Saturday, January 30, 2016

NHS A&E: Jacaranda & My Friend's Life!

Jacaranda is known as the flower of good luck. Did one drop on her or was it her A&E doctor.                                                            Legend of Jacaranda in Pretoria, South Africa.

©2013Am Ang Zhang

“The best interest of the patient is the only interest to be considered, 
and in order that the sick may have the benefit of advancing knowledge, 
union of forces is necessary
…it has become necessary to develop medicine as a cooperative science.

Friends moved to France after their retirement and lived in one of the wine growing districts.

They were extremely pleased with the Health Care they received from their doctor locally. After all, not long ago, French Health Care topped the WHO rankings.

Then our lady friend had some gynaecological condition. She consulted the local doctor who referred her to the regional hospital: a beautiful new hospital with the best in modern equipment. In no time, arrangement was made for her to be admitted and a key-hole procedure performed. The French government paid for 70% and the rest was covered by insurance they took out.

They were thrilled.

We did not see them for a while and then they came to visit us in one of our holiday places in a warm country.
They have moved back to England.

What happened?

London A&E:
Four months after the operation they were back visiting family in England. She was constipated and then developed severe abdominal pain. She was in London so went to A & E at one of the major teaching hospitals.

“I was seen by a young doctor, a lady doctor who took a detail history and examined me. I thought I was going to be given some laxative, pain killer and sent home.”

“No, she called her consultant and I was admitted straight away.”

To cut the long story short, she had acute abdomen due to gangrenous colon from the previous procedure.

She was saved but she has lost a section of her intestine.

They sold their place in the beautiful wine region and moved back to England.

Thank goodness for a well trained A&E doctor. Or one with the Jacaranda flower.

It looks a though we are moving as far away from those ideals in the New NHS. It is indeed most obvious with our A & E department of hospitals in England. In the new market driven system, A&E is indeed the loss leader in Supermarket terms. If we are honest, there has not been any drop in demand. It is the one thing the NHS CUSTOMERS will buy!

Government would like us to believe that this has nothing to do with OOH service. Perhaps there is a belief by the average citizen that they will be seeing real doctors at A&Es.  
 Guardian latest: Study says it costs hospitals more to treat accident and emergency patients than they are paid to deliver service.

In a Market system, A&Es are run by Hospitals and OOH by CCG/GPs; business rivals so to speak. Hospitals wants to maximize income and CCGs did not want anyone to attend A & E if at all possible.     NHS A & E: Unpredictable, Unruly & Ungainly

Looks like the battle is over as no doctor will want to work in A&E.

A top doctor from Somerset claims emergency patients could be at risk because half of the country's A&E departments are understaffed.

Dr Clifford Mann, registrar at the College of Emergency Medicine and a consultant at Musgrove Park Hospital in Taunton, said hospitals were increasingly struggling to find enough medics.

He told the Mail on Sunday that junior doctors were unwilling to train to become emergency medicine specialists because of the intense workload and failure of hospitals to increase staffing levels to match the number of patients admitted.
The situation is worsened by the fact that 10 per cent of all full-time consultancy posts in the country's 220 A&E units are unfilled as many training in the NHS have preferred to go abroad to work.

He said the shortages will "undoubtedly" have contributed to the closure or downgrading of casualty departments.

"The key message isn't so much the vacancies out there, but that there's no one coming through to fill them," said Dr Mann, an emergency medicine consultant.

There is of course a solution: remove the payer system and rotate GP and other trainee doctors through A & E as a compulsory part of training of any doctor and have full back up of the A & E consultants.

Prof Waxman in an earlier post:

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

…….Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

“The best interest of the patient is the only interest to be considered, 
and in order that the sick may have the benefit of advancing knowledge, 
union of forces is necessary
…it has become necessary to develop medicine as a cooperative science.

 Doctor William Mayo explained in 1905

Friday, January 29, 2016

NHS & The Ruling Class: CQC & Privatisation!

As the sun sets.............

 ©2012 Am Ang Zhang
The NHS faces the greatest scandal regarding CQC; it became clear that the idea of putting a non-doctor as its regulator is akin to getting a butcher to check on a top passenger aircraft. The Cockroach Catcher is of the opinion that despite the rhetoric, no SoS would put a doctor there. 

Why? A doctor might, just might have a heart.

