Paramount Advantage v. Ohio Dept. of Medicaid

2021 Ohio 4180
CourtOhio Court of Claims
DecidedOctober 14, 2021
Docket2021-00262PQ
StatusPublished
Cited by5 cases

This text of 2021 Ohio 4180 (Paramount Advantage v. Ohio Dept. of Medicaid) is published on Counsel Stack Legal Research, covering Ohio Court of Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Paramount Advantage v. Ohio Dept. of Medicaid, 2021 Ohio 4180 (Ohio Super. Ct. 2021).

Opinion

[Cite as Paramount Advantage v. Ohio Dept. of Medicaid, 2021-Ohio-4180.]

PARAMOUNT ADVANTAGE Case No. 2021-00262PQ

Requester Special Master Jeff Clark

v. REPORT AND RECOMMENDATION

OHIO DEPARTMENT OF MEDICAID

Respondent

{¶1} This action is filed under R.C. 2743.75, which provides an expeditious and economical procedure to enforce the Ohio Public Records Act, R.C. 149.43. On April 12, 2021, requester Paramount Advantage, an unsuccessful applicant in a managed care organization procurement process, made a public records request to respondent Ohio Department of Medicaid (ODM) to inspect and copy public records [in any format] that fall into any of the following categories: 1. Documents reflecting the scoring performed by the Ohio Department of Medicaid (“ODM”), as to all Plan Applicants, including but not limited to: (a) who performed the scoring; (b) the score cards; (c) score tabulations; (d) the process(es) applied to scoring; (e) assumptions made in scoring; (f) considerations taken in scoring; and (g) all other matters related to the managed care procurement scoring process of applications (the “Plan Applications”) that ultimately resulted in the Managed Care Procurement Award announced on April 9, 2021 (the “Procurement Process/Decision”) related to RFA ODMMR-2021-2024 (the “RFA”); 2. All Plan Applications received by ODM by all Applicants; 3. All recordings, video and/or audio, of oral presentations by all Plan Applicants; 4. Documents reflecting all ODM participants in oral presentations by Plan Applicants, including those participating in listen or observing mode and a list of those who scored the video portion of the process; Case No. 2021-00262PQ -2- REPORT AND RECOMMENDATION

5. Documents reflecting ODM internal communications between/among Plan Application reviewers/scorers; 6. Documents reflecting instructions to potential applicants outlining the RFA process as well as any follow-up questions from and responses to potential applicants related to the RFA process; 7. Documents reflecting the decision to not award any contracts to an application for only one or two regions; 8. Documents reflecting communications between the ODM and United Healthcare Community Plan of Ohio, Inc. related to the Procurement Process/Decision; 9. Documents reflecting communications between ODM and Humana Health Plan of Ohio, Inc. related to the Procurement Process/Decision; 10. Documents reflecting communications between ODM and Molina Healthcare of Ohio, Inc. related to the Procurement Process/Decision; 11. Documents reflecting communications between ODM and AmeriHealth Caritas Ohio, Inc. related to the Procurement Process/Decision; 12. Documents reflecting communications between ODM and Anthem Blue Cross and Blue Shield related to the Procurement Process/Decision; 13. Documents reflecting communications between ODM and CareSource Ohio, Inc. related to the Procurement Process/Decision; 14. Documents reflecting communications between ODM and Buckeye Community Health Plan related to the Procurement Process/Decision; 15. Documents reflecting communications between ODM and Aetna Better Health of Ohio related to the Procurement Process/Decision; 16. Documents reflecting communications between ODM and Medical Mutual of Ohio related to the Procurement Process/Decision; Case No. 2021-00262PQ -3- REPORT AND RECOMMENDATION

