Thursday, October 24, 2013

UnitedHealth & Simon Stevens: Your NHS! Your Money!

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© Am Ang Zhang 2009





Simon Stevens: now with UnitedHealth

Now Stevens is to play a crucial role in presenting the more responsible face of American healthcare and in persuading the key players in Britain that they need to allow companies such as his into the NHS. Recently UnitedHealth's European division won the right to take over two GP practices, in Normanton and Cresswell in Derbyshire. Stevens, who was running the European division at the time, was key to winning the contracts.

The company is a huge force within US healthcare, with 70 million Americans on its books, employing 400,000 doctors in 4,000 hospitals. UnitedHealth is America's biggest health insurer. And it's growing in influence in Britain.
It already runs two GP practices in Derbyshire and now the government has given the green light to 14 companies, including United, to bid for potentially much bigger contracts from the primary care trusts that run hospitals. They would be paid for providing data analysis and research, giving trusts a clearer idea of how to manage patients with chronic conditions such as diabetes.
But their role may be bigger than that. Companies may also be invited in to act as middlemen, negotiating with hospitals on the trusts' behalf to reduce costs, ushering in the prospect that some patients may find their care plan managed not by a doctor but by an American insurance company.
Allowing UnitedHealth and others into the NHS fills the unions and many health workers with horror. That dismay will be amplified when they watch Michael Moore's latest film, Sicko, which alleges that United and other big US insurers routinely deny care for patients who may be critically ill.

In the WSJ there was a report:
“……UnitedHealth Group Inc. (UNH) agreed to pay $912 million to settle two class-action lawsuits regarding its stock-options practices……”

Rewind to last year in the New York Times:
“In one of the largest corporate pay give-backs ever, William W. McGuire, the former chief executive of UnitedHealth Group, has agreed to forfeit at least $418 million to settle claims related to back-dated stock options.”
How very sad! $418 million is a lot of money!
“The payback is on top of roughly $198 million that Mr. McGuire, an entrepreneur who built UnitedHealth, had previously agreed to return to his former employer.”
An entrepreneur! This reminded me of Dr Crippen’s blog about NHS entrepreneurs, and I duly alerted him. UnitedHealth is said to cover the Health Insurance of 70 million US Citizens.
“As part of the settlement with the S.E.C., Mr. McGuire will pay a $7 million fine and will be barred from serving as a director of a public company for 10 years.”
Oh, no, another $7 million and 10 years! You must feel sorry for him.
“He will, however, be allowed to keep stock options valued at more than $800 million, including many that have been sharply criticized.”


Jul 20, 2010
UnitedHealth Profit Jumps as Medicare, Medicaid Grow
UnitedHealth Group Inc., the biggest U.S. health insurer by sales, raised its full-year profit forecast after increased enrollments and lower-than-projected medical costs lifted second-quarter earnings 30 percent.

The insurer forecast 2010 profit of $3.40 to $3.60 a share compared with a previous projection of $3.15 to $3.35, citing growth in sales or membership for all business units. Net income rose to $1.12 billion, or 99 cents a share, for the quarter, from $859 million, or 73 cents, a year earlier, the company said today. The earnings and forecast topped estimates.

Chief Executive Officer Stephen Hemsley boosted enrollment in Medicare Advantage, the U.S.-backed program for the elderly. Weakness in the economic recovery in the U.S. also helped, by keeping people away from doctors and hospitals, said Jason Gurda, a Leerink Swann & Co. analyst in New York. UnitedHealth did better than expected for commercial enrollment, taking business from rival insurers, he said.

October 18, 2006
UnitedHealth's Options Scandal Shows Familiar Symptoms

Stephen Hemsley, who upon being hired in June 1997 was presented with 400,000 stock options with an issue date of five months earlier. Hemsley told the Wilmer Hale lawyers that he "didn't recall focusing at the time" on the $2.9 million gimme he'd just been handed as a result of the backdating.