The Case: The Guardian 7 June 2011

A coroner has criticised hospital staff in Cumbria over a succession of missed opportunities to treat a newborn baby for an infection that later killed him.
Joshua Titcombe died at nine days old from a common infection that could have been cured by antibiotics after medical staff repeatedly ignored his parents' fears for his health and told them "not to worry".
Ian Smith, the Cumbria south and east coroner, said Joshua died of natural causes, but cited a number of failures by the hospital in relation to his care.
They included failing to recognise the symptoms of an infection, failure to act on those symptoms, failure to listen to the couple's concerns, inaccuracies in records made by staff, a lack of record keeping, an absence of continuity of care and a lack of special training for midwives on the postnatal ward.

The coroner also found a "strained and dysfunctional" relationship between midwives and paediatricians.
Smith said he believed 11 midwives at the hospital - all of whom gave evidence at the inquest - had colluded to cover up knowledge that low temperature is a common sign of infection. He said "incriminating" notes containing observations about baby Joshua's condition may have been deliberately destroyed.
The inquest heard there was an 80% chance Joshua would have survived if antibiotics had been administered in the hours after he was delivered. He was transferred by air for emergency care after he became seriously ill at Furness hospital in Barrow, and died in November 2008.
Joshua's father, James Titcombe, said he and his wife, Hoa, had urged staff at the hospital to treat their son with antibiotics, but were told he seemed well and did not need to see a doctor. He said they were told a paediatrician was "too busy" to deal with them.
Titcombe said: "The day after he was born I had come to take my wife and baby home when they found him not breathing well. It was a horrific shock. They told us he had a problem with his heart, then with his oesophagus. All the time I just suspected he had the same infection as his mother."
The baby was transferred to a paediatric centre in Manchester and then to a hospital in Newcastle for specialist treatment. Consulants there said his problem was an untreated pneumococcus infection, the same condition as his mother.

We now know that England's healthcare regulator, the Care Quality Commission, tried to cover up an investigation into a hospital trust where babies were dying. This appalling tale has been spun to be about the "rotten culture" at the heart of the NHS. The true story of the Morecambe Bay cover-up, however – just like Mid Staffs, where hundreds of patients died – is one of market failure.

Two questions in particular have not been properly addressed. Why would the CQC be complicit in the cover-up of poor performance? And why was the University Hospitals of Morecambe Bay NHS foundation trust so desperate not to expose the failings at its Furness hospital? The answer to both questions lies with the new market system that brought the CQC into being, a system introduced by New Labour and implemented by the Tories.

.....The CQC is has a legal imperative to get the market up and running by developing the systems to register more than 22,000 health and social care providers. The real story of the CQC scandal is that market-led changes are creating deficits and poor quality of care, which managers must seek to conceal in order to survive. Central to the government's NHS reforms is the concept of a well-regulated market. Behind the CQC controversy is an assumption that if a commercially run hospital is failing it has simply not been well enough regulated. But experience from the US shows that effective regulation of large healthcare corporations is impossible: we cannot afford it, or get the data necessary to carry it out. That is why the NHS had direct management in the first place.

One should perhaps ask the question: who put the head of CQC there and who is there now. Certainly not a doctor.

In the new world of doctoring, money comes into it and with that many doctors are losing their hearts. But we did have the infra structure to preserve it.

It would be such an irony if the new SoS be drawn in and become the unlikely and perhaps unwilling hero that Bevan used to save his NHS: a sort of reverse curse.

The Guardian:

Jeremy Hunt has said the Care Quality Commission's alleged cover-up of failings at a Cumbria hospital are shocking, and he will back appropriate action against those responsible "absolutely to the hilt".
 The health secretary told BBC Radio 4's Today programme: "These are very, very serious allegations and they should have very, very serious consequences if they are proved. "I know the CQC are looking into disciplinary procedures and what can be done: what sanctions are available; whether you can have forfeiture of pensions, all those things. There has to be due process, but … it is totally appalling that this kind of thing should happen." Hunt said such failings damaged the NHS and undermined "the millions of doctors and nurses who do an amazing job day in, day out". The health secretary also acknowledged serious systemic flaws with how the CQC was set up in 2009, saying it was wrong to have the same regulator charged with both identifying and rectifying problems. He said the CQC's "generalist" system meant that the same inspector would visit such different facilities as a dental practice, a GP surgery, a hospital and a care home.  
The Ruling Class:  Jeremy Hunt.

Cousin  of  Virginia Bottomley: Secretary of State for Health 1992-95   

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

As I listened to the Ring Cycle (Solti), I am reminded of the genius of Wagner who warned us about the Ruling Class years ago.      

