The state failed to collect at least $12 million from three insurers that cover Georgia children in government health programs, according to e-mails and...

The state failed to collect at least $12 million from three insurers that cover Georgia children in government health programs, according to e-mails and financial documents obtained by Georgia Health News.

One state spreadsheet shows Peach State Health Plan owes $6.5 million, WellCare $5.1 million, and Amerigroup $500,000. The period of time for that spreadsheet extends from January 2007 through March 2009 (for Amerigroup, through June 2009). The e-mails by state officials don’t give a current amount owed.

According to the e-mails, that total of $12 million had not been paid to the state Division of Public Health as of mid-September of this year.  State officials, in e-mails as recent as Oct. 13, raised questions on whether invoices had even been sent to the companies.

The three health insurers run care management organizations (CMOs) — similar to HMOs — for Georgia children on PeachCare and for children and some adults on Medicaid.

Tara Wall, a spokeswoman for Virginia Beach-based Amerigroup, said Thursday that the company had not yet received an invoice from the state of Georgia.

“A month ago we became aware that the CMOs were being billed,’’ Wall said. “Once the invoice is received, we will review it and quickly meet our contractual obligations relative to this matter.’’

The collection problem comes at a time of widespread budget cuts across Georgia state government.

Community Health spokeswoman Lisa Marie Shekell said the agency is investigating the vaccine payment issue. “Current Public Health leadership was made aware of an issue related to the submission of invoices to the CMOs,’’ she said. “Public Health is currently reviewing and vetting the matter.’’

She noted that the vaccine contract with the CMOs was created when the Division of Public Health was part of the state’s Department of Human Resources. The entire $12 million tab was built during that time. The Public Health unit moved to the Department of Community Health in July 2009.

Shekell said the Community Health audit would identify ‘’how long the problem has been going on and the full amount of funds owed by the CMOs.’’

Public Health orders childhood vaccines at a discounted rate from the Centers for Disease Control and Prevention, and it then makes them available to the three CMOs for immunizations of children in Georgia’s PeachCare program. The insurers, under the contract, pay Public Health for the vaccines.

St. Louis-based Centene, which runs the Peach State CMO, said Wednesday in a statement, “We have recently received an invoice from the Division of Public Health regarding Vaccines for Children and look forward to working with the state to resolve the issue.’’ Centene declined to answer other questions, including identifying the amount owed.

A spokeswoman for Tampa-based WellCare, Amy Knapp, said the company has cooperated fully with Georgia officials in this matter. ‘’We have provided to them the necessary information so we can be properly invoiced,’’ she said. WellCare did not identify the amount it owed to the state.

The public health system in Georgia has seen its state funds cut recently, and it lags behind other Southeastern states in per capita spending.  A state commission is recommending that Public Health become a stand-alone agency for greater visibility and accountability, among other reasons.

Georgia’s PeachCare program covers about 200,000 uninsured children of middle-income parents. It is jointly financed by the state and federal governments.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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