The World According to Nick
My take on Software, Technology, Politics, and anything else I feel like talking about.
Monday, September 26, 2005

Your Tax Dollars at Work 

I'm not surprised by this news in Milwaukee:

Taking advantage of language in state law and labor contracts, a small northwest side pharmacy has been paid hundreds of thousands of dollars more than it should have been paid to fill prescriptions for Milwaukee Public Schools teachers and retirees, MPS officials say.

The Pharmacy, 8430 W. Capitol Drive, has been allowed to "price-gouge with impunity," MPS said in legal papers filed as part of arbitration proceedings over a contract with teachers that was recently settled in favor of the School Board and administration.

In practices that go back more than 20 years, MPS employees have avoided paying the 20% share of prescription costs that they otherwise would have to pay when they get prescriptions filled by The Pharmacy. At least in recent years, MPS officials say the drug store then has billed MPS an amount far enough above the going rate for prescriptions to more than make up that 20%.

To get out of paying the 20%, teachers and retirees sign affidavits that say paying their share would impose "an undue financial hardship" on them. There are no standards set in state law for what constitutes such a hardship.
The high claims had to be paid because of little-noted language that has been in MPS labor contracts for well more than a decade that called for paying "100% of submitted cost" on "out of network" prescription claims. The provision did not spell out limits to what a submitted cost could be and, because The Pharmacy is an independent operation that is not part of a network that has a contract with MPS, it is not required to hold to a schedule of prices set by others.

And of course I'm also not surprised by the response from the teacher's union either:

Leaders of the Milwaukee Teachers' Education Association say they agreed that there were problems with the high billing from The Pharmacy but that they thought the issue could be resolved without taking the language about paying "100% of submitted costs" out of the contract. Sam Carmen, executive director of the teachers union, said the union offered to work with the administration to deal with The Pharmacy.

Heaven forbid that teachers be treated like every other employee of any other business. Do you know of any other insurance plan that allows a person to not pay a penalty if you go out of network? Seriously. Every plan I've always had enforced a higher price if you went out of network, not paid the whole thing.

Instead of simply treating one crook as a symptom, you need to take a look at the language of the contract and see it for what it really is... the cause of the problem. It's a loophole which people will continue to take advantage of, because nobody respects the taxpayer's dollar.


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Name: Nick
Home: Wauwatosa, WI, United States

I'm a Software Consultant in the Milwaukee area. Among various geeky pursuits, I'm also an amateur triathlete, and enjoy rock climbing. I also like to think I'm a political pundit.

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