This morning, The New York Times is reporting that New York prosecutors under the leadership of Attorney General Andrew Cuomo, are investigating whether Wall Street banks withheld crucial information about the risks posed by investments linked to subprime loans.
It's long, long overdue for state prosecutors to focus on the illegal and criminal activity of the health insurance industry.
I think I can speak for all of us in urging Mr. Cuomo to lead the nation, and swiftly turn his attention to the health insurance industry.
Does Cuomo have the courage to do this? Will Cuomo and his army of prosecutors ignore ongoing illegal criminal activity? Is Cuomo a leader, or part of the problem? It remains to be seen.
What follows is testimony before a committee of the New York State Assembly, of a courageous hospital CEO and his Director of Utilization Management. You'll glimpse the all-encompassing corruption and power of the health insurance industry in the United States. You'll be appalled and horrified to see how the political system is doing nothing to protect the American people from this predatory and merciless industry.
By the time you finish, you'll know why the Murder By Spreadsheet industry doesn't pay claims, doctors, or hospitals. You understand, why with reckless abandon, health insurers deny chemotherapy to cancer patients, prescriptions to policyholders, and MRIs to sick children.
It's all here. Rarely seen or heard candor. Indelicate, graphic, and explosive words and phrases to describe the insurance industry and its flagrant abuses and criminal behavior.
The words should set your hair on fire: "sociopathic", "profit", "defraud", "profit". You see, healthcare in America has only one goal--profit. Phrases like, "undeniably dangerous industry", "a failure of government to protect its citizens and the public trust", "a sociopathic willingness by HMOs to ignore laws".
All of this has fallen on deaf ears. Who's to blame? For starters, the corporate media. Without a doubt, look-the-other-way state and federal regulators. And yes, you and me. Blame us. The American people are being scammed, defrauded and destroyed, but we still tolerate, to one extent or another, this depraved state of affairs.
As I told you a few days ago, I had the pleasure of several lengthy meetings with David Rosen, the CEO of Medisys Health.
Last week, we met for over four hours in his office at Jamaica Hospital. We were joined by Michael A. Sedrish, MD Director of Utilization Management for MediSys Health Network. Rosen summarized his dealings with the insurance industry with this blunt assessment, "it's a scam a day". He paused, then added, " insurers are just like shoplifters, they devise a new scheme every day."
Before I headed back to Manhattan, Dr. Sedrish took me on a tour of the hospital's overflowing emergency room.
What follows is some of the breathtaking testimony Mr. Rosen and Dr. Sedrish gave in 2006 before the New York State Assembly Committee on Health and Insurance. It never saw the light of day, because I suppose, the corporate owned media didn't find it as compelling as say, John Edwards haircut or Britany Spears breakdown.
Like I said, I saw the ER. The patients lined two deep are people who would die under a bridge if not for a hospital like Jamaica.
Here are some excerpts. I urge you to read all of it. A link "Medisys Hospitals Battle Large Health Insurer" is posted on the front page of the Medisys Health web site.
A 'SAFETY NET' HOSPITAL UNDER SIEGE BY THE INSURANCE INDUSTRY
My name is David P. Rosen, and I am the President and Chief Executive Officer of the MediSys Health Network, and of Jamaica Hospital Medical Center, Flushing Hospital Medical Center, and Brookdale University Hospital and Medical Center.
These are "safety net" hospitals, serving vital community needs with services such as Level One Trauma Centers, obstetrics, (New York Department of Health)designated Stroke Centers, HIV, Traumatic Brain Injury, Psychiatry, and a vast array of off site ambulatory care facilities with over 750,000 patient visits annually. Jamaica and Brookdale’s ERs each provide over 100,000 visits per year. These community anchors serve numerous medically underserved zip codes, and provide employment for over 10,000 people, many of whom reside in the local communities served by these hospitals.
The hospitals are losing money but the insurers profits have never been better. In 2005, William W. McGuire, M.D., its CEO, earned $124 million. His compensation in the five years 2001-2005 was $341 million. Please read this SEC report about backdated stock options fraud which gave this criminal around a billion--with a B--dollars.
WHERE ARE THE REGULATORS?
I will recite specific examples of the kinds of egregious misuse of power by HMO’s that our current regulators have ignored that undoubtedly result from the increased power that health plan consolidation has spawned. One glaring example of the result of the imbalance between the power of the HMOs and the hospitals in our "market place" is the growing dichotomy of consecutive years of hospital losses in New York State contrasted with record and growing profits for HMOs and health insurers who sell coverage in New York. For the eighth straight year, New York’s hospitals have lost money -- totaling over $2 billion during that time. In 2005 alone, these hospitals lost nearly $100 million. In 2005, New York licensed HMO’s profits exceeded $1 billion, totaling over $4 billion during the past nine years. That imbalance ($4 billion in N.Y. HMO profits vs. $2 billion in NY hospital losses) has been allowed to proliferate under
our current system with HMO mergers being approved withoutpublic hearings, while HMO abuses of the system are going unchecked by their regulators.
