Sunday, September 27, 2009
In a bit of a pickle





Saturday, September 12, 2009
A pattern of behavior suggests less than full cooperation from the health care industry
After a rather aggravating discussion this past week with rank-and-file members of the local Democratic Party as well as representatives for elected officials, it became clear that hold-outs in Congress who refuse to commit that they will do everything possible to obtain the public option are not on the same page as us.They believe they need to make no commitments to anyone, including constituents, in order to have maximum negotiating power when bargaining with the health care industry.
We, on the other hand, believe they simply need to do their utmost to get the public option, which is not the same as bargaining away and settling for less.
I was pretty steamed about this situation. Perhaps if I knew less about the health care industry's performance over the last couple of decades I might be more amenable and understanding.
But I do know about these choice examples -– and they are only a very small number, a smattering of cases presented here in no particular order which exemplify a problem across the health care industry:
09/03/09 -- Justice Department Announces Largest Health Care Fraud Settlement in Its History
http://www.fiercehealthcare.com/press-releases/justice-department-announces-largest-health-care-fraud-settlement-its-history#ixzz0QrvWqayw
"...American pharmaceutical giant Pfizer Inc. and its subsidiary Pharmacia & Upjohn Company Inc. (hereinafter together "Pfizer") have agreed to pay $2.3 billion, the largest health care fraud settlement in the history of the Department of Justice, to resolve criminal and civil liability arising from the illegal promotion of certain pharmaceutical products, the Justice Department announced today.
Pharmacia & Upjohn Company has agreed to plead guilty to a felony violation of the Food, Drug and Cosmetic Act for misbranding Bextra with the intent to defraud or mislead. Bextra is an anti-inflammatory drug that Pfizer pulled from the market in 2005."
04/23/08 -- Former Bristol-Myers Squibb Senior Vice President indicted for lying to the Federal Government about popular blood-thinning drug
http://www.usdoj.gov/atr/public/press_releases/2008/232525.htm
"The Department of Justice announced today that the former senior vice president of Bristol-Myers Squibb Company (BMS), Andrew Bodnar, was indicted for his role in lying to the federal government about a patent deal involving the popular blood-thinning drug, Plavix, used by heart attack, stroke and other patients.
[snip]
On June 11, 2007, BMS agreed to plead guilty and pay a $1 million criminal fine for misleading the government about the Plavix patent deal. BMS paid the maximum fine permitted by statute for committing two violations under the federal False Statements Act."
08/23/05 -- Former Bristol-Myers Executives charged by SEC with Civil Fraud
http://www.sec.gov/litigation/litreleases/lr19343.htm
"The Complaint alleges that from the first quarter of 2000 through the fourth quarter of 2001, at Schiff and Lane's direction, Bristol-Myers stuffed its distribution channels with excessive amounts of its pharmaceutical products ahead of demand to meet the Company's internal earnings targets and the consensus estimate of Wall Street securities analysts, and improperly recognized revenue from $1.5 billion of such sales to its two largest wholesalers. According to the Commission's Complaint, when Bristol-Myers' results still fell short of its targets and the consensus estimate, at Schiff's direction, the Company used "cookie jar" reserves to further inflate its earnings. The Complaint also alleges that at Schiff's direction, and as a result of the channel-stuffing, Bristol-Myers also underaccrued for Medicaid and prime vendor rebate liabilities. As a result of its channel-stuffing and improper accounting measures, Bristol-Myers reported results that met or exceeded the consensus estimate every quarter during the scheme."
06/15/05 -- Bristol-Myers Squibb Charged with Conspiring to Commit Securities Fraud; Prosecution Deferred for Two Years
http://www.usdoj.gov/usao/nj/press/files/bms0615_r.htm
http://www.usdoj.gov/usao/nj/press/files/pdffiles/SchiffLaneIndictment.pdf
"Bristol-Myers Squibb Company (BMS) has agreed to pay an additional $300 million in restitution and undertake a series of corporate reforms as part of an agreement with the government to defer prosecution on a charge of conspiring to commit securities fraud for the company's failure to disclose its 'channel-stuffing' activities in 2000 and 2001"
September 2008 -- WellCare Health Plans Inc. has agreed to pay $35.2 million to the Financial Litigation Unit of the United States Attorney's Office
http://www.crowell.com/pdf/managedcare/Wellcare-Agreement.pdf
"WellCare Health Plans Inc. has agreed to pay $35.2 million to the Financial Litigation Unit of the United States Attorney's Office arising from understatements of anticipated premium refunds pursuant to its Florida Medicaid contract. This figure is based on WellCare's estimate of the maximum potential repayment owed to the Florida Agency for Health Care Administration ("AHCA") under the state's disease management law from December 1, 2002 through December 31, 2006."
