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Mississippi investigating its largest Medicaid provider over pharmacy benefits

JACKSON • Mississippi officials are investigating whether Fortune 500 company Centene and possibly other firms may have significantly overcharged taxpayers as they managed billions of dollars worth of state Medicaid health insurance benefits.

The Mississippi Division of Medicaid confirmed the probe to the Daily Journal on Monday. Medicaid officials said the attorney general’s office hired outside attorneys to “investigate and potentially pursue claims” that include Centene’s management of pharmacy benefits.

The investigation is in the early stages but is similar to a recently-announced Ohio lawsuit against Centene, said Colby Jordan, a spokeswoman for Attorney General Lynn Fitch. In that case, authorities allege Centene overcharged Ohio taxpayers by millions of dollars.

In Mississippi’s Medicaid managed care system, Centene subsidiary Magnolia Health and two other contractors oversee health insurance benefits for about 480,000 poor adults and children, disabled people, pregnant women, and others. The Division of Medicaid pays the companies a set rate per patient.

Mississippi investigation similar to Ohio lawsuit

In September, Fitch’s office retained Ridgeland-based law firm Liston & Deas to investigate possible Medicaid financial losses due to unnamed managed care firms, according to a contract between the two parties. The document mentions possible “fraud, waste, incorrect payment, or overpayment.”

Liston & Deas is the same firm working with the Ohio attorney general’s office in its lawsuit against Centene. That lawsuit is sealed, but a March 11 news release from Ohio Attorney General Dave Yost claims Centene – through its Ohio subsidiary Buckeye Health Plan – used a network of pharmacy benefit subcontractors to inflate costs.

“Corporate greed has led Centene and its wholly owned subsidiaries to fleece taxpayers out of millions,” Yost said in the release.

The Ohio suit, according to Yost, alleges three areas of wrongdoing: requesting reimbursements for amounts already paid by the state, failing to disclose the true cost of pharmacy services, and artificially inflating drug dispensing fees. Yost’s office suggested that Centene’s practice of subcontracting with more than one firm to provide pharmacy benefits had raised red flags.

In Mississippi, Magnolia Health uses at least two companies – Envolve Pharmacy Solutions and RxAdvance – to get drugs to Medicaid recipients, according to a 2019 Centene news release.

Centene has said the Ohio claims are unfounded, adding its pharmacy contracts were preapproved by the state. The St. Louis-based company – the largest Medicaid provider in the country with revenues topping $111 billion last year – did not respond to the Daily Journal’s requests for comment for this story.

Lawmaker demands oversight of Mississippi Medicaid managed care

The Ohio lawsuit caught the eye of Rep. Becky Currie, R-Brookhaven, a nurse who serves on the House Medicaid Committee. In a recent Facebook post, she linked to Yost’s announcement and wrote of her concern that companies running Mississippi’s Medicaid program are “ripping us off.”

“This (is) maybe a bigger scandal than (Chris) Epps at the Department of Corrections and Department of Human Services combined,” Currie wrote, referencing two of the largest Mississippi scandals involving taxpayer money in recent years. “But we will never know until they are audited. If they have stolen millions from Mississippi I want to know and I want to know now.”

Currie wants legislation passed to require independent and in-depth audits of the state’s managed care companies. Beyond Centene’s Magnolia Health, the state’s managed care program – known as MississippiCAN – includes UnitedHealthcare and Molina Healthcare. MississippiCAN provides benefits to about 60% of all Medicaid recipients in the state, and runs state and federal taxpayers about $3 billion annually.

“When you look at Ohio, the same company (Centene) is doing the same business here,” Currie told the Daily Journal. “And chances are, they’re doing the exact same thing (with pharmacy benefits). The reason I asked for a full audit is if you’re cheating in one thing, chances are you’re cheating in others.”

Legislature considers audit requirements for Mississippi Medicaid providers

The chairmen of the House and Senate Medicaid committees, Rep. Joey Hood, R-Ackerman, and Sen. Kevin Blackwell, R-Southaven, said they know of the Ohio lawsuit. Blackwell added he is aware the Division of Medicaid is specifically examining Centene’s practices in Mississippi.

The Legislature is considering a pair of bills in the final days of the session to reauthorize the state’s Medicaid program and make several tweaks to the agency. Both the House and Senate versions of the Medicaid legislation include provisions that would mandate independent audits or reviews of Mississippi’s managed care companies.

