Last week, the Sacramento Business Journal reported on irregularities in how health insurance/ managed care giant Aetna obtained a contract with the US military health plan Tricare:
Aetna Inc. hired a former high-level Tricare employee with access to proprietary information about Health Net Inc.�s performance that could have given Aetna a competitive edge in its bid for a lucrative military health care contract, the U.S. Government Accountability Office has concluded.
The GAO details six flaws in the procurement process in new documents posted online Tuesday and recommends that Aetna should be excluded from the competition, leaving Health Net 'as the only viable awardee.'
The agency recommends Tricare officials perform a thorough review of what sensitive information the former Tricare employee had access to and decide what action to take to address the problem. The GAO also recommends that Health Net be reimbursed the cost of filing the protest, including attorneys fees.
The Business Journal described the details of the irregularities:
The GAO decision pointed to six flaws in the in the bid evaluation process, including:
* The agency credited Aetna with past performance of its parent and corporate affiliates but did not record which entities were involved or establish the roles they would play in the contract
* The evaluation gave Aetna the highest past performance rating without considering that its past performance was small compared with the size of the Tricare contract
* The price evaluation did not consider whether Aetna�s proposed staffing reflected a lack of understanding of the technical requirements of the contract � or showed a willingness to take a risk on the business
* The agency failed to consider the risk involved with Aetna�s proposed plan to hire large percentages of Health Net�s work force at lower pay rates
* The agency did not consider Health Net�s network provider discounts when assessing its pricing information for the program and
* The agency failed to protest Aetna�s hiring a former Tricare official with inside knowledge of Health Net�s performance on the previous contract.
'The contracting officer never considered the matter � because the awardee did not bring it to his attention� and the record shows that the individual had access to non-public proprietary information,' the decision states.
The Montgomery Advertiser added:
Though it doesn�t allege that procurement integrity law was broken, the GAO said contracting agencies like TMA have an obligation 'to avoid even the appearance of impropriety' in government procurement. This time it failed.
It's been only about nine months since we discussed legal or regulatory issues for Aetna. In February, 2009 we discussed its settlement of accusations it underpaid claims in part through its use of a now discredited database marketed by Ingenix, a subsidiary of its supposed competitor, UnitedHealth Group.
Aetna boasts that it is
Helping to manage health care, one of the most important things in life
We believe we can help create a better health care system. This belief drives our daily decisions as one of the nation's leading health care benefits companies. We work hard to provide our members with information and resources to help them make informed decisions about their health.
Furthemore, it boasts of its mission
We help people achieve health and financial security by providing easy access to cost-effective, high-quality health care. And we continue to be a leader in building a stronger, more effective health care system by working with doctors, hospitals, employers, patients, public officials and others.
It seems one way in which Aetna works with public officials is to hire those that might have some inside knowledge of specific government contracting processes, and then take advantage of that to boost their chances of obtaining lucrative contracts, if I am reading the summary of the GAO findings correctly.
Maybe most people have grown cynical about health care organizations', especially commercial health care insurance companies' mission statements, and may dismiss them as marketing fluff, if not complete balderdash. However, to improve health care quality while controlling costs, facilitating access, and restoring professionalism, would be health care reformers need to make health care organizational leaders live up to their noble-sounding proclamations of corporate social responsibility.
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