Enjoy!

If you’re middle class (like most of us), you know about how health insurance premiums keep going up, covering less, and robbing you of more than your COL increments every year. In my post Health Insurance Racket as Organized Crime I outlined the details of how two of New York City’s major public health care providers filed RICO suits against UHC and its underlings.

Because it is a racket, it’s bankrupting citizens everywhere, and now it’s all the way to closing important hospitals DOWN because they can’t get insurance to pay for care to patients who *are* insured. A case study in how Corporate Greed and Unbridled Lust for Profit can end up destroying the entire fabric of the nation on which these corporate raiders depend for their very life.

Today New York state Attorney General Andrew Cuomo filed a formal Intent To Sue action against the database company Ingenix – owned by the same parent company as UHC – for its fraudulent manipulation of the database most insurance companies use to set reimbursement rates for out-of-network medical expenses.

The United insurers and many other health insurance companies relied on the Ingenix database to determine their “reasonable and customary” rates.  The Ingenix database used the insurers’ billing information to calculate a “reasonable and customary” rate for individual claims by assessing how much a similar type of medical service would typically cost, generally taking into account the type of service, physician, and geographical location.  However, the investigation showed that the “reasonable and customary” rates produced by Ingenix were remarkably lower than the actual cost of typical medical expenses.

Links:

Cuomo Announces Industry-Wide Investigation Into Health Care Insurers’ Fraudulent Reimbursement Scheme

The Health Care Plans: Worthless

The Health Insurance Racket as Organized Crime

The Truth About Insurance

NY Atty. Gen. announces investigation into health insurer fraud

“…insurers are just like shoplifters, they devise a new scheme a day.”
Michael A. Sedrish, M.D.
Director of Utilization Management
MediSys Health Network

In comments to other posts on the subject of the health care crisis in America, I have been asked to list some of the practices of health insurers that require rectification, and asked if doing away with health insurance altogether might be the best option for the country.

It is difficult to use examples from other people’s health insurance horror stories or even my own – though such horror stories are common enough – as objective justification for my belief that insurers need to be stripped of their excessive profits retroactively for at least a decade and a half (by means of punitive fines), and that a complete realignment of health care in America to single-payer, universal care is the best possible option for our society in the 21st century.

So instead of simply re-telling horror stories people find too easy to ignore, I will instead offer some facts and testimony related to current lawsuits against major insurers, their subsidiaries and partners in New York State. The suits were filed in February of 2007 for violations of the RICO Act [Racketeer Influenced and Corrupt Organizations] by Jamaica Hospital Medical Center, the Flushing Hospital Medical Center in Queens (1) and the Brookdale University Hospital and Medical Center (2) against United Health Group, United Health Care and other of their subsidiaries in one suit, and HIP, Cogent, Central Brooklyn Medical Group, P.C., HealthCare Partners, LLC and others in the other, for implementing a “pattern of racketeering activity” to deny coverage, and implementing a “rogue business plan” on a “national level.”

United-Oxford Racketeering Complaint

HIP-Cogent Racketeering Complaint

The suits are particular to New York State, but allude to nationwide practices in hopes that a favorable judgment will allow punitive actions in all other states against the racketeers conspiring to loot and destroy the nation’s health care system entirely. To take it specifically apart from New York, the record notes that the State of Nebraska Department of Insurance filed a petition charging that UHG and several of its subsidiaries (including the United Health Care parent of United-NY) of “flagrantly and in conscious disregard of Nebraska insurance Statutes and Rules and Regulations” violated more than ten Nebraska laws governing the conduct of HMOs and their insurers.

The list of New York statutes violated in the RICO suit is lengthy, taken from among hundreds of violations found in the different hospitals’ records. There are an even dozen violations of law listed in one complaint.

The Associated Press reported on United Healthcare’s nationwide scam back in October of 2006 with the story United Healthcare’s Stock Options Problems, when UH fired its then-current CEO for violations of SEC law. A problem the AP reported extended well beyond United to hit “at least” 135 companies who disclosed that their stock options practices were under investigation by the SEC or Department of Justice.

In testimony before the New York State Assembly Committees on Health and Insurance on December 1, 2006, David Rosen, M.D. (President and CEO of MediSys Health Network) accused United Health of some serious violations, including…

– Wrongful denial of coverage, often after services have been provided to patients whose admission to the hospitals was approved by United and oxford for their members, “in intentional and systemic violation of the Public Health Laws and Insurance Laws (and thereby breach their contracts with the Hospitals) in order to reduce their financial responsibilities to hospitals and increase their own profits at the direct expense of the institutions.”

– By backdating its contract with Jamaica, (which they subsequently admitted in a sworn statement) fraudulently requiring Jamaica Hospital to remain in the United/Oxford network at the time Jamaica Hospital attempted to remove itself from the Oxford network.

– Using economic pressure that Oxford fraudulently created to coerce Jamaica Hospital and Flushing Hospital to “strong arm” a group of anesthesiologists who practiced at Flushing Hospital to joint the Oxford network.

– Wrongful denial of coverage at Flushing Hospital by falsely telling their members that flushing Hospital was “not a network provider,” thus “allocating a greater share of the costs of the medical services as the patients’ responsibility.”

So you see, it’s not just the middle class insured who are being screwed into going bankrupt because the expensive insurance they’ve been paying for (often for many years) refuses to cover their health care. It’s also the poor, and the taxpayers of the states who pay for coverage for them from insurers like UHG. The public and teaching hospitals charged to provide care to these people sometimes must wait years to be paid for services – if they are ever paid at all – and it is of course the taxpayers who must make up the shortfalls in order to keep those hospitals open.

Read some of the complaints, press releases and testimony linked above and below if you have any doubts at all as to just how insidious the situation really is, or just how desperate the screwed health care providers are becoming. Fact is, the health insurance scam is bankrupting our entire nation’s health care system – on purpose, for profit – while the taxpayers end up having to pay for the care twice or three times as these billionaires laugh all the way to the Caymans.

This is THE MOST EXPENSIVE, LEAST EFFECTIVE, MOST INEFFICIENT method of providing what amounts to universal health care in America. We can simply outlaw the scammers, fine them the illegal profits they haven’t already hidden away in Swiss bank accounts, and use that money to cover the necessary immediate switch-over to more efficient, less expensive single-payer health care.

Any questions remaining on whether or not there’s a “real” crisis in this country? Is anybody ever going to ask the Republican candidates for President why they’ve chosen to pretend otherwise? Any defense of Democratic candidates’ band-aid plans that do nothing more than force everyone to purchase junk insurance that won’t pay for their health care needs?

Denial is not just a river in Egypt. We must deal with this situation sooner, not later. And in our current age of “Greed Is Good,” there’s really only one sane way to deal with it. It’s called Single-Payer, Universal Care. Once we are not being robbed blind by white collar criminals, we CAN afford it!

Links:

United-Oxford Racketeering Complaint

United-Oxford Racketeering Suit Press Release

HIP-Cogent Racketeering Complaint

HIP-Cogent Racketeering Suit Press Release

Hospitalists’ role at center of racketeering lawsuit

Testimony by David P. Rosen, President & CEO, MediSys Health Network

Testimony by Michael A. Sedrish, M.D., Director of Utilization Management, MediSys Health Network

Hospital execs slam UnitedHealth: “sociopathic willingness to ignore laws”

United Healthcare’s Stock Options Problems

AHIP: America’s Health Insurance Plans (lobbyists for industry)