Tuesday, February 10, 2009

Beware, Coventry, America Rages

Tuesday’s Tirade
The Likes of Coventry and Bernard Madoff

Whistleblower Harry Markopolos tried to report the illegal scam of Wall Street financier Bernard Madoff for a decade to the SEC. On December 11, 2008, the FBI arrested Bernard Madoff and charged him with what may be the largest fraud ever. As wealthy victims raged, others asked, “What took our government so long?”

Markopolos recently gave a highly disturbing testimony before a House Financial Services subcommittee hearing:

"(The SEC is) captive to the industry it regulates and is afraid" to bring big cases against prominent individuals,” Markopolos said. … He and his colleagues avoided taking their allegations to the industry self-regulatory agency, now called Finra, he said in the statement, because he believed Mr. Madoff and his brother, Peter B. Madoff, wielded too much power with that organization.
Read more at http://www.freewebs.com/courageoffaith/Madoff%20SEC%20Hinders%20Case.doc

In my four year investigation into the unjust and illegal practices of Coventry Health Care, Inc. of Bethesda MD, I have met like resistance. Since January 2007, the West Virginia Insurance Commission has refused to enforce Final Order 02-AP-064 dated December 14, 2006, and signed by the Insurance Commissioner against Carelink Health Plans, a subsidiary of Coventry. This order mandated radical change in how HMOs do business in West Virginia.

Frank Hartman, former Chief Advocate for the Office of Consumer Advocacy, represented me at the formal hearing before Judge Jack Debolt. Hartman forcefully explained the significance of this order:

A few of the reasons your case is so important:

First and foremost it is important because consumer victories against insurance companies are few and far between. Think of all you have gone through, from the physical suffering of your illness to the treatment you received by Carelink representatives. The long drawn-out process is emotionally draining and extremely difficult. The vast majority of people quit long before this. You have survived. Simply by being here and fighting you have won.

Next, the case is significant for the far-reaching implications about how HMO’s must do business in the state of West Virginia henceforth. As a result of the Commissioner’s Order, HMO’s must evaluate all reasons for the coverage determination of a requested procedure and make a more thoughtful and accurate initial decision because they will be bound to that decision throughout the appeals process. They can no longer deny first and determine a rationale later only to subsequently change the stated rationale yet again.

Read Post

Last year, in an intolerable situation, the health insurance regulatory agency NCQA rated my former HMO as “excellent” despite the final order and the filing of a civil law suit (Christine Stenger v. Carelink Health Plans and Patrick Dowd with allegations of discrimination against someone with a disability). Greatly disturbing, NCQA based its evaluation solely on voluntary information provided by the health insurance plan.

Some day the truth will set us free. There will be consequences; it is inevitable. America will demand the truth about how HMOs operate under the radar and destroy lives. West Virginians will demand the truth about West Virginia’s captivity to special interests.

In the meantime, no one should be surprised at the growing discord and raging storms. As government fails to listen to the frustrated voices of ordinary citizens a growing storm rises. How much more can we endure? No one has the answer.

Tuesday’s Tale
Coventry: There’s no place to hide.

Our country desperately needs people to rail against injustice. The internet is a source of ideas and supporting evidence that will help inform people’s consciences. That will create change.

Coventry Health Care, Inc. of Bethesda MD wears a public and private face. It is the private face that interests the consumer. Rules of Governance? Stellar operation? Just “google” Coventry and read of real problems. Serious problems, according to some experts.

For the third quarter in a row, unexpectedly high medical costs appear to have taken the management of Coventry Health Care by surprise. The cost, this time, was severe: shares of the health-insurance firm lost more than half their value today, meaning that while Coventry was worth more than $4 billion yesterday, today it’s valued at only a little more than $2 billion.
~Coventry Health Suddenly Looks Like a Target — If Anyone is Buying October 22nd, 2008, By David P. Hamilton

Here's the ugly truth - and it reflects not on you (Coventry employees), but on Coventry management. Their arrogance and hubris has been the cause of their downfall. So confident were they in their abilities that they ignored the basics of the business - issue cards on time, monitor IBNRs, track medical trend and all its components, stick to what you know, treat customers as you would like to be treated. Now that it's too late, we finally hear a chastened, perhaps even humble tone from Coventry management.

~Managed Care Matters, 2009

"Allen Wise earned a strong reputation for leading Coventry Health Care Inc. (CVH) through a turnaround years ago, and now the struggling managed-care company's board is looking for him to stage a repeat performance. With the industry facing a host of economic, cyclical and political pressures, the job may be more challenging this time…While Wise is highly respected in the managed-care industry and helped deliver strong results during his earlier tenure as chief executive, the analyst said, he faces the task of "turning the company around in the middle of a brutal recession as well as a much tighter current industry pricing environment than we saw during 1999-2005."

~Easybourse January 27, 2009

There are still examples of eyebrow-raising paydays, including the options valued at $37.5 million that Coventry Health Care gave incoming CEO Dale B. Wolf, making him Maryland’s highest-paid chief executive.
~U.S. ‘Not Getting What We Pay For’: Many Experts Sa Health-Care System is Inefficient by Ceci Connolly, Washington Post, Sunday, November 30, 2008;

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