Munson as Community Care's CEO. Kenneth Munson is the two time Deputy Secretary of the WI Department of Health Services. Most recently Mr. Munson served as an Obama appointed director of Region V for the US Department of Health and Human Services. The hiring of Munson has some citizens concerned about a serious conflict of interest. As one citizen put it, "One hand washing the other". Stay tuned as this story develops.
Your link to the biggest stories in the suburbs delivered Thursday mornings.
Enter your e-mail address above and click "Sign Up Now!" to begin receiving your e-mail newsletter Get the Newsletter!
- St. Matthew's Lutheran Church to Present Christmas Concert
- December 14th Book Signing for Milwaukee’s Town of Lake
- Encourage your kids to become involved in extracurriculars
- Drop Your Mail on Sundays
- Christmas Egypyian Cookie Sale
- AWA Star "Baron Von Raschke"
- Community Toy Drive
- Tree Lighting Party @St. Francis Public Library
- Brunch and Photo with Santa
- Help Your Neighbors This Season