Updated: 09/18/2013 3:35 PM KSTP.com By: Mark Albert
Bloomington-based Health Partners did not follow federal rules for spending taxpayer money when it used a surplus to purchase - regardless of need - electronic toothbrushes and accessories for everyone enrolled in a Minnesota-created health plan for low-income seniors, according to the federal regulators who had actually approved the purchase at the time.
In response to an inquiry this week from 5 EYEWITNESS NEWS, the Centers for Medicare and Medicaid Services determined Thursday that the expenditure "shouldn't have been a mandatory supplemental benefit" for 3,100 enrollees in the Minnesota Senior Health Options plan, a managed care program for seniors who are dually-eligible for Medicare and Medicaid.
Instead, the electronic toothbrush kits are considered "over-the-counter" and not a "true dental benefit," and therefore should have been voluntary for seniors to decide whether they wanted to participate, a CMS spokesperson confirmed.
CMS will review the matter with Health Partners to clear up any "miscommunication," a spokesperson said.
5 EYEWITNESS NEWS was alerted to the issue by a viewer in Fridley whose 94 year-old mother received the kit last month in the mail, despite having dentures and not ordering the product.
"I thought: this is really strange," recalled daughter Renei Schmitz. "My mother has dentures and she has no need for this."
The box, which exceeded four pounds and was shipped via FedEx, contained an Oral-B Precision 5000 electronic toothbrush, accessory brushes, toothpaste, mouthwash, dental floss, tote bag, and a Health Partners dish plate.
The electronic toothbrush alone retailed on Thursday for $109.99, making the retail value of the purchase for 3,100 seniors in the MSHO plan exceed $340,000, not counting the other accessories and the cost of shipping.
"You're paying for it, I'm paying for it, everybody's paying for it because we all pay taxes," Schmitz said in an interview.
The purchase of so many electronic toothbrushes without asking plan enrollees first, she said, is "crazy, in my book. I just don't understand how you can do that. And how you can justify it."
According to the Bloomington HMO, its management of the MSHO contract resulted in a surplus - formally known at CMS as "rebate dollars" - in the most recent year. Federal rules prohibit a managed care provider from returning all of the surplus money to federal coffers.
Instead, a CMS representative explained, the rebate dollars should be used to provide a "supplemental benefit" to enrollees, since the money has already been allocated for their care.
Such benefits have included periodontal maintenance, root canals on molars, a second dental exam, additional crown coverage, and more, according to information provided by Health Partners.
The company chose to provide the electronic toothbrushes, as well, and that decision was included in a packet of benefits that was reviewed and approved ahead of time by CMS, Health Partners stated.
But the toothbrushes do not meet CMS requirements for supplemental benefits, which are considered "mandatory" and must be provided to all members, the federal agency explained on Thursday.
It suggested that offering the toothbrushes to seniors on a voluntary basis would have been acceptable.
In a statement issued Thursday shortly before CMS determined that federal rules were not followed, Health Partners stated: "The dental care kit was part of a supplemental package of benefits we provided to MSHO enrollees for 2013 as required and approved by the Centers for Medicare and Medicaid Services. Oral health is an important piece of preventing more serious illnesses, and this package was designed to address oral health care services that have been cut back or traditionally inaccessible under Medicare and Medicaid. We believe it meets a critical need among our MSHO participants, and have received a great deal of positive feedback from our members."
A Health Partners spokesman did not respond to a 5 EYEWITNESS NEWS email notifying it of the CMS determination.
The company would not disclose the cost of the toothbrushes or the amount of the surplus, describing such information as "proprietary."