You might say that Hemsley comes honestly to his lack of focus and ethical sensitivity. Before coming to UnitedHealth -- I'm not making this up -- he'd spent the previous 23 years at Arthur Andersen, rising to chief financial officer. That's the same accounting firm that helped bring you Enron, WorldCom and Freddie Mac. And, you'll be shocked to learn, it's the same Arthur Andersen that served as a consultant to Spears and other members of UnitedHealth's compensation committee.

Hemsley was rewarded for his lack of focus by being named to succeed McGuire as chief executive. He was also directed to root out the senior executives in the legal, accounting and personnel departments who provided the bad advice on which the board and chief executive now say they have relied. Hemsley, too, has volunteered to reprice his options.

The reward:
Chief executive Stephen Hemsley pulled in $102 million in 2009, with $98.6 million coming from exercised stock options, according to a filing with the Securities and Exchange Commission Wednesday.    Star Tribune

Friday 16 July 2010
The Minnesota-based firm beat Bupa and Humana to win the contract from the health department to advise PCTs

The Minnesota-based UnitedHealth has already become a key adviser to primary care trusts (PCTs) on commissioning health services and operating bids to run GP practices. Earlier this month it beat Bupa and Humana, another US health insurer, to win the contract from the health department to advise PCTs.

The decision follows successful bids to run two GP practices in Derbyshire in 2006 and three practices in central London in 2008, taking over from the Brunswick Group. In April the company announced a 21% increase in profits for the first three months of the year to $1.2bn (£784m).

United said it brought high level management expertise and efficient provision of services to the UKhealth service but it has faced accusations of overcharging and malpractice in a series of legal suits.

New York Settlement:
January 15, 2009 
UnitedHealth Group Inc., the biggest U.S. health insurer, said it will spend $400 million to settle allegations it has manipulated payments to doctors and patients for the last 15 years.
The company agreed to put $350 million into a class-action restitution fund to pay physicians and policyholders for services provided by out-of-network providers, the company said in a statement today. On Jan. 13, the Minnetonka, Minnesota-based insurer settled allegations from New York Attorney General Andrew Cuomo by paying $50 million and transferring to a nonprofit group its database that set the amount to be reimbursed when patients used doctors outside their network.
UnitedHealth has been battling the largest physician group, the American Medical Association, over out-of-network costs since 2000. The settlement affects less than 10 percent of health benefits because most policyholders use their health plan’s network providers to minimize out-of-pocket expenses. Still, the AMA said it stopped rampant cheating Its California subsidiary was fined a record $3.5m in the same year for mishandled claims against patients and doctors. In 2006 The UnitedHealth chief executive William McGuire resigned after an investigation "concluded he had received stock option grants 'likely backdated' to allow insiders to maximise financial gains." During his tenure as chief executive, McGuire was granted more than $1.6bn in stock options. In 2007, McGuire avoided trial after he agreed to repay $468m.


In one example, Cuomo’s office said that when $200 was a fair-market rate for a 15-minute doctor’s visit for a common illness, Ingenix said it was $77. UnitedHealth would pay $62 when it should have paid $160, leaving the consumer with a $138 bill.


Forbes:

I recently learned that this month a class-action lawsuit has been filed against California United Behavioral Health (UBH), along with United Healthcare Insurance Company and US Behavioral Plan, alleging these companies improperly denied coverage for mental health care.
According to the class action lawsuit, United Behavioral Health violated California’s Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnosis according to “the same terms and conditions” applied to medical conditions. Specifically, the insurer is accused of denying and improperly limiting mental health coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions.

The British Medical Association may now have a new role.




The future is here now:




Ex-NHS:

Patricia Hewitt: now with Cinven (Bupa Hospitals)






Related:





2 comments:

Julie said...

Thanks for that comprehensive summary of United Healthcare - I think! I remembered that they had something to do with a major Medicare fraud in America, but hadn't got round to looking it up. I wish we could get rid of this damned Health and Social Care Act.

Cockroach Catcher said...

It is getting sadder & sadder by the day. NHS as we know will disappear from England.