17. Documents reflecting communications between ODM and Ohio Employee Health Partnership related to the Procurement Process/Decision; and 18. Documents reflecting communications between ODM and any person or entity who/that was not an Applicant related to the Procurement Process/Decision. (Complaint, Exh. B.) The same day, ODM responded that it was in receipt of and working to fulfill the requests (Id., Exh. C.) On April 14, 2021, ODM sent a written response to each request and attached responsive records. (Id., Exh. D.) On April 15 and 20, 2021, ODM produced additional responsive documents. (Id., Exh. E, F.) In a letter dated April 19, 2021, Paramount made a second public records request for: 1. All Records (as defined in R.C. 149.43) related to a problem in the enrollment of Medicaid members into the Paramount Advantage plan as reflected in the data shared in the Paramount/ODM Data Meeting presentation dated August 29, 2019, and attached hereto as an Exhibit;

2. All Records related to problems with the enrollment of Medicaid members into the Paramount Advantage plan including but not limited to problems regarding (a) deceased members being retroactively enrolled, (b) ABD members being placed in incorrect rate cells, (c) MyCare members assigned to Paramount Advantage, and (d) extension members being moved to CFC; 3. All Records related to a problem with the algorithm that assigned Medicaid members among the managed care plans resulting in a disproportionately large population of high cost, high risk members enrolled in Paramount Advantage; 4. All Records related to the reimbursement to Paramount Advantage by ODM of approximately $57 million in connection with the enrollment or algorithm issues referenced in Requests 1, 2, and 3; 5. All Records reflecting communications between ODM and Aetna Better Health related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

6. All Records reflecting communications between ODM and Buckeye Community Health Plan related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4; Case No. 2021-00262PQ -4- REPORT AND RECOMMENDATION

7. All Records reflecting communications between ODM and Caresource related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

8. All Records reflecting communications between ODM and Molina Healthcare of Ohio related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

9. All Records reflecting communications between ODM and United Healthcare Community Plan of Ohio, Inc. related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

10. All Records reflecting communications between ODM and Accenture related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

11. All Records reflecting communications between ODM and Milliman related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4;

12. All Records reflecting communications between ODM and any outside consultant or advisor related to the enrollment, algorithm, or payment issues referenced in Requests 1, 2, 3, and 4; and

13. All Records related to any disciplinary or threatened disciplinary actions against any ODM employee in connection with the enrollment, algorithm, and payments issues referenced in Requests 1, 2, 3, and 4. (Id., Exh. H.) On April 23 and May 4, 2021, ODM sent an email and letter acknowledging receipt of the second request. (Id., Exh. I, J.) {¶2} On May 7, 2021, Paramount filed a complaint pursuant to R.C. 2743.75 alleging that ODM had denied access to public records in violation of R.C. 149.43(B). The case was referred to mediation. On June 28, 2021, the special master denied the motion of UnitedHealthcare Community Plan of Ohio, Inc. to intervene. On July 13, 2021, the mediator entered an order reporting that as a result of mediation, the requests set forth in the letter of April 12, 2021, attached to the complaint numbered 1 (scoring notes only), 5, and 8 Case No. 2021-00262PQ -5- REPORT AND RECOMMENDATION

through 18 remain unresolved: all other matters have been resolved or are otherwise not disputed. On July 29, 2021, ODM filed a combined response to the complaint and motion to dismiss (Response). On August 26, 2021, Paramount filed a reply. Burden of Proof {¶3} The Ohio Public Records Act, R.C.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Miller v. E. Holmes School Dist.
2025 Ohio 1653 (Ohio Court of Claims, 2025)
Jones v. Columbus Div. of Police
2025 Ohio 465 (Ohio Court of Appeals, 2025)
Cass v. Mercer Cty. Sheriff's Office
2025 Ohio 478 (Ohio Court of Claims, 2025)
Jones v. Allen Cty. Common Pleas Court
2023 Ohio 1863 (Ohio Court of Claims, 2023)

Cite This Page — Counsel Stack

Bluebook (online)
2021 Ohio 4180, Counsel Stack Legal Research, https://law.counselstack.com/opinion/paramount-advantage-v-ohio-dept-of-medicaid-ohioctcl-2021.