October 26

UK’s Elderly Care Plan Run by US "Cheats"

UK’s Elderly Care Plan Run by US “Cheats”

Tue, 12 Nov 2002

Healthcare fraud is bankrupting the American healthcare system, and leaving 41.2 million Americans without healthcare insurance because the cost is so high. British newspapers–The Observer and The Guardian–report that the UK government has hired United Healthcare, a US company, as consultants for its National Health Services.

But United Healthcare has been engaged in corrupt practices in the US: the company was fined $7 million within the last two years for cheating US taxpayers, doctors and patients in nine states. Among the corrupt practices found by state insurance commissions and federal auditors, the company had over-billed for nursing home care for people who weren’t in nursing homes. Furthermore, a United vice-president, Michael Mooney, was sentenced in August to 3 1/2 years in jail and fined $220,000 after he was prosecuted by the American Economic Crimes Unit for insider trading.

Notwithstanding the company’s record of crimes and fines, the UK Health Secretary has hired the company to set up “a model” of healthcare for the elderly after having talks with US Secretary Tommy Thompson. When asked about the company’s corrupt practices, a UK spokesperson said simply: “this was part and parcel of operating in the health industry in the US.”

So it would appear.

Could it be that President Bush, who is reported to have publicly praised the company, have been unaware of its corrupt activities? Or, could it be that the company’s contribution to the Republican Party might have influenced the President and his administrators to disregard corporate defrauding of the American taxpayers?



UK’s elderly care plan run by US “cheats”
Firm fined $7m in string of cases
Antony Barnett and Solomon Hughes
Sunday November 10, 2002
The Observer

An American firm hired by Health Secretary Alan Milburn to transform the way elderly patients are treated in the NHS has been fined more than $7 million (£4.4m) in the past two years for allegedly cheating the US government, doctors and patients.

United Healthcare, an American private insurer, claims that its Evercare programme in the US has halved the number of elderly people being admitted to hospital by treating them at home or elsewhere in the community.

Milburn announced in October that he was signing a major contract with United Healthcare for consultancy advice on how to cut costs in the NHS by keeping the elderly patients out of hospital. The firm is being hired initially to help design, monitor and advise on the running of 10 pilot schemes expected to start in the NHS before Christmas.

However, The Observer discovered that over the past two years, United Healthcare has been forced to pay millions of dollars in fines to settle charges that it had defrauded the US government, patients and doctors .

The firm paid $2.9m last November to settle claims that it had falsely charged the US government for patients it claimed were in nursing homes. The over-billing was discovered when federal auditors checked the records of a random group of United Healthcare patients listed as institutionalised, and found that almost one in three was not in long-term care at all.

United Healthcare paid the fine to settle the suit, but did not admit any wrongdoing.

In July the New York Department of Insurance fined United Healthcare $1.5m for cheating patients out of money. The firm was ‘failing to give proper notice of the right to appeal’ when denying patients health insurance payments.

The Observer has identified a further 10 fines levied by State Insurance Commissioners since March 2000. United paid out almost £2m in nine states, including Florida, Texas, Ohio and New Jersey. Some of these fines were for late payments to doctors, patients and hospitals and in one case for passing work to a doctor whose medical licence had been revoked.

The firm has faced other controversies. In August Michael Mooney, a United vice-president, was jailed for three and a half years and fined $220,000 after he was prosecuted by the American Economic Crimes Unit for insider trading.

Milburn became interested in United Healthcare after talks with US Health Secretary Tommy Thompson last month.

President George Bush has publicly praised the firm’s Evercare programme, which Milburn wants to use as a model for the NHS. This year the firm has paid $84,000 to the Republican Party.

A Department of Health spokesman said that an independent evaluation for the US government this year concluded that Evercare had reduced hospital admission by about 50 per cent without increasing patient mortality.

Asked about the firm’s catalogue of fines, a Health Department spokeswoman said this was part and parcel of operating in the health industry in the US. She said: ‘We are entirely satisfied that the procurement process was correctly following before signing the deal.’

A spokesman for United Healthcare said: ‘We look after the healthcare of millions of Americans and most are extremely happy with what we offer. Of course we occasionally make mistakes and because of the litigious nature of the US these are often settled in court.’

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