The American Spectator

DrTomVoter| 10.23.09 @ 1:57PM

What a nice convenient number. Let's see $90 x 10 years = $900B, in the realm of what Obamacare is alledged to cost. Problem solved! Details on eliminating the perpetually elusive fraud to follow later. Much, much, much later, if at all.

BigJava| 10.23.09 @ 2:38PM

Let's see, 60 Minutes has been doing stories
about Medicare/Medicaid fraud for how many DECADES now???!!!

Eric Cartman| 10.23.09 @ 6:23PM

Let's look at this equation:
Obama is having problems with his Obamacare bill. +
Nancy doesn't have the votes for the public option. +
Obama getting snarky with Fox News. +
Big percentage of Americans don't want Obamacare = Puff piece and examinations on why Obamacare will work better than medicare/medicaid and why we should support it.

Liberal Reader| 10.23.09 @ 6:33PM

60 Minutes to take up Medicare and Medicaid Fraud?

Impossible. 60 Minutes is part of the liberal conspiracy to destroy America.

Next thing you'll want us to believe is that the major news broadcasters are sticking up for Fox News!

Then ... and this will be a REAL joke ... you'll try to get us to believe that lib media organizations COMPETE with one another!

Ha! Ha!

That's a good one Klein!

What will they dream up next at the American Spectator?

DG in GA| 10.24.09 @ 12:30PM

It will be interesting to see how "60 Minutes" manages to hype the Obama Plan for cleaning up the Medicare/Medicaid fraud. They can't possibly do a truthful, unbiased story about this during the healthcare debate!

The Gamester Chronicles | 9.24.10 @ 12:56PM

The Players and whats up for grabs. Profits United Health Group 2010 $4.293 billion
Here are some other 2010 budget numbers: Wonder what it cost CMS ( Can't Manage Shit) to operate each year. $453 billion Medicare/// $290 billion Medicaid ///$78.7 billion Department of Health and Human Services/// UnitedHealth Group Awarded TRICARE Managed Care Support Contract ... Jul 13, 2009 ... UnitedHealth Group Awarded TRICARE Managed Care Support Contract for more than $20.3 billion. BILLIONS awarded and still to be awarded United's AmeriChoice unit is the largest government contractor administering state Medicaid programs for the poor and federally sponsored plans for children. AmeriChoice's revenue rose 34% last year, to $6 billion.

United Health Group and its subsidiarys must be exhausted from signing Corporate Integrity agreements each and every year and as reward for their violations well what happens? they are awarded more contracts and more money and maybe even an ambassadorship here and there and if anybody should question what the heck is going on, then send them a Elmo doll. (Americhoice sponsors Sesame Street) Up side, Billions to be made, down side pay some fines (cost of doing business) move on and nobody goes to jail or gets excluded from the game. Get up the next day put on your Elmo costume and its back to work as usual. WOW, even in the Casino world or Mob world this would be a no no, suprised Hollywood has not done a movie on this or maybe even great TV.

rudy| 10.13.10 @ 4:34PM

AmeriChoice is proud to collaborate with Mayor Nutter’s administration for the second consecutive year to help overcome the obstacles that could have resulted in the City closing its pools this summer,said Executive Director of Pennsylvania East AmeriChoice Ernie Monfiletto.Following the check presentation, AmeriChoice was presented with a health care Innovation Award by the National Association of Health Services Executives in recognition of its services to its Medicaid and Children’s Health Insurance (CHIP)members.

2009 and 2010 $120,000 blatant inducements from your tax dollars for the protected Medicaid vendor. Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools. These checks came from AmeriChoice Health and on the surface seems like fine gifts.Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind inducements in order to promote its share of the market place. This is not allowed as a use of your taxpayers dollars yet it happens.What will it really cost the City of Philadelphia to receive this money? Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that? Inducement. Section 1128A(a)(5) of the Act bars the offering of remuneration to Medicare or Medicaid beneficiaries where the person offering the remuneration knows or should know that the remuneration is likely to influence the beneficiary to order or receive items or services from a particular provider. The "should know" standard is met if a provider acts with deliberate ignorance or reckless disregard. No proof of specific intent is required.

