Big Ohio care provider accused of putting profit over patients — in the UK

Health care giant Centene — which was accused of fraud in Ohio — is now in hot water in the United Kingdom.

The BBC program “Panorama” this week published a documentary film and a news story saying that a Centene subsidiary there appeared to be skimping on costs and compromising care. 

For its part, Centene’s British subsidiary Operose Health says the report is inaccurate and that it has filed a “formal complaint” over it.

The dispute could be a glimpse of what happens when features of American-style managed-care are grafted onto the National Health Service, the UK’s health system, under the rubric of “privatization.” 

In its statement to the Capital Journal, Centene accused the BBC of providing “an unchallenged platform for anti-privatization health care activists in the UK to push their agenda after their recent failed attempt to stop Operose Health from acquiring a network of General Practitioner practices in North London.”

In the United States, the main line of business for St. Louis-based Centene is managing care for Medicaid patients. In Ohio, its Buckeye Health Plan contracts with the state Department of Medicaid to set up networks of providers, sign up patients, coordinate their care and see that providers are paid.

Last year, Attorney General Dave Yost sued the company after a 2018 newspaper investigation showed that Centene-owned pharmacy middlemen appeared to overbill the state by $20 million. Centene didn’t admit wrongdoing, but it quickly agreed to pay Ohio $88 million and to set aside more than $1 billion more to settle similar claims with 21 other states.

Despite the fraud allegations, the Ohio Department of Medicaid decided to rehire the company just two months after the settlement, giving it a contract worth billions.

In the UK, Centene is in a different business. But as in the states, governments mostly pay its subsidiary on a per-patient, per-month basis, thereby giving it an incentive to seek savings where it can.  

General-practice doctors had traditionally worked with the British National Health Service as independent contractors. But in 2007 the Labour government changed the rules, allowing big businesses to buy up the practices and pay docs as salaried employees. Centene subsidiary Operose Health has become the largest such provider in the country. 

It’s been part of a trend. The Commonwealth Fund in 2020 reported that almost 60% of British general practitioners were still self-employed, but the number employed by outfits such as Operose was “increasing and is currently around 22%.”

As part of its investigation, BBC journalist Jacqui Wakefield worked undercover as a receptionist for several months in a busy Operose Health practice in London.

The investigation said that Operose had far fewer physicians on staff than the average doctor’s office, or “surgery,” as they’re sometimes called there. Operose relied instead on physician associates, the report said.

Wakefield also obtained undercover footage in which she’s told by a supervisor not to tell patients that doctors weren’t available — even though they weren’t. Other footage records several colleagues telling Wakefield that the Centene-owned company relies so heavily on physician associates because they work far more cheaply than actual doctors do.

Perhaps even more disturbingly, administrative workers described a backlog of paperwork that in some instances left patients waiting as long as six months for a referral to a doctor or a pharmacist. In one sequence, Wakefield, working as a receptionist, describes a caller crying in pain and frustration because she can’t get help.

A prominent British doctor told BBC’s “Panorama” that such delays are “a massive risk to patients, both in terms of the development of a more serious disease and them dying earlier.” He added that Centene’s Operose Health was “putting profits, money ahead of quality of care. And that will have an impact.”

Centene denied those charges.

“If the BBC had allowed us an opportunity for balanced discussion, they would have learned that Operose Health has consistently been able to meet the health care needs of its patients, make substantial investments in General Practitioner recruitment, including over £5m in additional staff support in the past year, and meet all NHS contracts and regulators requirements,” it said. “Therefore, it is not surprising that the Care Quality Commission rates 97% of Operose Health’s practices as Good or Outstanding in providing safe, effective, responsive, and well-led health care.”