Health Plan Faces Fines of $1.33 Billion | By Lisa Girion | The Los Angeles Times | Tuesday 29 January 2008
California regulators are expected to announce today that they are seeking as much as $1.33 billion in penalties from Cypress-based PacifiCare as a result of widespread problems stemming from its takeover two years ago by healthcare giant UnitedHealth Group Inc.
In an investigation prompted by widespread complaints, the state Department of Insurance uncovered 133,000 alleged violations of state laws and regulations regarding payments for medical care. Each violation carries a maximum penalty of $10,000 for a possible total of $1.33 billion.
Separately, the state Department of Managed Health Care alleged that 30% of the medical claims it reviewed were improperly denied. That agency is seeking an additional $3.5 million in fines.
"These were very serious violations," said Cindy Ehnes, executive director of the Department of Managed Health Care. "The most fundamental promise of insurance is that they will pay when you are sick, and they will pay those physicians and hospitals in a fair manner." ...
...
The potential fines are the latest black eye for UnitedHealth. Longtime Chief Executive William McGuire resigned in 2006. Last month, in the first settlement of its kind under post-Enron corporate reforms, he agreed to pay $468 million to avoid trial on charges that he secretly padded his paycheck by manipulating stock options. ...
Wednesday, January 30, 2008
Vitorin: found to work no better than lower priced Zocor ... $3 a pill compared with 3 cents a pill
Tuesday, January 29, 2008 by CommonDreams.org | Pay No Attention to That Clinical Data or Squandered Tax Payer Dollars for Medicaid Drugs | by Martha Rosenberg
“The American Heart Association is cautioning patients if they stop taking Vytorin abruptly, Schering-Plough and Merck’s stock price will fall.”
That’s how a cartoon showing a news anchor would read after revelations that the American Heart Association–which receives nearly $2 million a year from Vytorin makers Merck and Schering-Plough–and the American College of Cardiology told patients to stay on the drug despite a recent damning study.
Cholesterol drug, Vytorin was hyped as treating “cholesterol from two sources: food and family” but found to work no better than lower priced Zocor in the Enhance clinical study whose results were released in January.
...
The state of New York, for example, spent $21 million for Medicaid prescriptions for Vytorin in the last two years–it costs $3 a pill compared with 3 cents a pill for Zocor–prompting New York Attorney General Andrew Cuomo to also launch an investigation.
“Drug companies are on notice that concealing critical information about life-saving prescription drugs, profiting at the expense of patients’ health, and wasting taxpayer dollars, is simply unacceptable,” said Cuomo. ...
“The American Heart Association is cautioning patients if they stop taking Vytorin abruptly, Schering-Plough and Merck’s stock price will fall.”
That’s how a cartoon showing a news anchor would read after revelations that the American Heart Association–which receives nearly $2 million a year from Vytorin makers Merck and Schering-Plough–and the American College of Cardiology told patients to stay on the drug despite a recent damning study.
Cholesterol drug, Vytorin was hyped as treating “cholesterol from two sources: food and family” but found to work no better than lower priced Zocor in the Enhance clinical study whose results were released in January.
...
The state of New York, for example, spent $21 million for Medicaid prescriptions for Vytorin in the last two years–it costs $3 a pill compared with 3 cents a pill for Zocor–prompting New York Attorney General Andrew Cuomo to also launch an investigation.
“Drug companies are on notice that concealing critical information about life-saving prescription drugs, profiting at the expense of patients’ health, and wasting taxpayer dollars, is simply unacceptable,” said Cuomo. ...
Monday, January 21, 2008
1 in 5 returning troops may have brain injury
1 in 5 returning troops may have brain injury | Many do not know symptoms can be treated, U.S. Army officials said | AP | Jan. 17, 2008
WASHINGTON - As many as 20 percent of U.S. combat troops who fought in Iraq or Afghanistan leave with signs they may have had a concussion, and some do not realize they need treatment, Army officials said Thursday.
Concussion is a common term for mild traumatic brain injury, or TBI. While the Army has a handle on treating more severe brain injuries, it is "challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said Brig. Gen. Donald Bradshaw, chairman of a task force on traumatic brain injury created by the Army surgeon general. ...
WASHINGTON - As many as 20 percent of U.S. combat troops who fought in Iraq or Afghanistan leave with signs they may have had a concussion, and some do not realize they need treatment, Army officials said Thursday.
Concussion is a common term for mild traumatic brain injury, or TBI. While the Army has a handle on treating more severe brain injuries, it is "challenged to understand, diagnose and treat military personnel who suffer with mild TBI," said Brig. Gen. Donald Bradshaw, chairman of a task force on traumatic brain injury created by the Army surgeon general. ...
Thursday, January 17, 2008
Drug trails bias[ed] toward reporting positive results: 94 percent of the positive studies ... [only] 14 percent of disappointing results
Antidepressant Studies Unpublished | By BENEDICT CAREY | Published: January 17, 2008
The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.
In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.
Previous research had found a similar bias toward reporting positive results for a variety of medications; and many researchers have questioned the reported effectiveness of antidepressants. But the new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.
The finding is likely to inflame a continuing debate about how drug trial data is reported. ...
The makers of antidepressants like Prozac and Paxil never published the results of about a third of the drug trials that they conducted to win government approval, misleading doctors and consumers about the drugs’ true effectiveness, a new analysis has found.