03/03/08 -- New York takes on United over tactics as industry arbiter of physician pay
http://www.ama-assn.org/amednews/2008/03/03/bil10303.htm
"An investigation into how a UnitedHealth Group subsidiary determined reimbursement for out-of-network physicians across multiple insurers alleges to show a pattern of underpricing services to shift the payment burden from insurers to patients.
[snip]
Cuomo, speaking at a news conference in New York City, said Ingenix had manipulated UCR rates to keep them artificially low, resulting in additional profit for United and unnecessary costs for consumers.
[snip]
Cuomo's investigation is extending to other plans that use Ingenix. He said he is issuing subpoenas to 16 other health plans, including WellPoint's Empire BlueCross BlueShield, Cigna, Humana and Aetna. Humana has acknowledged receiving a subpoena."
02/09/04 -- HealthSouth fraud figures higher than thought
http://www.ama-assn.org/amednews/2004/02/09/bisc0209.htm
"The embattled outpatient services giant HealthSouth now believes its accounting fraud could total as much as $4.6 billion, significantly more than previous estimates.
In a meeting with investors on Jan. 20, HealthSouth officials said an audit was expected to reveal between $3.8 billion and $4.6 billion in fraudulent accounting. In July 2003, the company estimated the fraud to total at least $2.5 billion."
12/22/08 -- SEC Files Settled Enforcement Actions Against UnitedHealth Group, Inc. and Former General Counsel in Stock Options Backdating Case
http://www.sec.gov/news/press/2008/2008-302.htm
“The Securities and Exchange Commission today filed a civil injunctive action against UnitedHealth Group Inc., a Minnetonka, Minn., health insurance company, alleging that it engaged in a scheme to backdate stock options. Without admitting or denying the allegations, UnitedHealth agreed to settle charges that it violated the reporting, books and records, and internal controls provisions of the federal securities laws.
In a separate complaint, the Commission charged former UnitedHealth General Counsel David J. Lubben with participating in the stock option backdating scheme. Without admitting or denying the allegations, Lubben consented to, among other things, an antifraud injunction, a $575,000 penalty, and a five-year officer and director bar.
The Commission alleges that between 1994 and 2005, UnitedHealth concealed more than $1 billion in stock option compensation by providing senior executives and other employees with “in-the-money” options while secretly backdating the grants to avoid reporting the expenses to investors.”
04/28/09 -- Federal court approves $350 million RICO case settlement
http://www.ricolawblog.com/2009/04/articles/rico-law/drug-companies/federal-court-approves-350-million-rico-case-settlement/
"A federal court in Massachusetts approved a $350 million settlement. The case alleged a drug wholesaler of inflating drug prices.
[snip]
The suit alleged that McKesson and FirstData violated the Racketeer Influenced and Corrupt Organizations Act (“RICO”). The complaint alleged that the companies used interstate mail to fraudulently raise the average price of McKesson’s drugs."
07/29/02 -- Blue Cross of California and WellPoint Health Networks to pay U.S. $9.25M to settle allegations of Medicare Fraud
http://www.usdoj.gov/opa/pr/2002/July/02_civ_435.htm
"Blue Cross of California (BCC) and its parent company, WellPoint Health Networks, have agreed to pay the United States $9,250,000 to resolve allegations that BCC defrauded Medicare, the Justice Department announced today. BCC, which was under contract with the Centers for Medicare & Medicaid Services to process Medicare claims in California until December 2000 (Medicare Part A fiscal intermediary) is alleged to have knowingly falsified data regarding its performance of cost report audits for Medicare."
06/29/06 -- Tenet Healthcare Corp. to pay U.S. more than $900 million to resolve False Claims Act allegations
http://www.usdoj.gov/usao/cac/pressroom/pr2006/088.html
"Tenet Healthcare Corporation, operator of the nation's second-largest hospital chain, has agreed to pay the United States more than $900 million to resolve several "whistleblower" lawsuits and investigations alleging that Tenet and its hospitals knowingly submitted false claims to the Medicare program and other federal health insurance programs over the past decade.
The settlement is the largest single settlement in the nearly 150-year history of the False Claims Act. Previously, the Justice Department settled with HCA for $840 million, as part of a total recovery from HCA of $1.7 billion."
Again, let me reiterate that this list is a tiny number of cases culled from the last seven years alone. There are many, many more like them, and there's one hell of a lot of money involved.
