In the race to sign up the 1.1 million people covered by Tennessee's eight-month-old TennCare Medicaid program, commissioned salespeople for managed-care organizations have used high-pressure tactics. Turkeys, applications for secured credit cards and even cash were among the inducements reported to the Tennessee Division of Consumer Affairs, said the division's director, Elizabeth Owen.
TennCare, which started Jan. 1, put the state's 750,000 Medicaid recipients into capitated plans and pays about $100 per month per enrollee. The anticipated savings is used to cover 350,000 people who previously were uninsured. In total, that's almost one-quarter of Tennessee's population.
The state has been criticized for implementing TennCare before the market had a managed-care infrastructure in place. Hospitals that hadn't participated in managed-care networks, such as public and academic institutions, lost Medicaid business overnight, said Robert Hurley, an associate professor of Virginia Commonwealth University's department of health administration who has studied Medicaid managed care for 10 years.
The hasty implementation meant consumers were confused and ripe for unscrupulous tactics, Ms. Owen said. "I had phone calls from people who were saying, `So-and-so threatened me. He wouldn't leave my house until I signed up,"' she said.
The state of Tennessee is trying to prevent more questionable marketing practices by managed-care organizations in TennCare.
On July 1 TennCare implemented 30 pages of "very clear" marketing guidelines for managed-care organizations, said Susie Baird, TennCare's director of policy and intergovernmental relations. "We had guidelines in the contract (with managed-care organizations). We needed to elaborate on them," she said.
So far, she said, they are being followed.
Only one organization has been sanctioned. Baptist Hospital in Nashville and an affiliated plan, Health Net, were accused by the state attorney general's office of illegally using the state's letterhead in solicitations to 22,000 Medicaid recipients. On Feb. 1 the hospital and health plan signed a settlement in which they admitted no wrongdoing but agreed not to engage in certain practices.
But the president of OmniCare Health Plan in Memphis, whose salespeople were accused in a sheriff's department investigation of trying to enroll prison inmates who already received free care, called for "a little patience."
Eric Taylor, writing recently in Memphis' Commercial Appeal, said his plan, previously called Affordable Healthcare, took steps to make sure its independent marketing agents comply with TennCare rules.
However, Mr. Taylor also agreed with a state official's view that the consequences of unethical marketing are "less than a tenth of a percentage point" of the amount of fraudulent billing under the old fee-for-service system.