Among its provisions, the anti-kickback statute penalizes anyone who knowingly and willfully solicits, receives, offers or pays remuneration in cash or in kind to induce, or in return for: A. Referring an individual to a person for the furnishing, or arranging for the furnishing, of any item or service payable under the Medicare or Medicaid program; or B. Purchasing, leasing or ordering , or arranging for or recommending purchasing, leasing or ordering, any goods, facility, service or item payable under the Medicare or Medicaid program. Violators are subject to criminal penalties, or exclusion from participation in the Medicare and Medicaid rograms, or both. A violation of the anti-kickback law is a felony offense that carries criminal fines of up to $25,000 per violation, imprisonment for up to five years and exclusion from government health care programs.The federal anti-kickback statute, 42 U.S.C.§ 1320a-7b(b), prohibits individuals or entities from knowingly and willfully offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by Medicare, Medicaid or any other federally funded program. For purposes of the anti-kickback statute, "remuneration" includes the transfer of anything of value, directly or indirectly, overtly or covertly, in cash or in-kind

If this were any one person they would be in jail now, if the FBI were called in on this matter they would be in jail now, if the IRS were notified they would be in jail now. Since all Ameri-Choice checks come from the United Health's home office they should be held equally responsible for any bribes, kickbacks, Stark, Fraud and inducements violations that have occured. Federal and State Governments have developed such a depended position with this company that laws and rules no longer apply. This role is nothing new for AmeriChoice Health, its been going on for years, look at some of the prior news articles that date back for years only now they can afford to hire the best of Law firms and give the most for Political contributations all on the back of the taxpayer.

Can you feel the Love| 11.4.10 @ 5:43AM

United Health Group Defrauded 100 Million Americans Posted on January 13th, 2009 by iwaller
An investigation begun by New York’s Attorney General, Andrew Cuomo said the company Ingenix, a research firm owned by UnitedHealth Group deliberately shorted reimbursements on out-of-network health insurance claims for Americans to the tune of hundreds of millions of dollars! Ingenix claimed it relied on ‘independent research from across the health care industry’ to determine reimbursement rates. However, UnitedHealth Group and its company Ingenix manipulated the health care claims presented by millions of Americans having health insurance and shorted their reimbursements between 10% and 28% of what the coverage should have paid. Instead, UnitedHealth Group, pocketed the millions of dollars it shorted Americans. UnitedHealth Group provides health benefits to 26 million Americans. Nearly all health care insurance companies in the country were using the same low reimbursement rates. Some of the largest health insurance companies who utilize the same Ingenix system are United Health Care (owned by UnitedHealth Group), Aetna, Cigna, Wellpoint/Empire BlueCross BlueShield and Genix. These companies are currently under investigation in New York suspected of participating in the same reimbursement fraud. How ironic UnitedHealth Group’s mission statement says in part: “We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve…We work with health care professionals to expand access to high-quality health care so people get the care they need at an affordable price.” Rather than anyone going to jail, UnitedHealth Group settled with the New York Attorney General by agreeing to pay $50 Million as the settlement to be used to establish and create a new database to determine rates for patients who choose physicians outside of the insurance giant’s network. Little good this does for the millions of Americans who were ripped off by these insurance scumbags. “This is a huge scam that affected hundreds of millions of Americans [who were] ripped off by their health insurance companies,” says Cuomo. “This was unethical, and it robbed vulnerable patients of insurance reimbursements they deserved.” Cuomo is now investigating other insurance companies that use Ingenix’s database. There may be millions more on the line as well. Of course, as is the corporate way of the guilty, UnitedHealth Group stated “We respectfully disagree with the New York Attorney General’s findings that we manipulated data … (or that our ownership of Ingenix was a conflict of interest.) We agreed to his settlement because it was an effective way to address any perceived conflict of interest.” The American Medical Association, represented by Dr. Nancy Nielson, president-elect of the AMA stated “there is a profit motive for keeping reimbursement low.” ”It is shocking and unacceptable for an insurance company to hide behind a shroud of secrecy”. Nielson also said “It is another example of UnitedHealth playing by its own rules.” This is not the first time UnitedHealth has been involved in legal action. In 2000, the AMA filed a lawsuit in federal court in New York over the exact same reimbursement issues. In May of 2008, Oxford Health Insurance, Inc, a unit of UnitedHealth Group, had to refund $50 million to small business customers in New York to settle claims it overcharged for health insurance policies back in 2006. More trouble from the past, when former CEO, William W. McGuire, M.D. was charged with securities fraud by the SEC. Mr. McGuire ultimately found guilty, had to repay $468 million as a partial settlement of the prosecution. In summary, I am of the opinion that corporate America is as corrupt as anywhere on earth. CEO bilking millions in golden parachutes and executive compensation, while American citizens fund their luxurious lifestyles with hard earn money, simply to be overcharged, cheated and ripped off by the rich and powerful. The UnitedHealth Group scam, is no different that the crooks on Wall Street: AIG, Goldman Sachs, Morgan Stanley, Merrill Lynch, Lehman Brothers, Bear Stearns, Fannie Mae, Freddie Mac, Citigroup, and other corporate manipulators such as Shell Oil, Exxon-Mobile, and so many other financial and energy leading companies. The free market system is over in America, thanks to corporate greed which took its roots during the Reagan trickledown economic philosophy. Corporate America cannot and should not be trusted and the federal government is almost in the same boat. Disdain for hardworking Americans by the Wall Street and Corporate America is so prevalent, they no longer tried to hide. The ‘haves’ continues to increase the divide between the ‘have not’s. Americans, Republicans and Democrats, should be outraged and the raping and pillaging of their money by Corporate America. We must begin to demand a government that works with incorporating fines and bringing to justice those criminals who rob, steal and cheap on a national basis from hard working citizens. None of the men leading these companies have gone to jail. Where is the justice for middle American who pays the bills for these outlaws?