Soon they will start selling off the famous hospitals.

The NHS (England) as we know it will soon disappear. 

Wagner’s opera will always be there: The Ring: Child Psychiatry & Human Behaviour

                                                                                                                                                                                                                                                                                                      A culture of corruption pervades the links between government and business,
 fuelled by and fuelling privatisation. 
These relationships are  – a conspiracy against the public interest.

Adam Smith

There is no end, it seems, to the fiasco of rail privatisation. For the second time in three years, the holder of the coveted east coast franchise has walked away from a contract it can no longer afford. Not only that, but it turns out that National Express – whose chief executive, Richard Bowker, has decamped to the Gulf in a hurry – has protected itself from the vast bulk of the £1.4bn it owes the government by insulating its subsidiary, Fred Goodwin style, as a "special purpose vehicle".

But far from slinking off into the corporate undergrowth, National Express is now threatening to sue the government if it also takes over the company's two other profitable franchises. Once again, we are in the world of the Metronet consortium, whose collapse finally discredited Gordon Brown's disastrous public-private partnership for the London underground: where instead of transferring risk to the private sector, the government ends up subsidising private profit and picking up the bill when the music stops.

For all its rise in passenger numbers, Britain's rail system remains hobbled by the folly of privatisation: overcrowded, unreliable, fragmented and exorbitantly expensive. But far from putting it out of its misery to create a reintegrated publicly owned railway at zero cost, the transport secretary, Lord Adonis, was yesterday insisting the east coast line would be up for tender again as soon as he could manage it.

Now NHS:

As we are ourselves experiencing the worst from our ruling class over the NHS and its so called reform, Wagner’s opera is an uncomfortable reminder that we should never have trusted the ruling class.

Even before the new Bill was passed, changes were in place in the NHS that made it impossible to go back. Now it looks as though the changes were much worse than first thought. Doctor leaders were hoping that there is still decency in our ruling class. 

Well, unfortunately many of us will be dismayed, disgusted & disappointed!

Please do not get me wrong, it is not a simple privatisation. We are not really following the US. They regulate insurers where we do not. If we were required to get insurance Obama Style it might have been better. No, basically even if you get the top insurance there will be conditions that will be left to your friendly NHS hospitals. Just check your policy if you do not believe me. 

No it is under the guise of COMPETITION.

It is allowing Any Qualified Provider (privateer if you must know) to cream off. But it is not as simple as that. Recent PIP private clinics not only refused to remove the implants but went into administration to avoid paying compensation. There is as yet not legislation to guarantee NHS patients. Even travellers seem better protected.

In health care, DEATH is irreversible.

The NHS has been by and large highly efficient as it has avoided the pitfall of internal market system until recent years.

The crazy bonus system, internal market and Pavlovian style reward system skewed the efficient NHS to breaking point.

A once fairly integrated health care system where many doctors and nurses contributed free extra hours became a scandal ridden system where OOH fight not to see patients and not let A & E see them either. Or else OOH are run by so few doctors that patients suffered or died.

But it could be worse as the new AQPs do not seem to be liable:

The Guardian:

The family of a young woman is suing the country's biggest out-of-hours GP provider and one of its nurses, whose failures meant her fatal condition was not diagnosed, because neither will accept liability in a test case over legal responsibility in a privatised NHS.

Clare Secker, 19, died of bronchopneumonia in December 2008 after a nurse working for the privately-run telephone service told her parents to give her paracetamol and fluids.

Earlier this year the nurse admitted through her lawyers that she had been "in breach of her duty by failing to arrange for [Secker] to be seen by a doctor". If the young mother, who died when her son Tyler was less than a year old, had been prescribed antibiotics she would have recovered fully.

Despite this neither the firm, which was part of the Harmoni out-of-hours service until it was bought by Care UK in November 2012, nor the nurse has offered compensation to the family.

The nurse claims she does not need to pay out as her employment contract specifically states that the company had insurance in place "to indemnify … for any claim arising from any wrongful act committed by … any employee while carrying out their contractual obligations". But Harmoni says its insurance excludes responsibility for negligence by nurses.

With the Health and Social Care Act 2012 leading to more NHS contracts going to private providers, lawyers are concerned that the fragmented system will lead to a loss of accountability.

