Tuesday, September 21, 2010

Coventry Health Care Inc of Bethesda MD in Legal Battle of their Life

Deceit Meets Perseverance
Since we have such a huge crowd of men of faith watching us from the grandstands, let us strip off anything that slows us down or holds us back, and especially those sins that wrap themselves so tightly around our feet and trip us up; and let us run with patience the particular race that God has set before us. Hebrews 12: 1

Coventry Health Care Inc of Bethesda MD wants to believe they know who I am, that an interview with their forensic psychologist Dr. David Clayman of Charleston WV in the spring of this year will enlighten them and enable them to “spin” a case against me. Ultimately, my peers will be the judge.

There has been talk of "loose relationships" and a questioning of the role catholic clergy have played in my life these past five years. Just words. Ever so casually spoken, I believe, to place doubt about my character.

I have enjoyed a close, warm relationship with Bernard W. Schmitt, retired Bishop of the Catholic Diocese of Wheeling-Charleston (WV) for over thirty years. Bishop Schmitt recommended me to become a member of the Persons with Disabilities Advisory Council of my diocese in 2008:

Persons with Disabilities Advisory Council Candidate Recommendation

I am happy to recommend Penny Stenger to be considered as a member of the Persons with Disability Advisory Council for the Diocese of Wheeling-Charleston. I have read and understand the rationale, criteria for membership and eligibility guidelines and believe this person will be a good council representative.

Additional comments:

“A truly dedicated, committed, and persevering individual.”

Bernard W. Schmitt
Bishop Emeritus
Retired Bishop of the catholic Diocese of Wheeling-Charleston

April 28, 2008

Tuesday’s Tale
Coventry's Miscue

by Joe Padula
 Managed Care Matters
 July 2, 2010

Yesterday's Louisiana appellate court ruling against Coventry's First Health work comp network is a major blow to comp insurers, employers, and networks in Louisiana, with potential impact in other states as well.…

The court's finding supported a lower court's ruling affirming a state statute requiring PPOs to provide injured workers with PPO identity cards or give notice to providers 30 days before taking discounts. While Coventry will appeal to the state Supreme Court, the appellate court ruled against almost all of Coventry's arguments, making this an uphill battle for the nation's biggest work comp managed care firm. I'd also note that the decision itself takes Coventry's legal team to task for failings to accurately cite evidence in its written appeal, stating the "failure to provide record citations suggests that many of these assignments were interposed only for purposes of delay and confusion." (My emphasis)

Ouch. (no pun intended)

While the finding may be bad enough, the size of the penalty is stunning - Coventry will have to pay $262 million - $2000 for each of the "131,024 instances in the past 10 years when it discounted providers' charges below the state workers' compensation fee schedule." (WorkCompCentral)

Some workers comp networks decided early on to avoid doing business at all in LA; MedRisk (HSA client) left the state after the initial ruling against Coventry along with several other PPO and specialty networks.


For Coventry, it doesn't look good (My emphasis). While I have taken the company to task in the past for what I perceive to be missteps, and some would argue that they should have pulled out long ago, it's hard to fault Coventry for believing they could conduct business in LA as they do in most other states, by contracting with providers to deliver discounted care to workers comp claimants. The additional notice requirements in Louisiana are unique to that state; in retrospect all networks should have picked up on this nuance, but in retrospect we all would have sold our stocks two months ago...

It doesn't look good for employers in Louisiana either. As MedRisk's General Counsel, Darrell Demoss noted in the WorkCompCentral piece, WCRI data suggests comp medical costs are significantly higher in Louisiana than in other states. Now that the ruling has been upheld, expect insurers and managed care organizations to avoid the state completely in fear that they too could be nailed by class-action suit.

On a national basis, this ruling will likely cause many network vendors and insurers to stop and very carefully review each state's laws and regulations pertaining to networks, with compliance staffs tasked with doubly ensuring their contracts comply with the letter and spirit of each jurisdiction's rules and regs. That's not a bad thing, as it's a heck of a lot cheaper to pay attorneys and compliance staff than a $262 million penalty.

What does this mean for you?

Sorry, but bad news on a Friday - and a holiday Friday at that.

Except if you're a comp provider in LA.

Thanks to WorkCompCentral for the heads up.

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