Division of Medicaid officials told the Daily Journal they already conduct various audits, reviews and monitoring of the state’s managed care contractors. The agency’s statement said it “takes seriously its duty to administer a high-quality program that utilizes tax dollars appropriately.”

But Hood said the legislation would allow outside auditors – such as State Auditor Shad White or Medicaid experts his office might hire – to take an in-depth look at certain portions of the state’s managed care program that haven’t been scrutinized. Such outside audits would “make sure the managed care folks are providing the level of care that they’re supposed to be doing,” Blackwell said.

“I hope we find nothing’s going on,” Currie said of the state’s managed care companies. “I don’t want taxpayers to be the losers. But let’s look. All I’m saying is, it’s time. Ten years is long enough with no oversight.”

Bidding process to begin for managed care contracts

The AG’s investigation of Centene and possibly others comes as the state gets ready to bid out new five-year managed care contracts. Hood and Blackwell said they expected the bidding process for contracts worth billions of dollars in total will begin in the next month or two, even though the contracts for Centene, UnitedHealthcare and Molina won’t expire until next year.

Currie questions whether managed the care is the ideal way to run Medicaid. She pointed to a recent legislative hearing where many medical professionals complained about the current system. Multiple lawmakers including Currie also criticized the system four years ago, following a report sharply critical of the contractors’ performance.

“When you have hospitals and doctors and physical therapists and pharmacists – everybody in the medical community – saying (the managed care contractors) don’t pay us – then where is all of this money?” Currie asked. “Because the taxpayers of Mississippi are spending money. A truckload of money.”

Despite some criticism, the trio of companies maintains sway among many state leaders, in part thanks to their lobbying efforts.

Centene, for instance, hired two of the top lobbyists in the state last year, according to state records, for a combined fee of $385,000. It has paid lobbyists more than $2.5 million since winning its first Mississippi Medicaid contract in 2011.


djr-2021-03-20-news-cliff-moore-twp1

Cliff Moore is Tupelo’s new director of bands. The 1997 Tupelo High School graduate said he’s eager to take over as leader of the high school’s bands, but he believes his role goes beyond sheet music and metronomes; it’s about helping students develop life skills through band.


Education
Cliff Moore named Tupelo Public School District director of bands

TUPELO • After serving as associate director of bands for four years, Cliff Moore will take up the baton as director of Tupelo’s bands this summer.

The Tupelo Public School District Board of Trustees approved Moore’s hire as Tupelo High School’s band director last week. His first official day as head of the department is July 1.

Moore was a member of the high school band from 1993 to 1997. His return to his old band department, he said, felt less like a homecoming, and more like falling back into step.

“In a lot of ways, I feel like I never left,” he said.

In his new role, Moore will oversee and set the course for the district’s entire sixth through 12 grade band program.

Moore said he’d hoped for years to have the opportunity to serve as director of bands. He’s relieved that the wait is over but also feels intensely aware of the legacy of the Tupelo band directors who came before him – particularly Floyd Stevens and Vance Wigginton, two of his personal heroes.

“The knowledge that I’m going to have their chair, that I’ve got their legacy to live up to, is something that inspires me, and it motivates me,” Moore said. “I’m excited to have the opportunity to be the next in line here at Tupelo and to carry on that work.”

During his 18-year teaching career, Moore spent eight years as a band director at Nettleton, served for a year at Okolona High School and spent five years at North Pontotoc High School before coming to Tupelo.

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“What better place to be than home with a chance to invest and give a lot back to the place that gave me so much,” Moore said.

Moore had an interest in music at an early age, even before he joined the band in seventh grade.

Although his dad “can’t play the radio,” his mother’s side of the family is extremely musical.

“They’re all singers or musicians on some level,” Moore said. “So I grew up being exposed to music, grew up with instruments in the house. When seventh grade rolled around, it just seemed like the right thing to do.”

He started out playing the trombone but took it upon himself to learn other instruments as well. By the end of high school, he had picked a variety of brass instruments along with the saxophone. He learned how to play the rest of the band instruments in college.

Moore decided in high school he wanted to be a band director because it looked fun and knew that on some level, he had a gift for music.

“It’s always great when you can do something that you love as a career,” he said.

Although the profession has remained enjoyable, Moore realized it wasn’t fun for the reasons he once thought it would be. Teaching a child how to play music, he said, is only one part of music education.

Dreaming big for the band here. Our goal is to raise the performance level of the band to such a high level that we really get a lot of regional and national spotlight.

Instead, Moore sees music education as an opportunity for band directors to prepare students for life after school, using music as a pathway to deliver that instruction.

