Tuesday, May 11, 2010

FBI told Honolulu shooting linked to Ohana Medicaid program

The following information was reportedly provided by email to the FBI today.

This is what happened about the following case.
Client was unable to secure a PCP from Ohana and/or Psychiatrist, everyone he called (including his mother) would not take Ohana (Wellcare) Insurance.  As a result when he went to pick up his prescriptions, it was denied for "prior authorization PCP".  Martin had no PCP assigned and was unable to secure one, which was the responsibility of Ohana (Wellcare) Healthplan.  He was never visited by his Care Coordinator as required by Contract for Ohana (Wellcare).

Although APS healthcare (Fee For Service Contractor for SMI) may be responsible for the payment of the psychotrophic drugs as he is a Severally Mentally Ill (SMI) client (see attached Demograpics Highlighted), a PCP was still required to pick up meds and Martin could not secure one (Ohana failed to get him one assigned since Feb 1, 2009).  He was never visited by his Care Coordinator, his card from Ohana reflects no PCP, the system was rigged to deny services for client.

Ohana receives $3,890 per month for this client and was responsible for coordinating his care.   The medication only cost $80-90 per month.  Martin just wanted to die and because of his religion suicide was not an option.  This is another example of Wellcare's practice.

Here is a link to the original story that appeared today in the Honolulu Advertiser.

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.