In published trials, about 60 percent of people taking the drugs report significant relief from depression, compared with roughly 40 percent of those on placebo pills. But when the less positive, unpublished trials are included, the advantage shrinks: the drugs outperform placebos, but by a modest margin, concludes the new report, which appears Thursday in The New England Journal of Medicine.
Previous research had found a similar bias toward reporting positive results for a variety of medications; and many researchers have questioned the reported effectiveness of antidepressants. But the new analysis, reviewing data from 74 trials involving 12 drugs, is the most thorough to date. And it documents a large difference: while 94 percent of the positive studies found their way into print, just 14 percent of those with disappointing or uncertain results did.
The finding is likely to inflame a continuing debate about how drug trial data is reported. ...
Wednesday, January 16, 2008
Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004
ER waits dangerously long in U.S.: study | Tue Jan 15, 2008 11:45am EST
WASHINGTON (Reuters) - Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, especially people with heart attacks, U.S. researchers reported on Tuesday.
They found a quarter of heart attack victims waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36 percent longer between 1997 and 2004, the team at Harvard Medical School reported.
Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40 percent longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs.
Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found. ...
...
"Emergency physicians have said for years that crowding and long wait times are hurting our patients -- insured and uninsured equally," ACEP president Dr. Linda Lawrence said in a statement.
"Ever-lengthening waits are a frightening trend because any delays in care can make the difference between life and death for some patients. The number of emergency patients is increasing while the number of hospital beds continues to drop. It is a recipe for disaster." ...
WASHINGTON (Reuters) - Patients seeking urgent care in U.S. emergency rooms are waiting longer than in the 1990s, especially people with heart attacks, U.S. researchers reported on Tuesday.
They found a quarter of heart attack victims waited 50 minutes or more before seeing a doctor in 2004. Waits for all types of emergency department visits became 36 percent longer between 1997 and 2004, the team at Harvard Medical School reported.
Especially unsettling, people who had seen a triage nurse and been designated as needing immediate attention waited 40 percent longer -- from an average of 10 minutes in 1997 to an average 14 minutes in 2004, the researchers report in the journal Health Affairs.
Heart attack patients waited eight minutes in 1997 but 20 minutes in 2004, Dr. Andrew Wilper and colleagues found. ...
...
"Emergency physicians have said for years that crowding and long wait times are hurting our patients -- insured and uninsured equally," ACEP president Dr. Linda Lawrence said in a statement.
"Ever-lengthening waits are a frightening trend because any delays in care can make the difference between life and death for some patients. The number of emergency patients is increasing while the number of hospital beds continues to drop. It is a recipe for disaster." ...
France best, US worst in preventable death ranking
France best, US worst in preventable death ranking | Tue Jan 8, 2008 12:15am EST | By Will Dunham
WASHINGTON, Jan 8 (Reuters) - France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.
If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.
...
Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study. ...
...
France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said.
After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.
...
The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings. ...
WASHINGTON, Jan 8 (Reuters) - France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday.
If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.
...
Nolte said the large number of Americans who lack any type of health insurance -- about 47 million people in a country of about 300 million, according to U.S. government estimates -- probably was a key factor in the poor showing of the United States compared to other industrialized nations in the study. ...
...
France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said.
After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last.
...
The researchers compared these rankings with rankings for the same 19 countries covering the period of 1997 and 1998. France and Japan also were first and second in those rankings, while the United States was 15th, meaning it fell four places in the latest rankings. ...
Monday, January 7, 2008
Death by Profit Margin: Let's start with a fundamental truth: Insurance companies are in the business of not paying claims.
Death by Profit Margin | Posted by Christy Hardin Smith, Firedoglake at 11:10 AM on December 25, 2007.
This is not an isolated incident. The next one could be you or someone you love...
This is not an isolated incident. The next one could be you or someone you love...
Let's start with a fundamental truth: Insurance companies are in the business of not paying claims.
By not paying your claim, they get to keep all those premiums you pay. Maximizing their benefit by minimizing their risk, by finding loopholes and other reason to deny claims unless and until they are either cornered into paying them or a claim is so clear-cut they can't avoid it under risk of bad faith. Welcome to the wonderful world of profit and to hell with the consequences.
From AP via the Insurance Times:
Many successful companies are known for taking risks. Cigna Corp. isn't one of them....
The lack of risky business, Wall Street analysts say, has helped Cigna avoid many problems associated with rising health costs, an issue plaguing competing health plans. And the company's low profile has made it less of a target for class action suits filed in recent years accusing HMOs of putting profits ahead of patient care. Cigna has been named in only two of six lawsuits, most of which are either pending or that have ended with rulings in the industry's favor. But Cigna officials say their quiet stance means the company's accomplishments aren't well known....
Insurance companies make money by finding ways to not pay claims. That's the truth of it. This past week, we sadly saw the result of this in the death of Nataline Sarkisyan. From the CA Nurses Association:
On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial. The physicians said that Nataline "currently meets criteria to be listed as Status 1A" for a transplant. They also challenged CIGNA's denial which the company said occurred because their benefit plan "does not cover experimental, investigational and unproven services," to which the doctors replied, "Nataline's case is in fact none of the above." ...
Subscribe to:
Posts (Atom)