Amerigroup

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Amerigroup
Company typeSubsidiary
Industry Health Insurance, Managed Health Care
Founded1994;30 years ago (1994) (as AMERICAID Community Care)
1996 (1996) (as Amerigroup)
Headquarters Virginia Beach, Virginia
Key people
Peter D. Haytaian, Executive Vice President, Government Business Division, Anthem, Inc.
ProductsPublicly funded health care program management
Number of employees
10,000+ (2020)
Parent Elevance Health Inc.
Website www.amerigroup.com/

Amerigroup is an American health insurance and managed health care provider. Amerigroup covers 7.7 million seniors, people with disabilities, low-income families and other state and federally sponsored beneficiaries, and federal employees in 26 states, making it the nation's largest provider of health care for public programs. [1] In July 2023, it was announced that Amerigroup's name would change to Wellpoint in six states beginning in January 2024. [2] [3]

Contents

History

Amerigroup began as AMERICAID Community Care in 1994 and was initially aimed at the health care problems of children, mothers and pregnant women enrolled in Medicaid. Amerigroup became a publicly traded corporation in November of 2001. [4] [5]

In 2006, Amerigroup entered the Medicare Advantage program, serving low-income people who are eligible for both Medicare and Medicaid through special needs plans.

In 2007, Amerigroup began the operation of traditional Medicare Advantage plans. Currently, Amerigroup offers health care services through three government programs that target different segments of the country's low-income population: Medicaid, the Children's Health Insurance Program (CHIP) and Medicare. [6]

On July 9, 2012, Anthem Inc. (then known as WellPoint) entered into an agreement to acquire Amerigroup Corporation for $4.9 billion. [7] Anthem has since re-branded to Elevance Health, Inc. [8]

On March 1, 2020, Amerigroup told Grays Harbor Community Hospital (GHCH) and Harbor Medical Group (HMG) of their decision to terminate their relationship with the company effective June 28, 2020. [9]

Health care products

[10] As of December 31, 2012:

Children's Health Insurance Program (CHIP) [11]

Seniors and People with Disabilities (S/PD) [12]

Temporary Assistance for Needy Families (TANF) [13]

FamilyCare [14]

Medicare Advantage [15]

National Advisory Board

In 2007, Amerigroup developed the National Advisory Board (NAB) to focus on meeting the needs of seniors and people with disabilities, who are a significant proportion of its clients. The NAB provides policy recommendations for improving programs and services for seniors and people with disabilities. Convened by Lex Frieden, who was instrumental in conceiving and drafting the Americans with Disabilities Act of 1990, the NAB is made up of 19 community advocates, health care experts and academics. [16] The NAB advocated that the modernized health care infrastructure be required to meet the needs of people with disabilities and seniors. [17]

Corporate social responsibility

Amerigroup Foundation

The main goals of the Amerigroup Foundation are to foster access to care, encourage safe and healthy children and families, and promote community improvement and healthy neighborhoods. [18] In the past year, (2013) the Foundation contributed more than $3 million to various community organizations across the United States. Since inception, the Foundation has awarded $17.3 million to community health centers, service organizations, and local programs. [19]

Volunteerism

Amerigroup has a Community Volunteers program, created to recognize and support the contributions employees make in communities across the country and to inspire others to volunteer. [20] All Amerigroup employees receive a paid day off each year to do volunteer work in their communities.

Medicaid fraud

Former Executive Cleveland Tyson provided federal prosecutors with evidence that Amerigroup was systematically declining services to low-income pregnant women in Illinois from 2001 to 2003. Their contract with the state required that they enroll all eligible clients, but prosecutors submitted emails showing that Amerigroup had a policy of targeting healthy enrollees and specifically excluded pregnant women and others with expensive conditions.

In October 2006, a federal jury found Amerigroup liable for $48 million in damages, which was tripled by statute to $144 million. In March 2007, an additional fine of over $190 million was levied for 18,000 false claims. After appealing the judgments, Amerigroup agreed in July 2008 to settle the charges for $225 million. As a whistleblower, qui tam provisions entitled Tyson to $56 million of the settlement. [21] [22] [23]

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

<span class="mw-page-title-main">Medicare (United States)</span> US government health insurance program

Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).

<span class="mw-page-title-main">Centers for Medicare & Medicaid Services</span> United States federal agency

The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov. CMS was previously known as the Health Care Financing Administration (HCFA) until 2001.

<span class="mw-page-title-main">Children's Health Insurance Program</span> Health Insurance program for families administered by the United States

The Children's Health Insurance Program (CHIP) – formerly known as the State Children's Health Insurance Program (SCHIP) – is a program administered by the United States Department of Health and Human Services that provides matching funds to states for health insurance to families with children. The program was designed to cover uninsured children in families with incomes that are modest but too high to qualify for Medicaid. The program was passed into law as part of the Balanced Budget Act of 1997, and the statutory authority for CHIP is under title XXI of the Social Security Act.

Dual-eligible beneficiaries refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status. Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries.

<span class="mw-page-title-main">Medicare Part D</span> United States prescription drug benefit for the elderly and disabled

Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Under the program, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government. Part D plans typically pay most of the cost for prescriptions filled by their enrollees. However, plans are later reimbursed for much of this cost through rebates paid by manufacturers and pharmacies.

<span class="mw-page-title-main">Long-term care</span> Services for the elderly or those with chronic illness or disability

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.

The California Medical Assistance Program is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and support. Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020.

The Balanced Budget Act of 1997 was an omnibus legislative package enacted by the United States Congress, using the budget reconciliation process, and designed to balance the federal budget by 2002. This act was enacted during Bill Clinton's second term as president.

The Medicare Part D coverage gap was a period of consumer payments for prescription medication costs that lay between the initial coverage limit and the catastrophic coverage threshold when the consumer was a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap was reached after a shared insurer payment - consumer payment for all covered prescription drugs reached a government-set amount, and was left only after the consumer had paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date were re-set to $0 and continued until the maximum amount of the gap was reached or the then current annual period lapses. In calculating whether the maximum amount of gap had been reached, the "True-out-of-pocket" costs (TrOOP) were added together.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the child health component of Medicaid. Federal statutes and regulations state that children under age 21 who are enrolled in Medicaid are entitled to EPSDT benefits and that States must cover a broad array of preventive and treatment services. Unlike private insurance, EPSDT is designed to address problems early, ameliorate conditions, and intervene as early as possible. For the 25 million children enrolled in Medicaid and entitled to EPSDT in 2012, the program is a vital source of coverage and a means to improve the health and well-being of beneficiaries.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.

Medicare Advantage is a type of health plan offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs. The sponsors vary from primarily integrated health delivery systems to unions to other types of non profit charities to insurance companies.

<span class="mw-page-title-main">Social programs in the United States</span>

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