$20 million higher insurance costs spark debate over medical fraud; Senator argues government should bear costs, not workers

Despite the increase, it could have been even more expensive, according to Dr. Commissiong. The board successfully negotiated rate caps with Cigna Healthcare, whose plan covers active government employees. Without those rate caps of 8% for health insurance and 3% for dental insurance for the coming fiscal year, the expected increases would have been closer to 25%, he said. But further cost savings would require significant changes to the coverage offered.

“Because both plans are not doing well, they say they cannot make any more price cuts without changing our plans or reducing the benefits offered,” said Dr. Commissiong. However, the board believes it is “important” to keep the current insurance plans unchanged to ensure that copayments, deductibles and out-of-pocket maximums are not increased.

Cigna will continue to offer a number of proven holistic programs that benefit the community, including nursing fellowships at the University of the Virgin Islands and the continuation of a “modest prediabetes prevention program.” Cigna will also maintain two mobile vans, and the Cigna Foundation will “continue to award $250,000 in grants to nonprofits in the area over the next year to help people with obesity, hypertension, diabetes and other chronic diseases,” said Dr. Commissiong.

Meanwhile, United Healthcare was “the only insurer to respond to coverage for retirees 65 and older,” noted Dr. Commissiong. As with Cigna, United’s new offering also comes with increases. Total payments will increase 32%, up from 38%. Still, “the 32% increase represents a total increase of approximately $6.35 million.” As with Cigna’s insurance, the board felt it wise not to seek further savings in order to “forego further changes that would further increase costs to retirees in the form of higher deductibles, copayments and out-of-pocket maximums.”

“As you may recall, the Senate has adopted the increases for workers and retirees in the current fiscal year 2024,” Dr. Commissiong told lawmakers. This means that the state will cover 73% of the insurance costs, while workers and retirees will pay the remaining 27%. “If the state goes back to the 65/35 split, it would drastically increase the wage contribution of a worker or retiree,” the panel co-chair warned.

In view of the current financial constraints, Dr. Commissiong pleaded: “If the Senate cannot fully absorb the increase, we request the Senate not to increase the wage deductions of our employees and pensioners by more than 4%.”

“The Virgin government will have to bear these costs,” said Senator Ray Fonseca. He argued for at least maintaining the current distribution and told his colleagues: “At the moment we cannot afford to impose additional burdens on employees or pensioners.”

Other MPs asked about other areas where additional cost savings could be made. Senator Marvin Blyden wondered if there were ways to curb fraud and abuse. Deepali Sahi, a senior account manager at Cigna, said such cases had been identified over the years but pointed out that dealing with these issues is often a tricky business. “Because of the doctor shortage … they get a message or communication saying we know this is happening rather than saying we are not going to work with you as a provider,” she said. “We don’t want to take people’s doctors away,” Ms Sahi explained.

Senator Blyden insisted there must be consequences for doctors who cheat the system. “In my opinion they can’t just get a slap on the wrist… something has to be done,” he countered. Ms Sahi said her team was working with VI Equicare on the issue “because these doctors are part of the VI Equicare network.”

‌The GESC board, for its part, is pursuing “several initiatives to control and reduce health care costs.” However, those present agreed that the surest way to reduce costs is a healthier population.

The matter will be voted on at one of the following Senate meetings.