Jean rumbaugh centene

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Sam Brownback's managed care reform that, at the beginning of , placed most of the state's , Medicaid recipients under the administration of three private-sector insurance companies. Two of those three "managed care organizations," or MCOs, acknowledged during a KanCare Advisory Council hearing Wednesday that there have been "bumps in the road" when it comes to claims processing and told the council they are working to smooth them out before a Jan.

Rumbaugh said the company has learned from last year's roll-out and a limited pilot program that includes Kansans with developmental disabilities. She encouraged providers to go up the chain of command with claims complaints that linger. Tim Spilker, of United HealthCare, also said "there have been bumps in the road in terms of claims payment timeliness and accuracy," adding that some claims might be filed incorrectly by providers, but some delays might be due to "configuration" issues that the MCOs themselves need to address.

Spilker said claims denials are running about 10 to 12 percent, "which is actually about right. Major hospital systems including Via Christi and Stormont-Vail HealthCare have reported increases in payment delays under KanCare and some pharmacies have reported prescription reimbursements that don't cover costs. State and MCO officials have vowed to address the issues.

The advisory council is made up of legislators, providers, KanCare recipients and state agency employees. Search All Parties Attorneys Judges. Sign Up. Federal Courts U. This case was last updated from U. Update This Case. This case was filed in U. District Courts, Kansas District Court. The Judges overseeing this case are John W. Lungstrum and Teresa J. The case status is Disposed - Other Disposed. Case Details Parties Documents Dockets. Case Details.

Judge Details. John W. Teresa J. Party Details. Jacqueline Leary. Jean Rumbaugh Wilms. Sunflower State Health Plan, Inc. Centene Corporation. Rob Hitchcock. Lewis M. Jovita M. Louis Forsyth Blvd. Louis, MO Krystle M. Bradley M. Court Documents. Read More Read Less.

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Two of those three "managed care organizations," or MCOs, acknowledged during a KanCare Advisory Council hearing Wednesday that there have been "bumps in the road" when it comes to claims processing and told the council they are working to smooth them out before a Jan. Rumbaugh said the company has learned from last year's roll-out and a limited pilot program that includes Kansans with developmental disabilities.

She encouraged providers to go up the chain of command with claims complaints that linger. Tim Spilker, of United HealthCare, also said "there have been bumps in the road in terms of claims payment timeliness and accuracy," adding that some claims might be filed incorrectly by providers, but some delays might be due to "configuration" issues that the MCOs themselves need to address.

Spilker said claims denials are running about 10 to 12 percent, "which is actually about right. Major hospital systems including Via Christi and Stormont-Vail HealthCare have reported increases in payment delays under KanCare and some pharmacies have reported prescription reimbursements that don't cover costs.

State and MCO officials have vowed to address the issues. The advisory council is made up of legislators, providers, KanCare recipients and state agency employees. Shawn Sullivan, secretary of the Kansas Department for Aging and Disability Services, said ensuring a smooth billing transition is one of the top priorities as the expansion date approaches. Wilms dismissed Ms. In the following months, Plaintiff orchestrated the closing of the member panels for KUMED as she had been instructed against her protests to Ms.

Wilms regarding the propriety of those efforts. Leary was forced at the same time to determine how to alter the online and hard-copy provider directories to make these changes appear to somehow benign because KUMED administrators had not requested the closing of the member panels. Plaintiff was then instructed by Ms. Leary explained that she was uncomfortable complying with this instruction, and Ms.

In July , Ms. In August , Plaintiff informed Ms. Wilms that she was not willing to move members as she had instructed.

Neither, she said, would she instruct the staff to lie in response to inquiries of this type from inquiring providers whose panels were closed to auto-assignment or SSHP members — all for reasons related exclusively to the financial performance of SSHP and its parent, Centene. Wilms asked Ms. Leary to run a report to determine which members had actually been to see their PCP.

For those that had not yet done so, Ms. Wilms proposed change in this regard would have directly affected approximately 7, members. In September , Plaintiff requested from an internal business analyst the report that Ms.

Wilms sought. The analyst explained that it would take some time to generate. In the meantime, Ms. Wilms began a campaign of retaliation against Ms. Leary which affected the dayto-day terms and conditions of her employment. Wilms canceled meetings with Ms. Leary, explained that there was somehow no reason for the two key SSHP executives to meet for any reason, and generally refused to interact with her in the workplace. Wilms had instructed. On January 13, , Plaintiff documented in her response to her performance evaluation that she had informed Ms.

Wilms that she was not comfortable moving members as she had instructed. The following day, Ms. She noted her serious professional objection to this directive, and explained to Ms. As part of her complaint to Ms. Leary sought to discuss. Picotte asked Ms. Leary to forward the relevant provider agreements, as Brian Deutschmann had instructed her to do, so that they could be reviewed by Centene corporate compliance representatives, along with any other information which Ms.

Leary believed supported her concerns about the impropriety of the practice. Picotte explained that it was her job as VP of Compliance to confirm if Ms. She advised Ms. During the same converation, Ms. Leary expressed her concern that she might be terminated as a result of these complaints made regarding Mr.

Hitchcock and Ms. Picotte responded by assuring Ms. Picotte then explained further that she would discuss these issues with her superior, Brian Deutschmann, on Friday, January 17, and that she would thereafter respond to Ms. Leary with appropriate next steps. The same day, Ms. Leary had described, and several emails which reflected the directives from Ms. Wilms in this regard. Picotte did not respond that day or thereafter. On January 24, Plaintiff asked Ms.

Picotte about the status of the investigation of her report made 11 days before. Picotte explained that she was waiting for Ms. Leary to send the materials she had requested, and Ms. Leary responded by explaining that she had sent the materials later the same day after their meeting. Picotte explained in response that she had somehow not had time to investigate any of the issues identified by Ms. Leary because she had been preparing for a state audit. The very same afternoon at p.