Amid questions, Medicaid director has governor’s confidence

The performance of Ohio Medicaid Director Maureen Corcoran has come under scrutiny in recent weeks, but she retains the confidence of Gov. Mike Dewine.

The governor appointed Corcoran to lead the $27 billion-a-year agency in January 2019, after it had experienced a series of controversies involving the pricing and acquisition of prescription drugs. They included a 2018 study showing that  pharmacy middlemen a year earlier billed the state $244 million more for prescription drugs than the middlemen paid pharmacists to dispense them.

Since then, pharmacists around the state — particularly those with a large Medicaid clientele — say problems with low reimbursements under the program continue. 

Also, they’re frustrated that they still haven’t received any of the $100 million the legislature appropriated last year to offset those losses.

On Monday, DeWine Press Secretary Dan Tierney said that delay was caused by outdated technology.

“When it comes to the pharmacist-payment issue, that falls into the category where we agree, we would like it implemented faster,” Tierney said. “But the complicated nature of this means we would have to upgrade software across the board.”

Overall, Tierney said, the governor is pleased with Corcoran’s performance.

“The governor has full faith in the director,” Tierney said. “During the COVID-19 pandemic the governor tasked Director Corcoran with implementation of our strategy regarding nursing homes and other care facilities.”

However, serious questions about Corcoran’s performance remain.

Perhaps most significantly, on Aug. 2 The Columbus Dispatch reported that Medicaid officials falsely denied the existence of earlier drafts of a drug-pricing analysis done by the same firm that uncovered what might have been price gouging in 2017, the paper reported. 

The final version of the report, which Medicaid officials last year said was the only version, eliminated seven pages of data.

The absence of the data arguably diminished the public’s ability to evaluate the performance of the state’s five Medicaid managed-care contractors and, by extension, Medicaid itself. But Corcoran on Wednesday said she had no interest in watering down the report.

During a hearing of the Joint Medicaid Oversight Committee, Sen. Dave Burke, R-Marysville asked Corcoran, “Is this story in The Dispatch true or not and if not, why?”

Corcoran replied, in part, “First of all, in the time frame we were doing this, there wasn’t any incentive for me to hide anything.” 

She went on to describe contacts between her legal staff and journalists at The Dispatch. 

And she described a temporary restraining order keeping information blacked out in the analyst’s earlier report that the pharmacy middlemen — CVS Caremark and OptumRX — contend are trade secrets. A lawsuit over the matter between them and the state is still pending.

For his part, Tierney said Medicaid couldn’t release what the businesses say is proprietary information until the restraining order is resolved.

But that doesn’t explain why the Medicaid Department didn’t simply black out, or “redact,” the information instead of removing entire pages. It also doesn’t explain why the department denied the existence of earlier drafts when it released the final version.

Perhaps similarly, Medicaid officials last year on two occasions falsely claimed that they hadn’t been notified that Walgreens was leaving the Caresource pharmacy network. Emails obtained through an open-records request show that the agency’s senior leaders — including Corcoran — were copied on messages confirming the massive change to the pharmacy network of Ohio Medicaid’s largest managed-care provider.

“We continue to work with the Department of Medicaid so that as these issues have arisen, we address them,” Tierney said Monday. “All I can really say is that we direct these agencies that they abide by the guidance that they give good customer service to the media on open records requests or any inquiry.”

There is also the agency’s sluggish implementation of a system to pay pharmacists to perform coronavirus tests. Despite months of promises, as August began, Medicaid hadn’t reimbursed a single Ohio pharmacist to perform one.

Emails obtained in response to a records request by the Ohio Capital Journal showed that inside the agency, there appeared to be little enthusiasm for the program.

In a phone interview, Corcoran asked that the senior Medicaid officials who sent the emails not be named in a story. She also said questions submitted to the agency indicated a lack of context, but she refused to provide any.

In addition, Attorney General Dave Yost’s 2020 Open Records Manual says “the public records law must be liberally interpreted in favor of disclosure.” But Corcoran appeared to say that a refusal to comply with her requests would result in future records requests being subjected to keen legal scrutiny.

Corcoran noted that her agency had provided emails about paying “pharmacies” for coronavirus testing instead of emails about paying “pharmacists” as requested. When the Capital Journal said it was going to publish a story naming Medicaid officials, Corcoran said:

“I’m just going to caution you… We tried to go the extra mile when we were given this request, we were given requests that were not lawful and were not in keeping with the law. And so, if what you’re saying to me is that… given your answers to me, understand that then I may feel the need to be more precise about our interactions with you as it relates to records and freedom of information.” 

Tierney did not respond specifically when asked about the incident.

“Our instruction to all our agencies is that we want them to provide good customer service to the media,” he said, later adding, “Our position is probably the same as the news media: We want the information out there.”