Over the last couple of months, I've told you about David Rosen, the CEO of Medisys Health.
In several conversation I had with Rosen, he discussed institutionalized and organized corruption at the highest levels of U.S. health insurance companies. He described regulators who look the other way, politicians who listen to his documented litany of insurance industry crimes, say they will "look into it," and then do nothing. He called what is going on in the United States "nationwide insurance industry fraud."
Then in a second diary, I told you about his testimony before a committee of the New York State Assembly.
Today, I'm going to give you a brief update on several very significant legal actions which may focus a harsh national spotlight on the murderous and predatory U.S. health insurance industry.
Finally, we may be seeing action. A few politicians (thank you, Andrew Cuomo), are finally getting the message and doing their jobs.
If you continue reading, please keep in mind, that companies like UnitedHealth and Blue Shield of California, are the corrupt institutions which both Senator Obama and Senator Clinton intend to entrust with the health of the American people when and if they enact healthcare reform. The status quo will only change on the margins--insurance may become slightly more affordable, pre-existing conditions will be covered, but you and I will still be in the death grip of a totally discredited industry.
This morning, I'm also going to introduce you to Michael Brown, the hero lawyer, who is spearheading the Medisys lawsuit, I've previously told you about.
The most high profile legal action seems to be in New York and California.
The always phenomenal Lisa Girion is reporting in the Los Angeles Times, that a retroactive recission suit against Blue Shield is headed to the 4th District Court of Appeals in California.
The outcome of the Haileys' case against Blue Shield could change the way insurers do business in California and influence reform efforts by state regulators and lawmakers. As the first case of its kind to reach an appellate court in California, it will test the legality of retroactive health policy cancellations, a controversial industrywide practice that has driven canceled consumers into debt and forced them to forgo needed medical treatment.
. . .Whatever the 4th District Court of Appeal in Santa Ana decides could affect hundreds of suits challenging such cancellations as illegal and unfair.
Such retroactive rescissions have come under scrutiny in recent months because of the hardships they create for patients. A Los Angeles Times article detailed the turmoil of a Murrieta family whose daughter had an aggressive cancer-like tumor, a Riverside couple who sold their home to pay off medical debts and a Van Nuys small-business owner who was maxing out credit cards to get therapy for his disabled infant twins.
http://www.latimes.com/...
Pay particular attention the the next blockquote. These health insurers feel so omnipotent that they are impervious to the regulators.
State regulators recently levied a $1-million fine against Blue Cross of California, the state's biggest health insurer, over retroactive cancellations. Regulators say they are investigating other carriers, including Blue Shield.
But regulatory actions have failed to stop the cancellations, and none of the lawsuits has resolved the dispute over whether such actions violate the law. The Orange County court is poised to do that.
Noting the "broad public interest" in the test case, the appellate court invited consumer advocates, regulators and industry representatives to weigh in, an unusual move suggesting that the panel sees more at stake than just the case at hand. The court asked for briefs on the law and public policy "against improper health policy cancellations and post-claims underwriting."
"They want to know: How big is this problem?" said Amy Bach, executive director of United Policyholders, a nonprofit organization based in San Francisco, which plans to submit a brief. "Clearly, the court is smelling something bigger."
http://www.latimes.com/...
Let's move to the other coast, New York, where the New York Attorney General, Andrew Cuomo is also turning up the heat on this criminal, Murder By Spreadsheet industry. You starting to see see something interesting happening?
Just as an aside, I'm now writing for the Huffington Post. Last month I wrote an essay called Falling in Love--with Andrew Cuomo, when he launched the investigation. It's a recap of round one.
The Cuomo investigation is widening, as well it should. Let's hope Cuomo gets these CEOs under oath.
New York Subpoenas Several Health Insurers
New York’s attorney general, Andrew M. Cuomo, said Thursday that he had issued new subpoenas to Aetna, Cigna, the UnitedHealth Group, WellPoint and other health insurers in a broadening investigation of a practice that he said was unfairly costing consumers hundreds of millions of dollars.
He is also looking to subpoena testimony from the chief executives of those companies, as well as from executives of Empire Blue Cross Blue Shield, Excellus and the combined Group Health Inc. and HIP Health Plan.
http://www.nytimes.com/...
I'll end by giving you an update on the David vs Goliath Medisys lawsuit, which I believe may have contributed to Cuomo taking action.
Michael Brown is the lawyer for Medisys.I had the pleasure of meeting Michael about a month ago. This is a man you'd want on your side if you were in trouble. You wouldn't want him as an adversary. He is clear, focused, meticulous and ready to do battle with the largest of our Murder By Spreadsheet insurers. He had a lot to say. I left the meeting with reams of legal papers and a notebook filled with my scribblings of our conversation.
Believe me, the Medisys fight is our fight. Medisys led the way several years ago.
These are a couple of things Brown said which may give you further insight into why notably New York and California have decided the time has come move more aggressively.
I am not going to put anything he said in quotes, because I may have missed a few words over the course of three or more hours.
I asked Michael why they are pursuing a rackeeting lawsuit, and I asked him to explain what rackeeting consitutes.
Implementing a fraudulent scheme, through what the law calls an entrprise. . .a group of two or more individuals who come together to commit a fraud through a pettern of racketeering.
Is UnitedHealth an example?
We have alleged in the complaint that the parent and several subsidiaries, including Oxford and UnitedHealth Care of New York have engaged in conduct which constitutes a violation of the RICO statute.
IS the CEO involved? [This is a huge--nyceve]
One motivation of their conduct was to fund McGuire's compensation.
Let me remind anyone who may have forgotten, former Chief Executive Officer William W. McGuire agreed to increase to more than $600 million his repayment of benefits after an investigation of stock options that investors claimed in a lawsuit were illegally backdated. Federal investigators are still probing the matter.
There's much more on the Medisys lawsuit, it's very technical and complicated. What's important to note is that the despicable way UnitedHealth does business has permeated deep into every nook and crevice of healthcare in the United States.
It's not just you, me, David Rosen, Michael Brown, Andrew Cuomo, who recognize this reality, it's just about everyone. Keep reading.
Survey of Hospital Execs Reveals Stark Differences Among Health Insurance Companies
Although many Americans seem to regard health insurance companies as equally objectionable and unresponsive, the DAVIES survey revealed that one insurer generated particularly intense feelings among hospital executives. A full 91% of those surveyed indicated an unfavorable opinion of United Healthcare. This compares with an average unfavorable rating of 41% among all other insurers in the survey. Last year’s survey reached a similar conclusion with 87% of participants ranking United as "difficult" or "very difficult" to deal with.
"The striking thing is that United was not the largest payor in terms of revenue for the average hospital, and its reimbursement rates were not significantly lower than other major payors," said Brandon Edwards, President/COO of DAVIES. "All insurance companies are big and most are regarded as tight-fisted by providers. But the survey indicates that United takes things to a different level: providers see them as untrustworthy and dishonest. This was an unanticipated finding."
http://biz.yahoo.com/...
Best case scenerio, the American people are being continually defrauded by the for-profit insurance industry. Worst case, these predatory companies know full well that people battling grave and life-threatening illness like cancer, cannot also battle teams of insurance company specialists trained in denying healthcare.
These companies are square in the middle of Clinton and Obama healthcare reform.
Can you understand why some of us are less than enthusiastic?