Summary
CareSource's $26 million settlement for alleged Medicaid fraud would be a huge embarrassment for any insurer. But it's a special problem for a nonprofit that bills itself as dedicated to poor patients and as one of the solutions to the crisis in Medicaid costs.
The Dayton-based insurer's business model is to save taxpayer money by "managing" the medical care it provides to poor people; "managed care" is supposed to be better care. Care-Source, for instance, places a big emphasis on ensuring that patients have a primary-care doctor, which cuts down on visits to expensive emergency rooms for routine care. The insurer also has pioneered incentive programs, like rewarding pregnant moms with baby products for keeping prenatal appointments.See the full content of this document
Extract
Caresource's Defense Just Doesn't Hold Up
Yet the organization has agreed to pay a huge sum to make the Department of Justice, the state attorney general and a bevy of private lawyers whose clients sued under a federal whistle-blower statute go away.
Pamel...See the full content of this document
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