So tell me exactly why it is we are negotiating at all with these organizations?
Would we tolerate this kind of widespread disregard for the law from any other industry, and still sit down to the table to negotiate with them, believing them to be working with us in good faith?
[Photo: Pharmaceuticals by Destinys_Agent via Flickr.com. Cross-posted to Firedoglake's The Seminal.]
Monday, September 07, 2009
An offended mother on President Obama’s speech to school kids

The text of President Obama's speech scheduled for delivery tomorrow to public school children has been released today; I've read it.
And I asked my both of my kids read it.
With a bored, so-what shrug, the new sophomore said, "It's rather elementary, but I suppose it has to be since it's meant to reach elementary school kids. Like kindergartners."
The new middle-schooler was more forthcoming.
"Yeah, I read this part about Obama and his mom this past year," by which he referred to the portion of the speech in which Obama recalls how mother got him up at 4:30 a.m. to study. "I already knew about that. And the President is telling kids the same thing you already tell us, that we need to go to school and study and work hard."
I asked him about parents being afraid to let kids hear President Obama's speech -- what did he think about this?
"Profiling. They're profiling him."
You could have knocked me over with a feather; I wasn't expecting this for an answer. Really? Profiling? What did he mean?
"Yeah, the parents are like Maxwell Smart in the Get Smart movie. Max says, 'I'm not profiling, I'm not profiling...he looks EVIL! But I'm not profiling...'"
And off he went to go and enjoy the last day of summer vacation; I doubt this includes packing his backpack, though.
* * * * *
I wish I could summon more cogent thoughts in response.
But all I can think at this point in time is Get. The. Hell. Off. It.
You, the conservatives whining about the President's speech to children tomorrow: Get off it.
The smart kids can see right through you. The older kids won't be impacted by his speech because they are already firmly on the road or they are already lost.
The younger ones are more savvy than you give them credit; they already know you are acting out of pure bigotry.
And the youngest of school kids? Well, we can only hope that a message like "Go to school because you need education" isn't going to scar them unduly. Goodness knows what crazy-ass messages you'd rather they heard from the government. We already know you are personally teaching them fear and bigotry instead of critical thinking.
You do realize that in a capitalist, free market society, workers compete against each other, right?
Fear and bigotry are going to make your kids unemployable in an adult work world where they compete for jobs with the rest of the globe -- as if a lack of critical thinking and education won't do that, too.
Over the past week you've managed to label encouragement to be responsible and completely prepared to compete for future jobs as socialist. What are you telling children about capitalism?
You've had your chance for the last decade-plus, between your former majority in Congress and your two terms in the White House. You've bankrupted us by lying us into an illegal war, by allowing greed to eat away at solid legislative protections and eventually eat away our nation's personal savings, too. You've dumbed us down with your ownership stranglehold on media, so that blabber-mouth cry-babies like Glenn Beck and Rush Limbaugh are seen as the benchmark of media success.
And now you want kids to avoid hearing a speech encouraging their personal responsibility to obtain a good education?
Just stop.
And stay the hell away from my kids, you frightened, bigoted, crazy freaks.
[Photo: Crazy bus by bunchofpants, via Flickr.com. Cross-posted at FDL's The Seminal.]
Monday, August 31, 2009
The evidence under our noses: there was no ticking time bomb
It's been the rational for using torture, a la Kiefer Sutherland's character on the television series "24" -- tick-tock-torture, to keep the time bomb at bay. But there never was a ticking time bomb, and they knew it. Their actions prove it.The flight logs and the timeline of the rendition flights skipped helterskelter across the world to different locations and venues; some of the flight plans took days, especially when teams of personnel from other entities and countries were involved. They didn't land at the closest place, nor did they land someplace where they would be out in the open, clearly questioning their rendered prey about the tick-tock-time-bomb because the immediacy of a potential attack warranted immediate action.
Tick-tock, tick-tock.
They even took their time to set up multiple black sites across the globe; imagine the hours-days-weeks-months of negotiations required to trade a missile defense system for a moldy old prison site, or HIV/AIDS money for a regional command post and another black site. Imagine the numbers of people involved in these negotiations.
Tick-tock, tick-tock.
Nor was any of the legal groundwork done rapidly, collaboratively, cooperatively where information could be shared quickly in a commons, because the safety of the nation's citizens and infrastructure demanded all of the brightest and best work on this with great urgency to prevent the next "mass casualty attack" surely pending at any moment.