Its Party Time| 11.5.10 @ 1:45PM

by New York State Insurance Department
NEW YORK, NY (12/10/2009)(readMedia)-- Governor David A. Paterson today announced that the Insurance Department has received requests from three New York State insurers or their subsidiaries to issue dividends of more than $1.2 billion, which will be sent to out-of-state corporate parents. The requests follow initial dividend actions from the same three insurers last year that totaled $948 million.

"The fact that health insurers take such large amounts of money out of the health care system while individual New Yorkers and small businesses struggle with skyrocketing health insurance premiums is deeply troubling," Governor Paterson said. "While rising unemployment is swelling the ranks of uninsured, the health insurance industry is making record dividends. State law allows them to issue these dividends to their out-of-state corporate parents, and there is nothing New York State regulators can do about it; they need the authority to protect consumers."

Insurance Superintendent James J. Wrynn said: "This is yet another reason the Legislature should reinstate the Insurance Department's authority to prior approve premium rate increases. Under the current 'file and use' methodology, the Department has little if any ability to review whether rate increases are excessive or consider the financial health of the insurer when it files for a rate increase. This year we received file and use applications for rate increases up to 33 percent. Prior approval would allow us to consider the insurer's overall financial condition when we review a proposed premium increase."

The following dividend requests were made to the Insurance Department and the Department of Health (dividend applications from HMOs are reviewed by the Department of Health, upon consultation with the Insurance Department):

Oxford: $800 Million. The total includes a request to dividend $400 million from Oxford Health Insurance, Inc. (OHI) to its sole shareholder and parent, Oxford Health Plans (OHP) and a request by OHP to dividend $800 million to its parent corporation, Oxford Health Plans, LLC. (The $800 million includes the $400 million from OHI, plus another $400 million from OHP's existing surplus).

Empire: $200 million. The total includes a request to dividend $90 million from Empire HealthChoice HMO, Inc. to its parent corporation, Empire HealthChoice Assurance Inc. and a request to dividend another $110 million from Empire HealthChoice Assurance, Inc. (for a total of $200 million) to its parent corporation, WellPoint Holding Corp.

Aetna: $134 million. Aetna Health, Inc. to its parent corporation, Aetna Health Holdings, LLC.

United Healthcare: $75 million. United Healthcare of N.Y. Inc. HMO to its parent corporation, AmeriChoice Corporation.

The dividends requested ranged as high as 18.7 percent of premiums:

Company Proposed Dividend 2008 Premium Percentage of premium
Oxford Health Plans(NY) HMO $800,000,000 $4,281,631,568* 18.7
Aetna Health HMO $134,000,000 $832,746,956 16
Empire Healthchoice Assurance $200,000,000 $7,866,209,688** 2.5
United Healthcare of NY, Inc. HMO $75,000,000 $730,572,429 10.3

* Includes $2,149,038,993 in OHI premium revenue.

