How a California health plan’s CEO and her husband, an executive consultant, got rich off the taxpayer-funded program for the poor. Critics see a conflict of interest, the plan doesn’t, and the state has no rules either way.
The Seattle jurist finds that Olympus Corp. failed to properly disclose evidence that it knew of concerns about cleaning problems with its redesigned medical scopes years before they hit the market and were linked to dozens of deaths. The company maintains the devices were not defective and intends to appeal.
An explosive report prepared by a SynerMed executive alleges the California firm, which oversaw care for 1.2 million patients, fabricated documents and violated state and federal regulations for years. The state says it left low-income patients on Medicaid managed care in “imminent danger.”
“‘Fingers crossed’ that I haven’t authorized something the FTC will hunt me down for,” a staffer wrote after destroying the documents. Sutter, a huge Northern California Health system with 24 hospitals, said it destroyed them by mistake.
De acuerdo con un juez estatal, Sutter Health, el gigante del sistema de salud que gerencia 24 hospitales en California, abusó de su poder para inflar precios y destruir documentación crítica de sus empleados.
The Department of Managed Health Care cited one example in which consumers and advocates had to call the insurer 22 times to contest a decision. Still, the complaint still was not resolved until the department became involved.
State regulators and insurers are looking into SynerMed, which medical groups depend upon to handle their finances and business operations. The groups, serving 1 million patients, fear a messy fallout.
Medicaid is rarely associated with getting rich. But some insurance companies are reaping spectacular profits off the taxpayer-funded program in California, even when the state finds their patient care is subpar.
UnitedHealth, a health industry goliath, has its hand in doctors’ offices, surgery centers, technology services and prescription drugs. It is the industry model, and CVS and Aetna, says one expert, are ‘wannabes.’
The president’s move to end payments that reduce out-of-pocket costs for low-income consumers had already been anticipated in California and some other states — and could hit a legal snag.