Friday, April 1, 2011

Death by Medicaid: A child has died

A child has died but insurance company profits remain high.

Wall Street's pillaging of Medicaid and Medicare to the tune of over $111 billion in 2010 helped push net earnings for some companies 21% to 81% higher than 2009. Seven of the nine companies I've been tracking bragged in their 2010 SEC filings about the $19.5 billion saved off the top of federal and state Medicaid and Medicare contracts by lowering the amount of every dollar actually spent on costs.

What even The Wall Street Journal has failed to notice is that lowering costs (variously called the Medical Loss Ratio, Medical Benefits Ratio, Health Benefits Ratio, etc.) only happens when you cut services.

There is a human cost to these cuts in services. When life-saving medications are suddenly denied, thereby lowering the MLR, the company is taking a chance the patient will continue to live while the savings are realized.

A little boy has paid the price for this with his life, however, and no one is doing anything about it.

Different branches of the Federal government have been receiving complaints about Hawaii's Med-Quest program and providers UnitedHealth Group and Wellcare since August 2009. Federal Medicaid regulators from the Centers for Medicare & Medicaid Services (CMS) along with the DHHS Office for Civil Rights have been kept aware of a continuing pattern of Medicaid service cuts that persistently violate federal Medicaid regulations and civil rights.

My daughter is alive because I have learned how to play the insurance company game. They will suddenly deny one of Hannah's medications (or refuse to fill a new prescription), and I don't find out until I call to see if I can pick it up. Hannah's Medicaid provider, UnitedHealth, has told the pharmacy they won't pay for it, and then starts the back and forth over prior authorizations. New medical orders for Hannah's ketogenic diet, used to control her seizures, have still not been filled fifteen days after submission. I also have not received anything in writing from the insurance company. One prescription was finally filled on Tuesday after I emailed the president of the company and the state Medquest office.

But what about the families who don't know the insurance company is just playing a game with them?

How many federal investigations does it take before somebody sees the pattern and puts a stop to it?

A young man who is a double amputee and lost the use of both arms now requires dialysis after twenty-two different medications have been denied insurance payment. CMS and state Medicaid officials have been following the case since January. CMS has also been looking into potential Medicare fraud by UnitedHealth as a result of this case.

A five year old medically fragile child's home nursing hours were cut 33% while she was hospitalized for a worsening of her seizure condition. The cut was to go into effect immediately upon her return home, with the parents never to this day (it's been two weeks) receiving anything in writing from UnitedHealth. CMS and OCR have been following this case closely as well.

Medicaid "hit squads" have been terrorizing the families of medically fragile children here for months. A mother was verbally abused for not understanding medically technical language, and another mom was told she didn't spend enough time with her child. UnitedHealth later tried to trick a mom into agreeing with their proposed reduction in nursing hours by repeatedly asking, "it's reasonable, isn't it?" CMS, OCR and state Medicaid officials are following these cases as well.

Meanwhile, Medicaid insurance company Wellcare admitted to drafting anti-consumer state legislation in Hawaii that would have directly benefited the company as well as UnitedHealth. State legislation is still alive that will deprive everyone covered by UnitedHealth and Wellcare of any outside appeals by patients who don't agree with the companies' cuts in services to bolster stock prices. (It will also do away with the current independent review source for such profit-based decisions for people holding employer-paid health policies at HMSA, HMAA, Kaiser, UHA and other insurers).

A federal whistleblower complaint unsealed last summer, using information gathered during an eighteen-month cloak and dagger investigation, quoted Wellcare executives lauding the profitability of Medicaid contracts to provide care for the elderly and disabled. The head of "utilization management" (cost cutting from state and federal contracts) was quoted saying "we would prefer it if they would die because it's cheaper."

Our government has essentially given Wall Street a license to kill the weakest members of our society: the elderly, and children as well as adults with disabilities. The recession has ironically boosted corporate insurance profits tremendously, as states carve out new Medicaid and Medicare contracts that are put out to bid to private insurers. Between June 2008 and December 2010, UnitedHealth Group's Medicaid revenue skyrocketed by more than 640%. The company hit its lowest medical benefit ratio in five years in fourth quarter 2010, coming in at less than eighty cents on the dollar while annual after-tax profit was up 21%.

How does the life of a little boy figure into these types of calculations?

A federal employee told me yesterday that his death is not a civil rights issue, it is an issue instead for the regulators. This information has distressed me, as it belittles his life. Our children's lives should not be profit centers. Federal and state dollars spent on care for the elderly and people with disabilities should be used to pay for services, not CEO salaries (almost $9.5 million to UnitedHealth's CEO in 2009).

The practice of allowing profit making companies to pillage federal coffers under the guise of providing cost-effective "managed care" to the elderly and people with disabilities must be stopped.

No more children can be allowed to die.

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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.