Tuesday, September 30, 2008

Intrigue at West Virginia PEIA

Tuesday's Tale
A Credibility Crisis in West Virginia

Make the lie big, make it simple, keep saying it, and eventually they will believe it. ~Adolph Hitler

Daily the headlines remind each of us that corporate greed has caused fear, panic, loss of jobs, and major distrust. Worse yet it has shaken the very foundations of our stock market.

The New York Times, September 26, 2008
The chairman of the Securities and Exchange Commission, a longtime proponent of deregulation, acknowledged recently, “The last six months have made it abundantly clear that voluntary regulation does not work.”

The New York Times, September 30, 2008
We’re living in an age when a vast excess of capital sloshes around the world fueling cycles of bubble and bust. When the capital floods into a sector or economy, it washes away sober business practices, and habits of discipline and self-denial. Then the money managers panic and it sloshes out, punishing the just and unjust alike.

The Washington Post, September 30, 2007
The leaders of the country said: Trust us. The people said: Not this time.

The news in the financial markets has turned frightening, yet the impact for West Virginians of the appointment in 2006 of a former Carelink CEO to be the Director of the West Virginia state employees’ insurance plans, PEIA, may be tragic.

Following this appointment was the announcement of a questionable awarding of a $55 million a year contract to manage the health insurance program for more than 35,000 retired public employees, teachers, and school service workers to Coventry Health Care, Inc., the former boss of the new Director of PEIA.

How do they do it? How does Carelink Health Plans, Inc. "voluntarily" police themselves and grow their business? It’s with the assistance of unchecked regulatory agencies and a government that apparently assists big business at the cost of the consumer. Special interests just may have a tight hold on our lawmakers, our executive branch and even our judicial branch.

Something sinister in the works? On September 22, 2006, Governor Joe Manchin, appointed Ted Cheatham, former Carelink CEO, to be the Director of PEIA. Cheatham appeared to be a credible choice to be Director of PEIA. A few of us, however, had made a discovery that cast serious doubt.

Apparently, there exists a questionable pattern of behavior on the part of Coventry Health Care Inc. of Bethesda MD to fill important outside and inside positions with “company” people and hired people from the private sector who could likely influence decisions in Coventry’s favor throughout the system.

Of particular importance to me was the appointment of Bernard J. Mansheim, M.D. to be Chairman of the Board of Directors of the insurance regulatory body, URAC. At the time I first contacted URAC in 2005 to look into the questionable business practices of Coventry, I was unaware that this then Vice President of Coventry was appointed Co-Chair of the Board of Directors. URAC never responded to my request and I knew not to waste any more time.

Conflict of interest after conflict of interest. Nasty business tricks. Is this acceptable to us as citizens of West Virginia, a state that is in dire need of quality health care?

Mr. Ted Cheatham, former Carelink CEO, became Director of the PEIA on September 22, 2006. Within a few months, in a very pubic and transparent move, Cheatham awarded a “lucrative” contract to Coventry, his former boss.

“What's this all about?" It may well be Cheatham's connections. The lucrative contract was given to Carelink, despite Carelink's being the highest bidder of three bids. Carelink was higher that Humana. Carelink was higher than Highmark. Incredulously, with apparently little regulation and oversight, Carelink emerged the winner from the fray that ensued. It appears that yet another dark plot was executed before our very eyes.

This is all so messy, is it not?

Do not be fooled. We all will pay for the sins of greed and mismanagement, either in deterioration of our health or losing more of our paychecks. Yet, there's another cost to consider. The cost of more embarrassment to our wonderful state as truth becomes known. The embarrassment to family and friends of those who participated in questionable activities. The cost to our youth whose heroes may be men and women in public office who secretly act in unjust ways.

Time is ticking. A little late for many, but justice will come down hard on those who operate without a conscience. The Corrupt. The Liars. The Greedy. The Indifferent.

With transparency, regulation and accountability all will see the games played in West Virginia.

Please visit uniteforjustice.blogspot.com. Mr. Cheatham’s appointment has made a lot of news on the internet. Not much good news. I have many links that flag subsequent failures and questionable behaviors of the West Virginia PEIA.

Tuesday’s Tale
A Huge Loophole

These tales are tragic and infuriating.

"They let a clerk thousands of miles away make a life-threatening decision about my life and my baby's life without even seeing me and overruled five of my doctors," said Slidell, Louisiana resident Florence Corcoran. It is a story that echoes so many tragedies recounted in this book. But as with many of the other stories, there's a twist — a second tragedy. "They don't get held accountable. And that's what appalls me. I relive that all the time. Insurance companies don't answer to nobody."

Corcoran faced a high-risk pregnancy. Her obstetrician ordered her hospitalized, as she had been in a previous high-risk birth. Yet her managed health care company, United Healthcare, overruled her doctor and denied the hospitalization, even though it had a second opinion agreeing with the doctor's advice. Instead, Corcoran's insurer ordered home nursing for ten hours each day.

During the last month of Corcoran's pregnancy, when no nurse was on duty, the baby went into distress. Denied the monitors and care she would have had in the hospital, Florence Corcoran's baby died.

…"If I go out on the street and murder a person, I am thrown in jail for murder and held accountable," said Corcoran. "What's the difference between me and this clerk thousands of miles away making a life decision which took the life of my baby and she gets off scott-free and keeps her job?"

This is the dirty little secret that lets HMOs walk away from responsibility for denying or interfering with medically appropriate treatment. ~ Making a Killing: HMOs and the Threat to Your Health, Chapter 5

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