Managed care firm SynerMed accused of improperly denying care to Medicaid patients
A confidential compliance investigation at managed care firm SynerMed found the company had improperly denied care to thousands of patients, many of them on Medicaid, and then falsified documents to hide their actions. That report was handed over to California regulators by a whistleblower, leading to a state investigation, insurer audits and the announced closure of the firm.
The report, obtained by California Healthline, said SynerMed had “routinely fabricated” denial letters without supervision from clinical staff to satisfy auditors. While patients in Medicaid managed care and commercial insurance plans are entitled to a written notice of denial of care, many patients weren’t properly informed by SynerMed and didn’t know they could appeal the denials—which results in those denials being overturned in nearly 70 percent of the review cases in California.
“As such, members may experience delays in care, lapse in coverage, delay in access to care and or financial hardship,” the report said.
The company’s senior director of compliance, Christine Babu, said she felt pressured to drop the matter and CEO James Mason said “one of our employees jumped the gun and disclosed confidential information regarding our clients and members” in a statement regarding the firm’s closure.
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John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.