Insurance Executive Admits To Killing Patients

blue note · Jun 30, 2009

Twenty stories to a page. Out of curiosity, I wondered how many pages of stories there were. I made it to page 145, (which means 2900 stories so far) and I am still going.
Herring is right, I don't understand how people can not see what happens when capitalism runs wild.

Yet, they are adamant about not letting the government compete in a free market by offering a public option as an alternative to the private insurance companies.

blue note · Jun 30, 2009

Even those with health insurance are going broke

Full article at Seattle Times

When Mark Moody and Glenda Krull could no longer afford both health insurance and mortgage payments, the Edmonds couple knew which had to go.
They sold their house.
Moody, 60, had a liver transplant four years ago and may need another. He alone pays $1,345 a month for the most generous policy he can buy from Premera Blue Cross.
And he's desperate to hang on to it-even though the costly premiums drove his wife to downgrade her own coverage, decimated their retirement savings and, just this month, forced them out of their well-appointed home into a newly purchased house half its size.
For Americans with serious illnesses, even good insurance is no guarantee they won't go broke and they will get all the medical care they need.
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"It's not just the uninsured. It's people who have insurance that doesn't protect them" who are fueling the hunger for reform, said Sara Collins, an economist and a vice president at The Commonwealth Fund, a private health-care foundation in New York.
Until about a year ago, Moody and Krull lived comfortably on her earnings as an associate broker for Windermere Real Estate. But despite their income and his seemingly gold-plated coverage, he can't get either a second organ transplant or an expensive drug that might eradicate his hepatitis C without risking financial peril.

blue note · Jun 30, 2009

We Must Stop the Rampant Fraud in the Health Care Industry

by Sen. Bernie Sanders (a real health care reformer)

As a member of the Senate health committee, one of two Senate panels dealing with health care reform, it has become apparent to me that real health care reform must address the billions of dollars in fraud and abuse that comes from the major corporations in the health care industry.
What we have seen over the last several decades is the systemic fraud perpetrated by private insurance companies, private drug companies, and private for-profit hospitals ripping off the American people and the taxpayers of this country to the tune of many billions of dollars.
The rampant fraud is another reason why our current health care system, dominated by private insurance companies, is the most costly, wasteful, complicated and bureaucratic in the world. Its function is not to provide quality health care, but to make huge profits for those who own the companies. With 1,300 private insurance companies and thousands of different health benefit programs designed to maximize profits, our country spends an incredible 30 percent of each health care dollar on administration and billing, exorbitant CEO compensation packages, advertising, lobbying and campaign contributions. Public programs like Medicare, Medicaid and the VA are administered for much less.
In recent years, not only have we seen massive fraud by the health care industry, but we also have been paying for a huge increase in health care bureaucrats and bill collectors. Over the last three decades, the number of administrative personnel has grown by 25 times the number of physicians. Doctors and nurses in Vermont have described to me in painful detail the amount of time and money they are forced to waste negotiating with insurance companies about how they can treat their patients.
Not surprisingly, while health care costs are soaring, so are the profits of private health insurance companies. From 2003 to 2007, the combined profits of the nation's major health insurance companies increased by 170 percent. And the top executives in the industry are receiving lavish compensation packages -- averaging $14.2 million for the top seven companies.
On top of all of this, a review of court records and other public documents shows that billions more dollars are being lost to fraud and outright corruption. Importantly, this is not the case of "one bad player" acting illegally. This is a situation where fraud appears to me part of the normal business model. It is the rule and not the exception.

There is example after example indicating that virtually all of the major pharmaceutical companies, insurance companies and private hospital chains have been involved in massive health care fraud over the past decade.
Health and Human Services Department investigators earlier this year found that 80 percent of insurance companies participating in the Medicare prescription drug benefit overcharged subscribers and taxpayers by an estimated $4.4 billion.
There also have been major criminal and civil cases against many of the leading corporate health care providers in the country, including:
In 2004, Warner-Lambert, a division of Pfizer Inc., pled guilty to two felonies and agreed to pay $430 million for fraudulently promoting the drug Neurontin.
In 2003, GlaxoSmithKline paid $88 million in civil fines for overcharging Medicaid for its anti-depressant Paxil.
In 1999, Hoffmann-LaRoche paid a $500 million criminal fine for leading a worldwide conspiracy to fix prices for certain vitamins.
In 2009, UnitedHealth, a leading insurance company, paid $350 million to settle lawsuits brought by the American Medical Association and other physician groups for shortchanging consumers and physicians for medical services outside its preferred network.
In 2009, the Centers for Medicare & Medicaid Services barred WellPoint, a major insurance company, from participating in Medicare Part D because WellPoint has "demonstrated a longstanding and persistent failure to comply with CMS's requirements for proper administration..."
In 2000, the Hospital Corporation of America agreed to pay $745 million to settle civil charges that it systematically defrauded Medicare, Medicaid and other federally-funded health programs.
It is absolutely imperative that real health care reform prevent major insurance companies, drug companies and hospital chains from perpetrating fraud and abuse on government health care programs and individuals, which are driving up health care costs in this country by billions of dollars every single year.
To me, the evidence is overwhelming that we must end the for-profit private insurance company domination of health care in our country and move toward a publicly-funded, single-payer Medicare for All system.