YOU ARE ON YOUR OWN
However, the marketplace can only "work" if there is REAL regulatory oversight with REAL consequences for those HMOs that seek to "game" the system to shift to their members, to publicly supported hospitals, and ultimately to the tax paying public, what should be the financial obligations of the HMOs. Unfortunately, as I will detail in a minute, there is NO REAL regulatory oversight and there are NO REAL consequences for HMOs that abuse the power our "regulators" have allowed the HMOs to accumulate. The results of this regulatory void are the EXCESSIVE PROFITS the HMOs drain from our healthcare system, and the attendant abuses that inevitably emerge with such unchecked incentives to cash in.
DEATH TO YOU AND ME BY A MILLION CUTS AND "LITTLE FRAUDS"
First, we must recognize some facts: HMOs defraud their individual members out of $1,000 here, $2,000 there in specific instances. No single member is likely to sue over such small amounts, as aggravated as they may be. But the total value to the HMO forthese "little" frauds is MILLIONS of dollars. Hospitals, particularly those like the ones I represent, can little afford to sue individually. Litigationis expensive -- not just in legal fees, but in the diversion of hospital administrative resources. On top of this, our state regulators are "paper tigers," or understaffed, or simply lack enforcement tools and a proper legislative framework.
The testimony of Dr. Sedrish is chilling--absolutely chilling.
"UNDENIABLY DANGEROUS MANAGED HEALTH-CARE DOMINATED INDUSTRY"
I am Michael Sedrish, Director of Utilization Management, MediSys Health Network, a practicing physician for 30 years. I have also been actively involved in health care policy and quality of care issues for many years.
I am deeply concerned with the prospect of further empowering abusive managed care companies to continue profiteering at the expense of the good of society. . .
My own opinion is that permitting any further consolidation within our currently dysfunctional and undeniably dangerous managed health care-dominated industry will without doubt further compromise all providers’ capacity to offer quality care, the level of care each of you would demand for your families, precipitate an unsustainable fiscal crisis, and serve to facilitate further abuses of defenseless providers and patients.
THIS IS NOT A DAILY KOS DIARY--BUT IT SURE READS LIKE ONE!
In the early 1990s the decision was made to hand over a public trust, the multi-billion dollar health care industry, to business people. Businesses are in business to generate profits. When obstacles to profit arise, social conscience and principles are often sacrificed to assuage the demands of shareholders and as we have recently discovered to feed the greed of executives. In recent years we have repeatedly witnessed the inability of industries to be trusted to regulate themselves. It is painfully clear that you get what you inspect, not what you expect. If our government compromises, we are all compromised.
We are today presented with the opportunity for public servants of vision and courage to step forward and rectify a failure of government to protect its citizens and a public trust.
"A SOCIOPATHIC WILLINGNESS BY HMOS TO IGNORE LAWS"
We witness on a daily basis an almost sociopathic willingness by HMOs to ignore laws and regulations originally promulgated to protect consumers and providers. Their ability to avoid effective regulatory enforcement and meaningful penalties, including the possibility of revocation of their license to operate within our State, has only emboldened these HMOs. Avoiding payments to hospitals and other providers of care by placing barriers to appropriate care, refusing payments (i.e. denials) or indefinitely delaying payments for appropriate services already provided in good faith, refusing to recognize inquiries or to fairly negotiate, are just some of the consequences which without doubt have severely compromised the availability and quality of health care as well as patient and provider satisfaction. Their demonstrated standard business practices and policies have progressively crippled hospitals struggling to continue to provide excellent care in the face of decreasing reimbursements and increased costs of operation.
When will CEOs and executives of hospitals across the nation step forward and give similar testimony?
Why wasn't all this on the front page of the New York Times?
Medisys Health is providing healthcare services to a drastically underserved, largely low-income, minority population. One glance at the frenetic emergency room was an eye opening experience. Doctors and nurses struggling to provide compassionate care under extremely difficult circumstances. Yet Rosen lamented that insurers "pull up a truck to the back door and stuff it with money".
Dear friends, this is the scenerio we're facing. These are the criminals that even our leading Democratic Presidential candidates want the American people to entrust with our lives. Maybe if they read this diary, and the ones that will follow, they'll understand piling millions of Americans into this sinking ship, under the control of pirate insurance industry captains makes no sense.
But despite all odds, David Rosen and his team have managed to keep the hospitals open, running and serving a very needy community. I'm telling you this so any detractors stay away.
When you're fighting the sort of monsters Rosen has decided he must take on, as you might expect, there will be people out to destroy you.
This is going to be the first in an ongoing series. Coming soon will be a diary on the RICO lawsuit Medisys Health has pending against UnitedHealth and others. The allegations are complex and shocking.
If anyone wants additional information or to speak to Mr. Rosen, they should contact Idan Sims at idan@simsinc.com