"It cannot be right that patients no longer know who is actually providing their care, or for those who are harmed to have the additional stress of providers trying to dodge responsibility by pointing to a clause in a contract or insurance policy. Until something disastrous happens we, the public, think we are still within the safety net of the NHS and increasingly that's just not the case. There is little transparency or protection, it seems to me."

Hospitals now fight other hospitals and the failed ones will be handed over to privateers. Some of these have the highest mortality rates. I am surprised that they are not sold  off for just a single pound.

The more failed hospitals, the better for the government. Once they washed their hands off, it is not their problem. If the privately run hospital failed, they change CEO, change ownership and continue. 

The GMC has been quiet about them as they have with the Breast Implant ones and many other plastic surgery private hospitals. 

Yet, right now the NHS picked up the mess of the PIP implants. The private companies pocketed the money. Lots of money.                                                                                                   

Lesson from Sweden:

Perhaps most damaging for private investors drawn by the potential profits to be made from the state has been the probing of their affairs by tax inspectors. The industry has been under scrutiny since 2007, when a spate of high-profile deals, including the buyout of Capio, led to investigations into financiers.
The charge is that private equity firms siphon profits out of the state's coffers while avoiding their fair share of taxes. Berglund, of Capio, says: "It is always thrown about that we are not paying taxes but it is not true."
Swedish tax authorities are, however, taking some companies to court because pay in private equity groups is often linked to the profits made on deals and has been incorrectly taxed, it is said, for years at rates lower than that required for income in Sweden.
Earlier this month one of Capio's owners, a private equity firm called Nordic Capital, lost a court case against the Swedish tax agency, leaving it with a bill of 672m Swedish krona (£63m). The authorities, it is reported, will also slap a tax bill collectively of 2.6bn krona on another 34 individuals.

"There has been a strong reaction in Sweden. These people have been paying themselves enormous sums of money," says Dahlgren. "It should be a worry for every health system where you have competition and private firms arriving."                            

If they are not RULING, where are they?

Virginia Bottomley: Secretary of State for Health 1992-95 now with BUPA. Cousin of Jeremy Hunt.
The Slog

So there’s Jeremy newly installed as Health Secretary after just seven short years as an MP. This is a summary of his meteoric rise:

He made a fortune at the taxpayers’ expense as monopoly supplier to a notorious quango where, by happy coincidence, his cousin sat on the Board. He became MP for SW Surrey where, by happy coincidence, his cousin had been MP previously. He became Minister in charge of Media & Culture where, by happy coincidence, he wound up steering his pals at Newscorp in the right direction. And he became Health Secretary partly because, by happy coincidence, his cousin is a lobbyist for the private health sector.

“Interestingly, former health ministers have done particularly well. The ex-health secretary Patricia Hewitt earns more than £100,000 as a consultant for Alliance Boots and Cinven, a private equity group that bought 25 private hospitals from Bupa. After leaving the department, her predecessor, Alan Milburn, worked for Bridgepoint Capital, which successfully bid for NHS contracts, and now boasts a striking portfolio of jobs with private health companies.”

Alan Milburn
Following his resignation as Secretary of State for Health (to spend more time with his family, his partner is a hospital doctor), Milburn took a post for £30,000 a year as an advisor to Bridgepoint Capital, a venture capital firm heavily involved in financing private health care firms moving into the NHS, including Alliance Medical, Match Group, Medica and the Robinia Care Group. He has been Member of Advisory Board of Pepsico since April 2007. Wikipedia

 Alan Milburn now also holds a place on the board of PepsiCo as an advisor.        Wikipedia

Patricia Hewitt

In January 2008, it was announced that Hewitt had been appointed "special consultant" to the world's largest chemists, Alliance Boots. Such an appointment was controversial given Hewitt's former role as Health Minister, resulting in objections to her appointment by members of a Parliamentary committee. Hewitt will also become the "special adviser" to private equity company Cinven, which paid £1.4 billion for Bupa's UK hospitals.

In March 2008, it was announced that Hewitt will join the BT Group board as a non-executive director.[40] She joined the group on 24 March 2008. In July 2009, Patricia Hewitt joined the UK India Business Council as its Chair.

In May 2009 The Daily Telegraph reported that Hewitt claimed £920 in legal fees when she moved out of a flat in her constituency, stayed in hotels and then rented another flat inLeicester. Claimed for furniture including £194 for blinds delivered to her London home. In June 2009 Hewitt announced that she will be stepping down from the House of Commons. She said she was leaving the Commons for personal reasons as she wanted to spend more time with her family.   Wikipedia
Ex-NHS: Patricia Hewitt: now with Cinven (Bupa Hospitals)

Shadow Elite: They are everywhere! Come fly with me!

