A former Samaritan Health executive, Melissa Isavoran, has filed a lawsuit claiming she faced retaliation and unlawful termination after concluding that the integrated system of hospitals and health plans was violating its contract to serve low-income people in the Oregon Health Plan.
According to an emailed statement attributed to Altove Rowley Esch, a senior assistant general counsel at Samaritan Health Services, “We just learned that this lawsuit was filed on Monday, March 11, and cannot comment on pending litigation.”
Samaritan Health Services operates five hospitals in Oregon, including Good Samaritan Regional Medical Center in Corvallis, Samaritan Albany General Hospital, Samaritan Lebanon Community Hospital, Samaritan North Lincoln Hospital and Samaritan Pacific Communities Hospital in Newport. Samaritan Health Plans, under the same management, provides coverage to employers, brokers, and under Medicare and the Medicaid-funded Oregon Health Plan.
For OHP, Samaritan operates the InterCommunity Health Network, a regional state-contracted coordinated care organization that operates as a highly regulated insurer. Such organizations tend to align the insurer with local health systems and other providers in managing care in ways that are intended to promote better care and reduce waste.
Isavoran, in her suit, claims that soon after coming on board as the associate vice president overseeing its Oregon Health Plan operations, she conducted a “gap analysis” that indicated “assessing various areas of non-compliance with the Medicaid contract,” and that she shared with other executives her “concerns that Samaritan Health was acting in violation of law.”
She claims that while some of her concerns were addressed in a “marginal” way, leadership “never addressed the more fundamental areas of non-compliance.”
She alleged the CCO had engaged in inaccurate claims processing and improperly denied benefits to patients who qualified for care due to having multiple conditions or “comorbidities.” The suit also claims she flagged administrative conflicts of interest as well as a practice of paying more to Samaritan-affiliated providers than other providers, which she termed “unlawful.”
According to the suit, Isavoran was removed from her Medicaid post in the spring of 2023, and moved to a position overseeing social determinants of health. Her replacement with the Oregon Health Plan, the suit claims, had “no relevant education and limited experience relating to Medicaid.”
According to Isavoran, her whistleblowing led to the change in responsibilities and her subsequent “constructive discharge.”
According to Isavoran’s Linkedin page, her time with Samaritan ended last August. She holds a master’s degree from the Arizona State University College of Law and a certification from the National Association for Healthcare Quality.
Before her Samaritan job, she worked for three years as a manager of external quality review activities in Oregon for the Phoenix-based Health Services Advisory Group, a company certified by the National Committee for Quality Assurance. Before that she worked as a consultant and as Arizona’s deputy director of efficiency review under then-Gov. Janet Napolitano
The suit seeks $460,000 as well as back pay and other damages.
When I sat on the committee of six with Governor Kitzhaber as the dental representative, one of my concerns about the CCO formation was not being able to spread the resources across the entire company to support those areas that did not have enough Medicaid lives, but needed the services. A good example of this was John Day which does not have enough Medicaid lives there to support a dental clinic and had enough private pay dentists at the time. Being a state-wide plan, it was possible to take money from other areas that had enough to support them and cover the short fall in John Day so the citizens there could have access to dental care. I wonder is this is happening in Tillamook where the small CCO does on have enough money to cover the costs and I wonder if this happens in other areas as well. As more and more are required for the CCO's to do and with the squeeze on money to provide care, going to cause things like this and could it be part of the consolidation that I predict will happen under CCO 3.0 and the out of state corporitization of health care that is happening and trying to be addressed by Rep. Bowman and HB4130?
Mike Shirtcliff DMD, Equity Dental, LLC
Former CEO of Advantage Dental