** Includes $2,642,361,151 in Empire Healthchoice HMO premium revenue.

Last year, insurers released almost $1 billion in dividends:

$500 million. Oxford Health Plans (NY) to its parent corporation, Oxford Health Plans, LLC.

$48 million. Aetna Health Plan to its parent corporation, Aetna Health Holdings, LLC.

$400 million. Empire HealthChoice Assurance, Inc. to its parent corporation, WellPoint Holding Corp. Empire notes that these funds were primarily repayment of a capital loan from the parent WellPoint for the New York State employee drug benefit contract.

Since 1999, more than $5 billion in dividends have been issued industry wide, for a total of $5.4 million from that year through 2008.

Governor Paterson and the Insurance Department have urged the Legislature to restore its ability to approve health insurance rates for several years. Under current law, the Department is only allowed to review rate increases after they have gone into effect. Unfortunately, by the time the Department learns that the health plan increased their rates excessively; many consumers have already been priced out of the market due to the increase.

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A previous version of this release incorrectly stated that the following statements were given in support of reinstating the Department of Insurance's authority to approve premium rates. This is not correct. The following statements are not meant to reflect a position on this policy.

Kenneth E. Raske, President of the Greater New York Hospital Association, said: "While insurers seek to distribute $1.2 billion in dividends to out-of-state corporate parents a staggering 25 percent increase over last year hospitals on the frontline of patient care are struggling just to break even. That disparity should outrage all New Yorkers."

Daniel Sisto, President of the Healthcare Association of New York State, said: "This is a wake-up call to New York's businesses that for-profit HMOs are an ally to no one. These plans have established an astounding business model: saddle businesses with huge annual premium increases, complicate service delivery to patients and payments to providers, ship billions in profits out of state, and all the while blame everyone else for increased health care costs. At a time when sacrifice is requested from all health care sectors, these for-profit HMOs have instead responded with self interested protectionism. Now we know what these plans were really protecting -- their ability to transfer billions of dollars to out-of-state corporate parents, instead of using a fraction of these New York-derived profits to help protect health services for the very New Yorkers who are footing the bill."

Dr. David T. Hannan, President of the Medical Society of the State of New York, said: "The enormous dividend to be paid to corporate parents and shareholders demonstrates the need to return to the State Insurance Department the authority to review and approve health insurance rate requests. Returning this authority will not only better control health insurance premium increases, it will assure that health plan profits are reasonable and that companies are not allowed to extract excessive amounts of resources from the health care system in New York State and divert such resources to company dividends and profits."

Mark Scherzer, Legislative Counsel for New Yorkers for Accessible Health Coverage, said: "The very healthy profits being generated in our very unhealthy insurance market suggest the need not only for additional regulatory authority for the Insurance Department, but also for laws imposing greater limits on insurers' administrative expenses and requiring higher medical loss ratios for individual and small group health coverage."

Elisabeth Benjamin, Vice President for Health Initiatives at the Community Service Society and a leader of the Health Care for All New York Campaign said: "Our polling shows that New Yorkers understand that insurers are over-zealously hiking premiums, this practice underscores the need for the State lawmakers to reassert their ability to approve premium increases before they go into effect. In fact, 67% of New Yorkers believe that State insurance regulators should have the power to prevent these excessive rate increases."

Todd L. Shimkus, President and CEO of the Adirondack Regional Chamber of Commerce, said: "It's deeply offensive to see such excessive dividends paid to these insurers while we're seeing a record number of small businesses and sole proprietors forced to go without health insurance because of skyrocketing rates. Beyond going without, many of our family owned businesses are being forced to shift to high deductible plans or to pay their premiums with high interest credit cards. The small business community or what's left of it needs the legislature to authorize the Insurance Superintendent to be our consumer advocate by reinstituting prior approval."

Paul Muoio, on behalf of Benefit Specialists of NY, a wholly owned subsidiary of the Greater Syracuse Chamber of Commerce, said: "Health care reform, as well as health insurance reform, is not an easy fix. An appropriate prior approval process is only one of the many avenues required to address reform. We believe that to be an effective process that benefits the public and the business community, aspects of 'prior approval' must address the early release of rates, adequate stop-loss levels, an effective and time sensitive review process, and penalties for providing misleading or erroneous information during the review process."

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