Healthcare Business News

La. rule targets docs steering patients into certain managed-care plans

By Virgil Dickson
Posted: December 4, 2013 - 5:30 pm ET

Regulators in Louisiana are attempting to crack down on a perceived pattern of physicians inappropriately steering patients into particular Medicaid managed-care plans.

Doctors caught exerting such influence could be booted from the program or asked to return payments for services they provided, and they face up to $5,000 in fines, according to an emergency rule effective Dec. 1 (PDF).

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The rule, issued by Louisiana's Department of Health and Hospitals, targets doctors that treat patients under the state's Medicaid managed-care program known as Bayou Health. Launched last year, Bayou Health coordinates care for 888,000 beneficiaries.

Enrollees are supposed to be free to choose from one of five health plans under Bayou Health without improper outside influence. The Department of Health and Hospitals, though, has been receiving reports of doctors nudging patients to favored plans.

The Louisiana State Medical Society considers the rule's penalties “pretty draconian,” said Greg Waddell, the society's vice president of legal affairs.

To his knowledge, “steering” isn't widely practiced and may be accidental in many instances. The association is concerned, he said, that the rule was written so broadly that it will have an “adverse effect on physician-patient relationships” by scaring physicians from helping patients understand their options.

The Department of Health and Hospitals doesn't have a formal count of infractions. Chief of Staff Calder Lynch said his department has also received copies of letters and voice messages received by beneficiaries in which doctors display overt bias for a particular plan. In one ruse, he said, doctors will falsely claim they don't participate in a particular plan in order to nudge patients to a different one.

Lynch said it's unclear what's motivating doctors to exert such influence but suggested the reasons could include financial incentives and simple preferences for a plan's administrative process.

The penalties apply to any conduct intended to recommend whether or not to enroll in a managed-care plan, or to enroll in a specific plan over another.

Activities specifically prohibited include giving patients incentives for choosing a particular plan and allowing them to use a fax machine, office telephone or computer to enroll into a specific plan.

Providers are allowed to talk about the health plans they accept and what services are offered under them, but they must disclose information on all the plans they accept.

Follow Virgil Dickson on Twitter: @MHvdickson

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