blue note · Jun 30, 2009

New Report: Private Insurance Mergers Lead to Near-Monopolies Across the Country

Full article here

Senator Charles Schumer (D-NY) joined Health Care for America Now (HCAN) - the nation's largest health care campaign - in releasing a new report today that shows extreme health insurance industry consolidation has resulted in a market failure where a small number of large companies use their concentrated power to control premium levels, benefit packages, and provider payments in the markets they dominate. As a result, health insurance premiums have skyrocketed, going up more than 87% - on average - over the past six years.
"This is the starkest evidence yet that the private health care insurance market is in bad need of some healthy competition," Senator Schumer said. "A public health insurance option is critical to ensure the greatest amount of choice possible for consumers. We believe that it is fully possible to create a public health insurance plan that delivers all the benefits of increased competition without relying on unfair, built-in advantages. If a level playing field exists, then private insurers will have to compete based on quality of care and pricing, instead of just competing for the healthiest consumers."
After reviewing the report entitled "Premiums Soaring in Consolidated Health Insurance Market," David Balto, former Policy Director of the Federal Trade Commission and now a Senior Fellow at the Center for American Progress, sent a letter -co-signed by HCAN - to the Department of Justice Antitrust Division asking for a comprehensive investigation into the health insurance marketplace.

StNeotser, ASN, RN · Jul 8, 2009

I'm hoping one day people like this will face homicide charges.

karenchad · Jul 8, 2009

DITO- It will be difficult to prove since it's probably burried under layers of camoflage. Look at the hospitals we work in- The CEO- High Salary, then all the entourage under him/her taking up office space, with a smoke screen of "all this paperwork" what EXACTLY do they do?? I always see them ambulating the halls- free physical therapy?? Mall walkers??? Hospital administrators- always posing for pictures/ maybe their supermodels and we don't know it. The hospital lawyer- who thinks up excuses to answer real or potential sentenal event- they blame the one who reports this stuff to them- it's what they do in the court room- discredit the witness. The finance director and the marketing director- controlling the purse strings of hiring more staff nurses- nursing is the first to get cut when they scream budget- all these years that never made any sence to me. If these business people want to practice nursing and medicine- they should go to school for it, or start being held accountable for their reckless decisions. I'm sick of them practising with my license- 6 patients on a Tele floor for dayshift. ( I went on a health fair to do B/P's- the Marketing director went also -- stood around all day with his arms folded, looking down at us nurses like we were dirt- he went and had 2 free chair messages- jerk) He gave all our most senior nurses early retirement packages( optional : take it or loose your retirement) and said bye-bye to them. I wonder if he took a pay cut? No new hiring to replace these nurses. He declared war on the neighboring hospital claiming it is taking our patients away (by suing them) -- How much does he think that's going to cost/ priorities. I also do agency(as no more overtime, must punch a clock)- as an agency I was sent to a hospital with 6 levels of nursing management- a charge nurse, a unit manager, a UNIT director, a director of the directors, , a VP nursing and a chief Nursing officer-WHY??? Talk about fiscal waste in healthcare. The entire system is corrupt and UNCHECKED. The only agency that seems to be watching the hospital/healthcare industry is Medicare. ( hospital aquired infection rates vs no reimbursement) Our Nursing Associations need to ban together and take back the practice of nursing, and the President needs to stop running off to Russia- don't forget he's a lawyer also and so is is wife. I don't think there's going to be much change coming anytime soon.

elkpark · Jul 8, 2009

I'm hoping one day people like this will face homicide charges.

Not only is that unlikely to happen -- while I was living in OH a few years ago, the OH state legislature passed legislation (at the behest of the insurance companies, of course) that specifically stated/defined that physicians who were employed by insurance companies (making determinations about paying or refusing claims) were not "practicing medicine" as legally defined in the state of OH -- so that those physicians could not either be disciplined by the state medical board or sued for malpractice as a result of the medical decisions they made while working for the insurance company ...

I don't know how many other states have passed similar "immunity" statutes for insurance company docs, but I would be v. surprised if OH were the only one ...