The 21st century power brokers -- less stable, less visible, more peripatetic, and more global in reach than their elite forebears -- are potentially more insidious and dangerous to democracy. Their manoeuvrings are largely beyond the reach of traditional monitors. Unlike the rest of us, these players are virtually immune to accountability to voters or government or corporate overseers, because the full range of their activities and their true agendas are more difficult to detect.                                      
  Janinie R. Wedel

Monday, January 25, 2016

NHS & Simon Stevens----Sell or Sail?

Is this the sound of music for the NHS? Steven’s plans for the NHS are a big shake up for the NHS, but this time executed at a micro rather than macro level. His clear call for real extra public funding for a national health service – efficiency savings alone will not fill the black hole - will rattle politicians’ cages, but at the same he has a history of travelling on the other bus, including time at the giant American private health firm UnitedHealth, not to mention bowling from the pavilion end when advising the then Labour government about health in the early noughties. His answers this morning on the Today programme on the question of greater private sector involvement in health service delivery made up in broadness what they lacked in depth

My Take a while back.

The Cockroach Catcher was privileged to be having dinner with his good friend.

He covered the bottle when he served his favourite red wine.

"See what you think."

"Fully of blackberry and long with good tannin that has softened."

"1996 and the tannin will keep it going for another 5 years."

"Of all the recent great wines that you have served and that included the second wines of Lafite and Margaux, this is the most impressive. Just like our NHS!"

"But now you have one of the most impressive guys running it."

"Selling it, you mean!"

"I did not want to upset you."

"So you know about Simon Stevens. Not just wines then."

"You need to know that Britain is responsible for producing all the great doctors in the old commonwealth. My cardiologist was trained there. Look at Singapore, Australia & New Zealand, generations of doctors were all trained in the UK and in turn the next generations.
Why do you think that UnitedHealth paid so much to get one of the top UK guys to add a new perspective?

UnitedHealth is based in Minnesota, home of the famous Mayo Clinic and Simon Stevens is married to an American and they have school age children. As you well know, it is not easy for Americans to adjust to British life."

"So you think he is not going to last that long?"

"He has a very natural excuse!"


"Lets see what Bloomberg say:"


UnitedHealth followed up on June 30 with another report for lawmakers pinpointing $332 billion in savings through better use of technology and administrative simplification. If enacted, those changes would potentially benefit UnitedHealth's Ingenix data-crunching unit. Ingenix, with annual revenue of $1.6 billion, is poised to establish a national digital clearinghouse to ensure the accuracy of medical payments and provide a centralized service for checking the credentials of physicians.

Stevens, an Oxford-educated executive vice-president at UnitedHealth, once served as an adviser to former British Prime Minister Tony Blair. In that capacity, Stevens tried to fine-tune the U.K.'s nationally run health system. Today he tells lawmakers that theU.S. need not follow Britain's example. Concessions already offered by the U.S. insurance industry—such as accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues. "We don't think reform should come crashing down because of [resistance to] a public plan," Stevens says. Many congressional Democrats have come to the same conclusion.

UnitedHealth has traveled an unlikely path to becoming a Washington powerhouse. Its last chairman and chief executive, William W. McGuire, cultivated a corporate profile as an industry insurgent little concerned with goings-on in the capital. From its Minnetonka(Minn.) headquarters, the company grew swiftly by acquisition. McGuire absorbed both rival carriers and companies that analyze data and write software. Diversification turned UnitedHealth into the largest U.S. health insurer in terms of revenue. In 2008 it reported operating profit of $5.3 billion on revenue of $81.2 billion. It employs more than 75,000 people. 

Stevens argues that while UnitedHealth will likely benefit financially from health reform, the company will also aid the cause of reducing costs. He cites what he says is its record of "bending the cost curve" for major employers. 

During a media presentation in May in Washington, Stevens said medical costs incurred by UnitedHealth's corporate clients were rising only 4% annually, less than the industry average of 6% to 8%. But that claim seemed to conflict with statements company executives made just a month earlier during a conference call with investors. On that quarterly earnings call, UnitedHealth CEO Hemsley conceded that medical costs on commercial plans would increase 8% this year. 