No, the work was done by one guy here, another guy there, on their own, without any clear trail that somebody at the uppermost echelons of governmental authority had asked for their work out of urgency. The sneaking around to acquire nebulous and shaky authority took time which a ticking time bomb scenario wouldn't offer. The legal pussy-footing and finessing the fuzzy legal authority for multiple intelligence, military and law enforcement agencies took years.
Tick-tock, tick-tock.
And finally, there is the body of commentary and testimony from those involved, none of which takes our breath away because of the urgency under which they worked after 9/11. The word of detainees clearly indicates they gave up very little real intelligence and far more false information to stop the immediacy of torture alone. Could they be lying even now? Certainly, but why would they? What do they have to gain by lying at this point in time?
This guy, on the other hand, has far more too lose by telling the unvarnished truth. His words here again sound chill, calculating, without the impetus of any driving need to save the country from an immediate attack as much as he needs to cover his backside after the fact from what became a systemic administrative policy:
WALLACE: Let me ask you -- you say you're proud of what we did. The inspector general's report which was just released from 2004 details some specific interrogations -- mock executions, one of the detainees threatened with a handgun and with an electric drill, waterboarding Khalid Sheikh Mohammed 183 times.
First of all, did you know that was going on?
CHENEY: I knew about the waterboarding. Not specifically in any one particular case, but as a general policy that we had approved.
The fact of the matter is, the Justice Department reviewed all of those allegations several years ago. They looked at this question of whether or not somebody had an electric drill in an interrogation session. It was never used on the individual, or that they had brought in a weapon, never used on the individual. The judgment was made then that there wasn't anything there that was improper or illegal with respect to conduct in question...
[crosstalk]
WALLACE: Do you think what they did, now that you've heard about it, do you think what they did was wrong?
CHENEY: Chris, my sort of overwhelming view is that the enhanced interrogation techniques were absolutely essential in saving thousands of American lives and preventing further attacks against the United States, and giving us the intelligence we needed to go find Al Qaeda, to find their camps, to find out how they were being financed. Those interrogations were involved in the arrest of nearly all the Al Qaeda members that we were able to bring to justice. I think they were directly responsible for the fact that for eight years, we had no further mass casualty attacks against the United States.
It was good policy. It was properly carried out. It worked very, very well.
WALLACE: So even these cases where they went beyond the specific legal authorization, you're OK with it?
CHENEY: I am.
Yeah, he's okay with the view that slow, plodding, methodical torture was necessary, that it was okay to send out plane after plane after plane, rendition after rendition after rendition, to gather up persons alleged to be al Qaeda and torture then detain them and for years on end, whether they were truly al Qaeda or not.
As a general policy, he says it was good and that he was okay with it.
Without one bit of hair-on-fire urgency conveyed in this testimony before the court of public opinion.
None.
Because there never was a ticking time bomb threatening Americans, and we're just realizing it now, years and years later.
[Excerpt above from interview of former VP Dick Cheney by Chris Wallace at Fox News (and no, I'm not linking to them). Photo: It's ticking, by Michael Tienzo via Flickr.com. Cross-posted at Firedoglake's The Seminal.]
Tuesday, August 25, 2009
Kitchen Garden: post-vacation review
Oh my. What a little time, less water and benign neglect can do to a garden.
These Early Girl tomatoes are just beginning to blush; I expect to pick them within the next 10 days.
The biggest disappointment remains the pole beans, all three varieties. Only one species of the three I planted has begun to flower. I'll let you guess which one it is.
The loveliest thing so far this year has been the Gypsy peppers. They are also beginning to blush, having started as a pale ghostly green, becoming Hungarian yellow, and now an appetizing red. I'm going to continue to resist the urge to pick them until they are scarlet, head to toe.Tuesday, August 18, 2009
Carpe inceptum quam minimum credula postero
This is an industry with rare consumer praise, even though consumers may want or need its services.Although there are far more than 1000 competing firms in this market, prices do not go down across the industry, suggesting competitive pressures have failed.
It's a mature product, been around for most of our life times, yet the product has not earned more loyalty from consumers.
Consumers die every day because of the failure of this industry to safely and effectively meet consumers' needs.
It's been propped up by government through a number of different methods including market guarantees and supportive legislation.
What industry is this?
It's not the American auto industry and its supply chain, trying to reduce capacity and costs while taking government financing and benefitting from Cash for Clunkers.
It's not the banking industry and the fat cat banksters wallowing in their TARP-funded bonuses.
Give up guessing?
It's health insurance.
