Aetna, Centene protest managed care bid loss in Louisiana, charge process was flawed

Flag of Louisiana, which contains a pelican mother and three baby pelicans on a blue background with a white ribbon that says "Union Justice Confidence"
Aetna and Centene's managed care divisions are protesting Louisiana's decision to not grant them managed care contracts for 2020. (Getty Images/Belyay)

Managed care divisions of Centene and Aetna charge that the bidding process to pick new Medicaid managed care plans in Louisiana was tainted and that Humana gave inaccurate information.

On Aug. 5, Louisiana selected Humana Health Benefit Plan of Louisiana, AmeriHealth Caritas Louisiana, Community Care Health Plan of Louisiana and United Healthcare Community Plan to offer managed care plans starting in Jan. 2020. The state shrunk the number of managed care plans from five to four starting next year.

But two of the plans up for consideration—Centene’s Louisiana Healthcare Connections and Aetna Better Health of Louisiana—filed protests with the state Monday charging that the bidding process was tainted.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

"After careful evaluation of competitor applications and scoring results, we filed a protest letter with [Louisiana Department of Health] to appeal the decision," said Aetna in a statement. 

RELATED: Study: Luring managed care organizations into ACA exchanges could drive down premiums

Louisiana Healthcare Connections argues that the bidding process was tainted with “multiple conflicts of interest within the evaluation committee, targeted inconsistencies in the scoring proposals and the possibility that evaluators may have destroyed public records related to the Medicaid [request for proposal] process, among other issues,” according to a release from the plan.

The managed care plan said in its complaint that the state’s Department of Health has failed to turn over handwritten notes of plan evaluators. The complaint theorized the notes were either shredded or the department has failed to turn them over.

Louisiana Healthcare also charged Humana with not providing accurate information on its provider network as required under the bid process.

The plan states that more than 320 primary care doctors and 150 specialists Humana listed in its provider network said they don’t accept Medicaid. Louisiana Healthcare says the state’s decision to credit Humana’s network was “arbitrary and capricious” and not supported by data.

RELATED: Centene aims to expand presence in 10 ACA markets

Louisiana’s State Procurement Office now has 14 days to consider the protest. The office declined to comment on the protests.

Both the state or Aetna and Centene have the right to appeal any decision all the way up to a federal court.

“We urge the administration to do the right thing for the members we serve and re-score fairly, or issue a new [request for proposals],” Louisiana Healthcare Connections said.

Aetna Better Health also protested the process for choosing managed care plans back in 2011, calling into question the scoring procedure for selecting the winning bids. The protest was eventually denied by the courts.  

The four plans that were chosen stand to get a slice of billions of dollars in Medicaid payments. Medicaid paid out $7.6 billion to five managed care plans during the 2018 fiscal year for Louisiana, according to the state’s Department of Health.

Suggested Articles

An influential group of Republican lawmakers released its latest healthcare plan, which closely resembles prior Affordable Care Act repeal efforts.

In its first-ever report on patient safety in ambulatory surgical centers and hospital outpatient departments, the Leapfrog Group found gaps.

An ACA public option could lead to lower premiums for commercial plans by sparking more competition, an analysis found.