Asked about the discrepancy, Stevens says the lower figure he is using in Washington represents the experience of a subset of employer clients who fully deployed UnitedHealth's cost-saving techniques, including oversight of the chronically ill. "These employers stuck at it for several years," he says. "We are putting forward positive ideas based on our experience of what works."


"So there is not reason for him to leave UnitedHealth! They love him. The best of British & of Oxford!"

"Perhaps he has not left UnitedHealth!"

"So perhaps a sort of UnitedNHS then!"

"Well despite what people say about Obamacare, even Stevens concede that:
.....the U.S. insurance industry—accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues.

"NHS as such was the most serious competitor to the Health Insurance Industry. It is serious because there is not even any co-pay!"

"And quality is the same as the actual specialist doctor on either side are the same."

"Only the coffee is better!"

"Whatever Stevens plan to do is not something most of us can begin to guess but my suspicion is that it would not be to anyone's liking..."

"Except the Health Insurance Industry."

"So, he will not follow the US example of insurance industry accepting all applicants, regardless of age or medical history."

"No way!"

"You see, UnitedHealth has decided to leave California because of that."

"Not profitable!"

"If Insurers need to cover everything in England, they would think twice and most likely do a California thing."

"And Stevens can go back to America then!"

"So what is the wine?"

"Big Sail Boat!"                                                              

"Big Sail Boat?"

That the logo might have helped to sell a wine is unthinkable if the wine is no good. Ch. Beychevelle was fortunate enough to have a boat on its label and the Chinese just embrace it now that Lynch Bages hit the roof and there are too many fake 1982 Lafites around.

When my friend stock up on his Beychevelle, it was he told me, just a third of the price right now.

"It will be the next Lynch Bages."

"That is why 50% has been sold to the Japanese!"


So will Simon sell or sail? Or sell then sail!

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. 
New York:

Pomerantz Law Firm has filed a Class Action Against UnitedHealth Group, Inc. 
for Violations of Federal and State Mental Health Parity Laws - UNH
NEW YORK, March 12, 2013 (GLOBENEWSWIRE) Pomerantz Grossman Hufford Dahlstrom & Gross LLP has filed a class action lawsuit against UnitedHealth Group Inc. (“UnitedHealth” or the “Company”)(NYSE: UNH) and various subsidiaries, including United Behavioral Health.  The class action was filed in the U.S. District Court, Southern District of New York, and docketed under 13 CV 1599, alleging violations of federal and state mental health parity laws and other related statutes. The action has been brought on behalf of three beneficiaries who are insured by health care plans issued or administered by United and whose coverage for mental health claims has been denied or curtailed. These plaintiffs seek to represent a nationwide class of similarly situated subscribers. In addition, the action was filed on behalf of the New York State Psychiatric Association, Inc. (“NYSPA”), a division of the American Psychiatric Association, seeking injunctive relief in a representational capacity on behalf of its members and their patients.

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says. The fine, if there is one, is likely to be much less than the maximum allowed.'


WASHINGTON, D.C. - United Healthcare Insurance Company has agreed to pay the United States $3.5 million to settle allegations that the company defrauded the Medicare program, the Justice Department announced today.
The government alleges that beginning in or about 1996 and continuing through 2000, United Healthcare's telephone response unit knowingly mishandled certain phone inquiries received from Medicare beneficiaries and providers and then falsely reported its performance information to the Centers for Medicare and Medicaid Services (CMS) concerning the company's handling of those calls. CMS is the federal agency charged with administering the Medicare program.
From October 2, 1995 to October 1, 2000, United Healthcare acted under contract with CMS as a Durable Medical Equipment Regional Carrier. Under that contract, United Healthcare processed Medicare Part B claims for durable medical equipment submitted to it by Medicare beneficiaries, physicians, and other health care providers and suppliers located in the northeastern United States.
"This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare," said Peter Keisler, Assistant Attorney General for the Department's Civil Division. "Medicare contractors, along with other health care providers, can and will be held accountable for their billing practices. This settlement demonstrates our unwavering pursuit of fraud and abuse."
The allegations of improper conduct were brought to the attention of the government by a former United Healthcare employee, who filed suit under seal in November 2001 under the qui tam or whistleblower provisions of the federal False Claims Act. The United States recently intervened in the whistleblower suit.
As a result of today’s settlement, the whistleblower will receive $647,500 of the settlement amount. United Healthcare did not admit any of the allegations in the complaint in connection with the settlement. Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any awards that are obtained through that legal action.

An Entrepreneur!         
UnitedHealth & Big Profits