Major Ohio healthcare provider accused of passing profit on to patients – in UK
Healthcare giant Centene – which was charged with fraud in Ohio – is now in hot water in the UK.
For its part, Centene’s UK subsidiary, Operose Health, claims the report is inaccurate and has filed a “formal complaint” about it.
The dispute could be a glimpse of what happens when features of American-style managed care are grafted onto national health serviceUK health system, under ‘privatisation’.
In his statement to Capital Journal, Centene accused the BBC of providing “an undisputed platform for anti-privatisation healthcare campaigners in the UK to push their agenda after their recent failed attempt to prevent Operose Health from acquiring a network of GP practices in North London.
In the United States, St. Louis-based Centene’s primary business is Medicaid patient care management. In Ohio, its Buckeye Health Plan contracts with the state Department of Medicaid to set up provider networks, enroll patients, coordinate their care, and ensure providers get paid.
Last year, Attorney General Dave Yost sued the company after a 2018 newspaper investigation showed that Centene-owned pharmacy intermediaries appeared to overcharge the state by $20 million. Centene did not admit wrongdoing, but it quickly agreed to pay Ohio $88 million and set aside more than $1 billion more to settle similar claims with 21 other states.
Despite allegations of fraud, the Ohio Department of Medicaid decided to rehire the company just two months after the settlementgiving him a contract worth billions.
In the UK, Centene is in a different business. But like in the states, governments mostly pay its subsidiary per patient per month, prompting it to seek savings where it can.
GPs traditionally worked with the British National Health Service as independent contractors. But in 2007 the Labor government changed the rules, allowing big companies to buy out practices and pay doctors as salaried employees. Centene’s subsidiary, Operose Health, has become the largest such provider in the country.
It’s part of a trend. The Commonwealth Fund in 2020 reported that almost 60% of UK GPs were still self-employed, but the number of employees at companies such as Operose was “increasing and is currently around 22%. »
As part of her investigation, BBC journalist Jacqui Wakefield worked undercover as a receptionist for several months at a busy Operose Health practice in London.
The survey found that Operose had far fewer doctors on staff than the average doctor’s office, or “surgery” as they are sometimes called there. Operose instead relied on associate physicians, according to the report.
Wakefield also obtained undercover footage in which a supervisor told him not to tell patients doctors weren’t available – even if they weren’t. Other footage records several co-workers telling Wakefield that the Centene-owned company is so dependent on the associated doctors because they work much cheaper than real doctors.
Perhaps even more troubling, administrative workers described a backlog of paperwork that in some cases left patients waiting up to six months before being referred to a doctor or pharmacist. In one footage, Wakefield, working as a receptionist, describes a caller crying in pain and frustration because she can’t get help.
A leading British doctor told the BBC’s ‘Panorama’ that such delays are “a huge risk to patients, both in terms of developing more severe disease and earlier death. He added that Centene’s Operose Health “puts profit and money before quality of care. And it will have an impact. »
Centene has denied these accusations.
“If the BBC had given us the opportunity to have a balanced discussion, it would have learned that Operose Health has always been able to meet the healthcare needs of its patients, to make substantial investments in the recruitment of GPs, including over £5million in additional staff support. over the past year and meet all NHS contracts and regulator requirements,” he said. “Therefore, it’s no surprise that the Care Quality Commission rates 97% of Operose Health’s practices as good or exceptional in providing safe, effective, responsive, and well-led healthcare.”
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