Watchdog Group Questions Conflict of Interest at Neighborhood Health Plan

Watchdog Group Questions Conflict of Interest at Neighborhood Health Plan

Allegations of a conflict of interest at Neighborhood Health Plan of Rhode Island (NHPRI) have been made by WatchdogRI's Chairman Ken Block -- which NHPRI is refuting. 

"Neighborhood has been the conduit for facilitating the reimbursement of community health centers for the Medicaid patients that they service. With the advent of the Affordable Care Act (Obamacare), Neighborhood has also seen a large increase in its insurance business," said former Moderate Party founder and Republican gubernatorial candidate Block. "The conflict of interest exists because the board of directors for Neighborhood is largely comprised of the heads of the community health centers who Neighborhood reimburses to service a portion of the state's Medicaid population."

"This situation has the potential to be a 'fox guarding the henhouse' scenario.  Neighborhood should have a fiduciary responsibility to return the best value for the state of Rhode Island, which might conflict with the best interests of the community health centers who control the board of Neighborhood," said Block.

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Tom Boucher with NHPRI said there was "no conflict" as far as they were concerned. 

"There's no conflict on the board, our board does not set the rates for any provider," said Boucher. "Moreover, they are subject to oversight by a number of agencies, including the Office of the Health Insurance Commissioner, DBR, and DHHS who have full oversight. "

"Board members sign an annual attestation that there are no conflicts," said Boucher. "We're proud of our record, our quality, and fiscally working closely with the community health centers -- we serve some of the most vulnerable, that's who we're taking care of."

Watchdog Issues, NHPRI Board

According to Block, in 2014, Neighborhood received more than $700 million in Medicaid dollars from the state of Rhode Island.

"It is reckless to have an insurer be controlled by the providers whom the insurer is supposed to oversee," said Block.  "WatchdogRI is not saying that something bad or illegal is happening - frankly we haven't looked - but this kind of a conflict of interest is obvious and something to be avoided at all costs for everyone's best interests."

"All their money comes from the state, so the office of the HHS should address this," said Block. "NHP is given nearly $I billion - in Medicaid -- in 2014 it was over $700M."

Block said he only recently put "two and two" together.

"I realized this probably just before the holidays, when I was looking for information from different nonprofits for their tax filings and I landed on the [NHPRI] board page," said Block. "When I was started adding it up, that is so wrong.  In fairness, their mission has changed dramatically. NHP was once just about being an umbrella org.  Now it's one of the main Medicaid disbursing mechanisms the state has."

Board 

According to Block, NHP's board composition is as follows:

Neighborhood has 16 members of their Board of Directors.  8 of those directors are employees (and often the heads) of the community health centers.  The head of the RI Health Center Association serves as a board member, as does the head of Neighborhood. 

"We count 6 truly independent members out of this board of 16", continues Block.  "How willing is this board going to be to press the community health centers for cost savings, or inquire into wasteful practices?"

While WatchdogRI recognizes that Neighborhood's current board structure is historical in nature and might have been appropriate in the past, it is now no longer appropriate and the state of Rhode Island should insist on a complete separation of Neighborhood from its services providers to best serve the interests of the state.

A complete list of Neighborhood's Board of Directors follows, which was taken from Neighborhood's website.  We have re-ordered the Board members here to place conflicted board members at the top of the list. 

CONFLICTED

Chairman 
Merrill Thomas
Chief Executive Officer, Providence Community Health Centers, Inc.
 
Vice-Chairwoman 
Jane Hayward
President & Chief Executive Officer, Rhode Island Health Center Association
 
Secretary 
Brenda Dowlatshahi
Associate Executive Director, Tri-Town Community Action Agency
 
Peter Bancroft
President & Chief Executive Officer, WellOne Primary Medical and Dental Care
 
William Hochstrasser-Walsh
Chief Executive Officer, Comprehensive Community Action Program
 
Chuck Jones
President/Chief Executive Officer, Thundermist Health Center
 
Raymond Lavoie
Chief Executive Officer, Blackstone Valley Community Healthcare, Inc.
 
Michael Lichtenstein
Chief Executive Officer, Wood River Health Services
 
Dennis Roy
Chief Executive Officer, East Bay Community Action Program
 
Peter M. Marino 
President and Chief Executive Officer, Neighborhood Health Plan of Rhode Island
 
 
UNCONFLICTED

Treasurer 
Peter Walsh
Director of External Relations, Rhode Island Housing  
 
Christopher Little
Partner, Little, Medeiros, Kinder, Bulman & Whitney, PC
 
Patricia Martinez
Executive Director, Center for Family Support & Student Development, Central Falls Schools
 
Pablo Rodriguez, MD
Chief Executive Officer, Women's Care
 
Richard Besdine, M.D.
Professor of Medicine, Director of the Center for Gerontology and Healthcare Research, and Director of the Division of Geriatrics in the Department of Medicine at Brown University
 
Doris de Los Santos
Director of Development & Community Strategies for Providence Schools