Senator Nienow focuses on combatting fraud in state’s health care programs

Although it was a constant battle, Senator Sean Nienow continued to push forward with investigating potential fraud claims pertaining to the state’s biggest health maintenance organizations (HMOs).

Senator Sean Nienow

During the last legislative session, Sen. Nienow spent a lot of time calling for a congressional inquiry into Medicaid funding in Minnesota.

Sen. Nienow, who initially brought attention to potential improper action last year and introduced legislation (SF 1824) to combat issues of fraud in the state’s health care program, explained approximately $4 billion is spent on HMO programs in Minnesota.

“Every turn I would get pushed back and rebuffed,” Sen. Nienow said. “But now we have congressional inquiries going on.”

Sen. Nienow explained allegations surfaced that the state may have inflated health care spending figures in order to receive additional matching funds from the federal government.

Sen. Nienow wrote a letter to U.S. Senator Chuck Grassely (R-Iowa) calling for a congressional inquiry into Medicaid funding. Sen. Grassely responded by a sending a letter to all 50 states, drawing national attention to HMO transparency issues.

Sen. Nienow explained UCare (which is the smallest of the four leading HMOs) already has given back $30 million as a result of the inquiries.

“If UCare had $30 million to give back and they are the little baby of the HMOs, imagine what we could learn about the three largers HMOs that includes Medica, Blue Cross Blue Shield and Health Partners,” Sen. Nienow said. “We could be looking at billions of dollars at the taxpayers’ expense.”

The bill requires certain changes in managed care plan financial reporting and also an annual independent third-party audit that shall include a determination of compliance with the federal Medicaid rate certification process.

Sen. Nienow said the independent audits will begin in 2015.

“You know when we have to have congressional inquiries, things are not right,” Sen. Nienow explained. “It finally got to the point where we have to do something.”

Sen. Nienow, who previously served in the Minnesota State Senate from 2003 to 2006 and was re-elected in November 2010, served this past session as the vice chair of Finance, and on the Agriculture and Rural Economies, Education and Health and Human Services committees. He said overall the past session went well.

“In the end we came out in a decent spot,” Sen. Nienow said. “It’s taken us at least three years to get things turned around. When I came back into office, we had a $4 billion to $5 billion deficit and no money in the bank. Now we’ve got about $1 billion cash in the bank.”

For the education funding formula, Sen. Nienow said they did “tinker” around the edges with this, but it still remains disproportionate as it relates to the larger school districts.

Sen. Nienow said if he’s re-elected he would like to continue to work on some of the bills he authored that didn’t come to fruition. One of those bills revolved around education policy and developing an annual assessment for teachers.

“The district would determine what this looks like and the criteria, and at the end of the day you determine if they’re meeting the expectations,” Sen. Nienow said. “We implemented the same concept last year for state employees. It’s a commonsense policy; everyone working gets an annual performance appraisal.”

A few of the other bills Sen. Nienow introduced that he intends to continue working on includes a bill to prohibit employers from requiring candidates to disclose their social network passwords as a conditional of employment; and a bill that would require hospitals to report medical futility policies if requested by parents or guardians of patients under the age of 18.