VIDEO: Rodriguez – Questions Over TakeCare’s Termination Not Answered Yet

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Guam – The controversy over the now rescinded termination of  Takecare’s contract with GMH has taken a new twist with the threat by the Attorney for GMH Board Chairman Lee Webber to take legal action against Senator Ben Pangelinan over remarks made by the Senator in a release issued Tuesday.

But Health Committee Chair Senator Dennis Rodriguez emphasized that the focus of the controversy should be on the reason why the Board terminated Takecare’s contract and he says that has not been answered yet.

  

Although an unsigned release from the “GMH Administration”  Wednesday declared “this is a closed case” that has been “amicably resolved for weeks”,  the settlement was not amicable and its not over.

TakeCare was reinstated only after weeks of acrimonious accusations. GMH’s CFO Siva Karupan resigned in the wake of the controversy.

And Health Committee Chair Senator Dennis Rodriguez, who sparked this current flare up with his request to the OPA to examine the payment records of the 4 major insurers, says he is still not satisfied with the explanations given for the Board’s decision to terminate the GMH contract.

Rodriguez told PNC News the case is not closed and remains open.

He still has an outstanding request for the minutes of the January 20th closed door Executive Session at which the Takecare termination was decided on.

Those records can not be released until 6 months after the meeting so they won’t be available until the end of July. Rodriguez has already issued a FOIA request for those minutes.

The attorney for the GMH Board, Tom Fisher, has always said that TakeCare was terminated by the GMH Board not because of its payment practices, but because of  TakeCare’s un-reasonable denial of coverage.

And Wednesday’s unsigned statement from the “GMH Administration” also makes the same case arguing that  “the result of the financial audit about TakeCare’s payment practices has nothing to do with the rate of denial concerns.”

Yet that explanation has always begged the obvious. If you deny coverage for a certain claim, you are denying payment for that claim.

Senator Rodriguez maintains “it all comes down to payment, it all comes down to the financials.” Which is why he requested a review of the payment history of the island’s 4 principal insurers, TakeCare, SelectCare, NetCare and StayWell. 

 

READ the Highlights of the GMH billing and collection audit HERE 

Rodriguez also pointed out the contradictions in the Hospital’s defense of the TakeCare termination, saying on the one hand it was the result of TakeCare’s “unreasonable denial of coverage” but on the other, accusing Takecare of being one of the worst payors.

At one point during the height of the controversy in February, former CFO Siva Karupan accused TakeCare of  being “one of the worst payers” paying only “50-cents on the dollar.”

However Rodriguez says “It wasn’t the case.We see it now from the OPA report.”

That supplemental audit released last week examined payor records over the past 3 years.

What was found was that on average, over the 3 year period, Netcare, SelectCare, Staywell and Takecare all had fairly similar records,  within 10 percentage points of each other.

The best payer over the 3 year period paid 78% of the bills GMH sent them. The other 3 providers were at 70%, 69% and 71%.

Senator  Rodriguez said what the OPA results tell us is that “the justification that the hospital used to terminate one of the carriers was really uncalled for.”

Although the audit report does not reveal the names, PNC News has learned that the 78% payer was NetCare. TakeCare was at 70% and Staywell at 71% and Calvo’s SelectCare was the lowest payor at 69%.

Which again raises the question, why was TakeCare’s contract terminated?

Three‐year totals

NetCare

TakeCare

SelectCare

Staywell

Misc Payors

Total

Billings

11,495,603

27,200,204

60,494,376

13,023,891

13,329,485

125,543,559

Collections

8,995,180

19,050,689

41,635,491

9,188,292

6,660,632

85,530,284

% of collections over billings

78%

70%

69%

71%

50%

68%

Rodriguez says that he thinks the GMH Board was given “bad advice” and that led to their initial decision to terminate TakeCare.