If health insurers don't catch a clue about their failed business model, we should do what we've done to other failed enterprises. It's a step not substantively different from preventing a massive loss of jobs and manufacturing capacity by stepping in on General Motors and Chrysler, or trying to prevent a market meltdown by salvaging what's left of the banks who are needed to fund business and provide services to citizens.
I say we rethink the public option and tell the industry it's time to quit screwing around and face up to the truth: their business model is bankrupting us, it's not delivering what we need, it's literally a threat to our health as a nation.
And then we tell them to start negotiating in good faith to deliver a public option or we're going to seize them because they have been cooking their numbers for years by dropping insureds at will off their rolls (and if you really think about it, you can think of numerous other ways they cook their books, like systematically denying claims unless forced to pay). At the end of the day, there may be a new industry with a smaller number of players who can provide coverage for all by way of economies of scale and by eliminating so many middlemen who don't add value while obstructing competition.
If it's good enough for one of our largest manufacturing industries and good enough for our banking industry, why not use the same approach with the health insurance industry?
Place no more trust in their intentions; they've proven they will not act in good faith.
Simply seize 'em.
[Graphic: Sign in MA restaurant window by Spatch via Flickr. Cross-posted to FDL's The Seminal.]
Thursday, July 30, 2009
Squeeze play in progress? Sen. Carl Levin subpoenas Goldman Sachs

Methinks I see a squeeze play in the making, that President Obama's "stern talking to" could have been a warning shot from a different direction while Congress works from another.
DailyKos diarist Badabing posted this morning that Sen. Carl Levin, chair of the Senate Permanent Committee on Investigations, has subpoenaed Goldman Sachs, Washington Mutual and more financial industry firms with regards to the financial meltdown. Note this key graf from WSJ excerpted in the DKos diary:
According to people familiar with the matter, the Senate Permanent Subcommittee on Investigations also has issued a subpoena to Washington Mutual Inc., a Seattle thrift that was seized by regulators in last year's financial crisis and is now largely owned by J.P. Morgan Chase & Co. It appears likely that several other financial institutions also have received subpoenas. Subcommittee investigators declined to comment. A Goldman Sachs spokesman declined to comment on the subpoena. Deutsche Bank didn't immediately respond to a request for comment.
Huh. Isn't that interesting?
Especially when one considers that then Sen. Obama was a co-sponsor of legislation along with Sen. Levin on corporate transparency, also cited in the same DKos post.
Perhaps Levin is going to finally make some traction with the hope of getting a DOJ referral after other attempts to reveal the criminality of subprime lenders and their aides and abettors further upstream in the financial industry. He's got better political headwinds this time, and a former fellow senator in the White House.
Goodness knows CBS' 60 Minutes' Steve Kroft and Scott Pelley tried to explain the problems in clear terms over the last year, but nobody in Congress or law enforcement picked up on it. (See below the list of 60 Minutes' programs which featured all related stories on mortgage fraud and the financial instruments up the food chain which were based on the fraud.)
And Elliot Spitzer also tried his hand after ALL 50 states' attorneys general were quashed by the White House when they tried to go after subprime mortgage fraud. We all know how that turned out after Spitzer called out the White House and Wall Street in his fateful WaPo op-ed, "Predatory Lenders' Partner in Crime", published only weeks before another fateful article in the NYT, and weeks before Bear Stearns crashed.
Let's hope Sen. Levin can get the dirt -- it's out there.
======================
House of Cards: how the U.S. sub-prime mortgage meltdown, in which risky loans drove a housing boom that went bust, is now roiling capital markets worldwide (Video, Feb. 26, 2009)
World Of Trouble: Three years before the housing market crash, Paul Bishop says he warned his superiors at World Savings that many of the mortgages they were granting were misleading and predatory. (Video, Feb. 19, 2009) [NOTE: This is the clearest statement of the amount of fraud involved. A must-watch.]
An Invitation To Fraud: Financial editor Jim Grant says that everyone got a cut in the subprime circle and many share the blame for the crisis. (Video, Feb. 9, 2009)
Credit Default Swaps: an examination of the complicated financial instruments known as credit default swaps and the central role they are playing in the unfolding economic crisis.(Video, Oct. 27, 2008)
Wall Street's Shadow Market: a look at some of the arcane Wall Street financial instruments that have magnified the economic crisis. (Video, Oct. 5, 2008)
The U.S. Mortgage Meltdown: report on the U.S. sub-prime mortgage meltdown, in which risky loans drove a housing boom that went bust, and how this crisis is now roiling capital markets worldwide.(Video, May 25, 2008)



