Tuesday, May 5, 2009

Coventry Health Care, Inc. Exposed Again

Tuesday’s Tirade
Deceptive Marketing or Fraud?

"The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy."
—Martin Luther King, Jr.

There is a systemic evil in our health care system. It costs lives.

Take a real close look at Coventry Health Care, Inc. of Bethesda, MD, formerly a Fortune 500 Company. They are not what they “appear” to be. In late 2008 a promotional brochure began to circulate:


With over 120,000 members throughout West Virginia there are many good reasons to choose Coventry.

Committed to Unparalleled Service

In September 2007, Carelink was awarded a three year accreditation status of “Excellent” on our commercial HMO/POS products by the National Committee for Quality Assurance, Carelink’s accreditation status is the highest possible level.

The reality, however, is shocking and disturbing.

We know that regulatory agencies must protect the public from the self-interests of health plans. One such agency is the West Virginia Insurance Commission, headed since 2001 by Jane Cline who describes her role on the Commission’s website:

“It is essential that a healthy, competitive insurance industry be accessible to all West Virginians. As Insurance Commissioner, my primary goal is to make certain that the insurance industry in West Virginia provides excellent service to consumers. I am also committed to increasing the number of quality insurance companies offering products throughout the state."

West Virginia Insurance Commissioner Jane Cline signed Final Order 06-AP-024 in January 2007. This order mandates a radical change in how Carelink is to do business in West Virginia due to its “egregious” treatment of a consumer. Carelink, a Coventry company, defied this order. Cline has refused to enforce an order she signed.

Even more disturbing, NCQA, the regulatory agency that accredited Carelink with “Excellent” in 2007, as stated in the 2007 Coventry brochure, was formed in 1979 by and for HMOs. That accreditation is paper thin as it is based solely on voluntary information. A health plan is not investigated and, therefore, does not have to provide involvement in questionable activities.

The dictionary defines fraud as deceit, trickery, sharp practice, or breach of confidence, perpetrated for profit or to gain some unfair or dishonest advantage.

As NCQA wields its influence across our country, US News and World Report annually publishes its top 100 health plans. It relies on NCQA data. Deceit? Trickery perpetrated for profit or to gain some unfair or dishonest advantage?

Google “HMO horror stories." Form your own judgment about Coventry, other health plans and the insurance regulatory system that should protect the consumer.
If you accept what is reported here, stand up against the ruthless treatment of consumers by their health plans. Today Congress is preparing to pass health care reform championed by special interests. We must hear your voice.

Join me today in making a difference.

Tuesday's Tale
A Milestone

It was May 5, 2005, when Dr. Bernard Costello, my neurosurgeon, requested that Coventry Health Care Inc authorize my medically necessary surgery to treat severe sleep apnea. Coventry quickly denied Dr. Costello’s request. That was four years ago today.
During four years of investigating Coventry, a new face was revealed. Coventry has operated with indifference to the pain and suffering of the consumer. And they are getting away with it!

Attorney Jim Bordas of the Wheeling law firm Bordas and Bordas employs a successful strategy when mediating with the Defendant. Bordas employs a taped reenactment of the events that led to a trial. The language indicts:

(The defendant) disregarded the laws of the state of West Virginia and federal government with deadly consequences. They demonstrated disrespect and contempt for the law with a direct knowledge of employers.

(The defendant) even disregarded its own policies and procedures to which they played lip service and which were established to protect the public. Worst of all, some of its actions were clearly deliberate.

They were willing to sacrifice lives for a profit. (The defendant) made conscious decisions puts people in peril for their lives; their indifference insures death.

The case in unusually strong, including powerful evidence of corporate wrongdoing and egregious violations driven by the bottom line. There is an avalanche of evidence that their own employees confirmed.

The jury will be shocked. Specific details will horrify the jury and send a message that this behavior will not be tolerated in West Virginia.

Coventry Health Care Inc of Bethesda MD will soon face a court of law, having been accused of discrimination and intimidation of a consumer. I believe that the attorney for the Plaintiff will employ much of the same language cited in the above case to convict Coventry.

And, yes, the jury will be shocked.

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