UK's elderly care plan run by US "cheats"
[Fred A. Baughman Jr., MD: Fred A. Baughman Jr., MD comments on (with thanks to Vera Sharav): Subject: UK's Elderly Care Plan Run by US "Cheats" Sent: Tuesday, November 12, 2002 6:32 AM] 

  ALLIANCE FOR HUMAN RESEARCH PROTECTION
   (AHRP)
  http://www.ahrp.org
  Contact: Vera Hassner Sharav
  212-595-8974
  e-mail: veracare@ahrp.org
 
  FYI
 
  Healthcare fraud is bankrupting the American healthcare system, and leaving
  41.2 million Americans without healthcare insurance because the cost is so
  high. British newspapers--The Observer and The Guardian--report that the UK
  government has hired United Healthcare, a US company, as consultants for its
  National Health Services.
 
  But United Healthcare has been engaged in corrupt practices in the US: the
  company was fined $7 million within the last two years for cheating US
  taxpayers, doctors and patients in nine states. Among the corrupt practices
  found by state insurance commissions and federal auditors, the company had
  over-billed for nursing home care for people who weren't in nursing homes.
  Furthermore, a United vice-president, Michael Mooney, was sentenced in
  August to 3 1/2 years in jail and fined $220,000 after he was prosecuted by
  the American Economic Crimes Unit for insider trading.
 
  Notwithstanding the company's record of crimes and fines, the UK Health
  Secretary has hired the company to set up "a model" of healthcare for the
  elderly after having talks with US Secretary Tommy Thompson. When asked
  about the company's corrupt practices, a UK spokesperson said simply:
  "this was part and parcel of operating in the health industry in the US."
 
  So it would appear.
 
  Could it be that President Bush, who is reported to have publicly praised
  the company, have been unaware of its corrupt activities? Or, could it be
  that the company's contribution to the Republican Party might have
  influenced the President and his administrators to disregard corporate
  defrauding of the American taxpayers?
[Fred A. Baughman Jr., MD: All of our friends in the UK should be forewarned. Nothing about the US healthcare scheme--all dollar-directed--none of it patient-directed (other than to get to the credit card) should be emulated. You are meeting the basic health care needs of your people keeping it affordable. Allow private practice for those who think they need more, sooner, not realizing that they are a target in the US scheme for physician-induced-need and for an increased volume and intensity of prescribing more likely to result in worse than better outcomes. Here in Southern California, where I live, Kaiser Permanente, does it right while containing costs, keeping care affordable for vastly more than if nothing but profit-directed care were available. Wise up before you take this step or turn decision-making over to these types. Here in the states, our medical schools--medical academia--has allowed the for-profit takeover by producing a monstrous glut of practitioners, meaning that doctors must view every new patient as a profit point. See Who Stole U.S. Health Care? (The A.M.A.-- A.A.M.C. Sell-Out of Marcus Welby, MD) by Fred A. Baughman Jr, MD ] 
  ~~~~~~~~~~~~~~~
  http://society.guardian.co.uk/longtermcare/story/0,8150,837698,00.html
 
  UK's elderly care plan run by US "cheats"
  Firm fined $7m in string of cases
  Antony Barnett and Solomon Hughes
  Sunday November 10, 2002
  The Observer
 
  An American firm hired by Health Secretary Alan Milburn to transform the way
  elderly patients are treated in the NHS has been fined more than $7 million
  (£4.4m) in the past two years for allegedly cheating the US government,
  doctors and patients.
 
  United Healthcare, an American private insurer, claims that its Evercare
  programme in the US has halved the number of elderly people being admitted
  to hospital by treating them at home or elsewhere in the community.
 
  Milburn announced in October that he was signing a major contract with
  United Healthcare for consultancy advice on how to cut costs in the NHS by
  keeping the elderly patients out of hospital. The firm is being hired
  initially to help design, monitor and advise on the running of 10 pilot
  schemes expected to start in the NHS before Christmas.
 
  However, The Observer discovered that over the past two years, United
  Healthcare has been forced to pay millions of dollars in fines to settle
  charges that it had defrauded the US government, patients and doctors .
 
  The firm paid $2.9m last November to settle claims that it had falsely
  charged the US government for patients it claimed were in nursing homes. The
  over-billing was discovered when federal auditors checked the records of a
  random group of United Healthcare patients listed as institutionalised, and
  found that almost one in three was not in long-term care at all.
 
  United Healthcare paid the fine to settle the suit, but did not admit any
  wrongdoing.
 
  In July the New York Department of Insurance fined United Healthcare $1.5m
  for cheating patients out of money. The firm was 'failing to give proper
  notice of the right to appeal' when denying patients health insurance
  payments.
 
  The Observer has identified a further 10 fines levied by State Insurance
  Commissioners since March 2000. United paid out almost £2m in nine states,
  including Florida, Texas, Ohio and New Jersey. Some of these fines were for
  late payments to doctors, patients and hospitals and in one case for passing
  work to a doctor whose medical licence had been revoked.
 
  The firm has faced other controversies. In August Michael Mooney, a United
  vice-president, was jailed for three and a half years and fined $220,000
  after he was prosecuted by the American Economic Crimes Unit for insider
  trading.
 
  Milburn became interested in United Healthcare after talks with US Health
  Secretary Tommy Thompson last month.
 
  President George Bush has publicly praised the firm's Evercare programme,
  which Milburn wants to use as a model for the NHS. This year the firm has
  paid $84,000 to the Republican Party.
 
  A Department of Health spokesman said that an independent evaluation for the
  US government this year concluded that Evercare had reduced hospital
  admission by about 50 per cent without increasing patient mortality.
 
  Asked about the firm's catalogue of fines, a Health Department spokeswoman
  said this was part and parcel of operating in the health industry in the US.
  She said: 'We are entirely satisfied that the procurement process was
  correctly following before signing the deal.'
 
  A spokesman for United Healthcare said: 'We look after the healthcare of
  millions of Americans and most are extremely happy with what we offer. Of
  course we occasionally make mistakes and because of the litigious nature of
  the US these are often settled in court.'
 
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