Dr. Gloria Wilder follows up on patient Steven Osborne, 4, who was sent to… (Bill O'Leary/The Washington…)
The letter faxed to Gloria A. Wilder’s Anacostia medical practice was short and to the point: D.C. Chartered Health Plan, the Medicaid contractor that insured roughly three-fourths of her patients, would no longer be paying its claims, effectively immediately.
That meant Wilder would not be getting paid anytime soon for hundreds of office visits she had already handled, as well as dozens more she had scheduled for the coming week.
“The breath got sucked out of me,” she said of the April 19 letter. “Here it was, payroll day, and you hear no money’s coming.”
Until this month, Chartered Health Plan was the city’s dominant Medicaid contractor, managing the health care of more than 100,000 low-income city residents. The company’s collapse has raised questions about its politically connected owner, its precarious finances and government oversight of a key component of the city’s health-care system. But for small medical providers, Chartered’s demise has presented a more urgent question: How to make ends meet?
Wilder said that Chartered owes her practice, Core Health and Wellness, about $45,000, that she has cut back hours to save on utility bills, and that she’s been forced to dip into her retirement account to make payroll in recent weeks. “We run a fiscally sound practice, but it still means you need to have revenue coming in,” she said.
The D.C. government has promised that help is on the way, but pending litigation and negotiations with federal Medicaid officials have greatly complicated the task of making providers whole.
Chartered’s messy dissolution is an outgrowth of legal and financial troubles besetting Jeffrey E. Thompson, the firm’s owner. Thompson was thrust into the public spotlight last year after being implicated in the financing of a “shadow campaign” that supported Vincent C. Gray’s successful 2010 run for mayor. As Thompson became associated with political corruption, his health-care firm edged toward a financial precipice, and insurance regulators forced the company into receivership in November.
Thompson is the subject of a federal grand jury investigation, but he has not been charged with a crime. His attorneys have declined repeatedly to comment on the probe or on Chartered’s problems.
This year, receiver Daniel L. Watkins sold Chartered’s subscriber rolls and other assets to AmeriHealth Caritas, a Philadelphia company that assumed responsibility for Chartered’s members as of May 1 and is poised to start a new contract with the city in July. But the proceeds from the sale were not nearly enough to cover the leftover claims.
$60 million owed
Watkins estimates that the company owes providers at least $60 million for services rendered to Chartered enrollees. About 70 percent of that figure, Watkins said, is owed to hospitals, with large clinics and practices accounting for nearly all the rest.
Small practices such as Wilder’s are owed only a sliver of the total, but their survival is most threatened by the company’s decision to freeze payments in the final days of its contract. Meanwhile, larger providers are nervous that what is, for them, still a manageable problem could grow into something more serious if a resolution isn’t found soon.
Christopher A. Warner, an obstetrician-gynecologist who practices in Northwest Washington’s West End neighborhood, said the Chartered crisis has put a nearly $100,000 hole in his practice’s books. He blamed not only the April 19 payment freeze but also a slowdown in payments before the freeze.
Warner, who was treating about 130 pregnant women covered by Chartered when payments were halted, said he has stopped taking new Medicaid patients. He has also stopped paying salaries to himself and his wife, the office manager, and they have been negotiating with vendors for payment extensions.
Wilder and Warner say they feel betrayed by government officials. They say officials talk about expanding primary care to the District’s poorest residents but have allowed front-line providers to bear the brunt of the Chartered debacle.
“We decided a long time ago that we wanted to take care of all patients, whether it be by Medicaid or private-payer [insurance] — that was our focus,” Warner said. “But things have been harder and harder to maintain.”
Until Warner closed his office at Ward 8’s United Medical Center this year, he was the only obstetrician-gynecologist in private practice east of the Anacostia River. He remains one of a very few private OB-GYNs anywhere in the city who accept Medicaid patients, and those patients account for about 55 percent of his practice.
Wilder said the current upheaval helps explain why so few private doctors serve the city’s low-income communities and why most residents of those communities are treated at community clinics and emergency rooms.