“They are going to need to know how to be on time, and they are going to need to know how to work together with people towards a team goal,” Moore said. “They are going to need to know how to put in the hard work on the front end, even though they might not see the results and the satisfaction from that until way down the road.”

The two most rewarding parts of being a band director are the camaraderie between band director colleagues and running into former students who are successful in their lives and careers who let Moore know the impact he had.

Under his leadership, Moore plans for the band’s impact to be even farther reaching than ever before.

“I’m dreaming big for the band here,” he said. “Our goal is to raise the performance level of the band to such a high level that we really get a lot of regional and national spotlight. To do that, we have to be the best of the best of the best – on an individual level and on a team level.”


Local
Food deliverers pick up steam during COVID pandemic

TUPELO • On a busy day – and there have been quite a few of those in the past year – Brandi Sain and Savannah Scott deliver some two dozen orders or more during an eight-hour shift as Tupelo2Go drivers.

Sain has worked with the food delivery business for three years, and she said the past year during the COVID-19 pandemic has been the busiest she’s experienced.

“We’ve always been pretty steady, but once the restaurants closed, and their only means of business at the time was takeout, we really picked up,” she said.

Tupelo2Go was founded five years ago, and co-owners Brittany Strong and Rebekah Payne have seen it grow quickly. Since starting with four restaurants and just a handful or drivers, Tupelo2Go now has partnerships with nearly 80 establishments.

Delivery businesses became a lifeline of sorts for restaurants and eateries that at first couldn’t open their dining rooms and were later limited in their capacities.

For hungry diners still wanting to eat but not wanting to cook, having delivery services like Tupelo2Go, DoorDash and Uber Eats available during the pandemic worked out nicely.

Not that it was easy at first.

Because of the uncertainly of the virus early on and how it would affect businesses, restaurant closures meant those operating or driving for food delivery services taking a step back to assess the situation.

“It took some time,” Strong said. “The first few weeks, everything was up in the air, with the CDC and what not figuring out what people needed to do.”

As restaurants slowly reopened their doors for curbside pickup and delivery, that’s when Tupelo2Go’s business started soaring.

“I would say business has doubled over the past year,” Payne said. “We’ve got about 50 drivers now, but we could use 20 more right now.”

The boom in business behooved drivers as well. Sain said before the pandemic, a good day would lead to 15 deliveries or so. Now that the number has nearly doubled.

“And then you have the double and triple orders that have really picked up,” she said. “Normally, it’s a single order you pick up and drop off. Now we’re getting two or three orders for a restaurant and dropping them off at different locations.”

That’s a lot of driving and waiting involved, and of course it doesn’t come free. Food delivery businesses typically charge a small delivery fee for the service, but tipping a driver is customary.

Scott has only been delivering since August, but she hasn’t missed out on the hectic pace Sain has experienced.

“It’s awesome, and I love it,” Scott said. “It’s super chaotic right now, but of course that’s to be expected.”

Weekends are even busier, especially on Fridays and Sundays. Scott and Sain said they sometimes receive more than 25 orders during the day. That’s quite a lot for a typical shift.

All that extra work, while good for the bottom line, can lead to extra pressure on drivers. Drivers aren’t allowed to check an order to ensure it’s correct, although they can spot obvious problems with an order – say, two boxes when there should be three – when they make a pickup from a restaurant.

Sain said a good driver will try to correct a mistake.

“We’re the middlemen, and sometimes people want to take it out on the driver,” Sain said. “Sometimes it is our mess-up. For example, yesterday I forgot the drinks for an order. So I went to a store and spent my own money and got the drinks that they ordered, rather than going back all the way and spend more time going back to the restaurant. “

As an increasing number of Mississippians become vaccinated and the threat of exposure to COVID-19 lessens, there’s a chance that business at food delivery services like Tupelo2Go and its national counterparts could slow. More people eating in restaurant dining rooms means fewer people eating in living rooms, right?

Not necessarily, Sain said.

Given the increase in deliveries – and a healthy competition among restaurants and food delivery services – Sain thinks business won’t be letting up soon. Food delivery services changed the idea of what types of restaurants could offer delivery, and the pandemic expanded their customer base exponentially. Now that so many people have had a taste of the service, Sain’s convinced there’s no going back.

When asked if she’s convinced she and her fellow drivers will stay busy, even as the pandemic winds down, Sain answered succinctly and with confidence.

“Oh, for sure,” she said.


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