Health insurers probed over reimbursement

New York Attorney General Andrew Cuomo said on Wednesday he is conducting an industry-wide probe of health insurers into an alleged scheme to defraud consumers by manipulating reimbursement rates.

Cuomo said he intends to sue UnitedHealth Group Inc (UNH.N) and four of its subsidiaries, including Ingenix Inc, the nation's largest provider of health care billing information.

The attorney general also issued 16 subpoenas to the largest U.S. health insurance companies, including Aetna Inc (AET.N), Cigna Corp (CI.N) and Empire Blue Cross Blue Shield, a unit of WellPoint Inc (WLP.N).

If I recall correctly United Health Group signed an agreement to acquire Sierra Health Services Inc.which provided health benefits and services to Nevadans and amazingly the Nevada Insurance Commission approved the purchase leaving Nevadans with only a few health care providers and giving United Health Group as much as 80 percent of the Nevada market.

At the time Forrest Burke, of United Health, said there would be no increase in rates and that reimbursement and other factors would be unaffected. (Nevada Appeal)

However, it is reimbursement that United Health is now being investigated for. Kind of makes it easy to set rates when there is no competition thanks to our ever watchful Nevada politicians.

For those who hate Governor Gibbons almost as much as Bush, there is one thing he may be getting right:

On November 9, 2007, Governor Gibbons sent a letter to the U.S. Department of Justice requesting that they seek a final and accurate determination, within their jurisdiction, of what this merger would mean to healthcare access and availability in Nevada.

"A merger of this magnitude could prove to be less than advantageous to Nevada consumers due to the overwhelming HMO and Medicare market share the UnitedHealth Group will control in our state," Governor Gibbons concluded.

He got one right. Read the Governor's office complete press release here.

According to a 2007 UNR study Nevada remains the fastest-growing older population in the U.S. .

The bad news, said the study, is the state is facing "critical shortages" of medical professionals.

"The convergence of an overburdened health-care system, inadequate resources for seniors and the sheer number of aging baby boomers is setting the stage for an aging perfect storm to hit Nevada," said the study, titled Elders Count Nevada: Key Health Indicators for Nevada's Elders.

According to the study, between 1990-2000, Nevada's 65-and-older population grew 72 percent, while the number of residents 85 and older more than doubled.

From 2000-04, the state's 65-and-older population grew by nearly 20 percent - more than five times the national rate.

The growth of Nevada's elder population is only expected to accelerate as baby boomers reach retirement age. Seniors made up 11 percent of the Nevada's population in 2004, but are projected to become more than 18 percent by 2030.

The study predicted Nevada will remain number one in terms of senior population percentage growth until 2030 with an overall senior population growth of some 264 percent between 2000-30.

The problem is Nevada already ranks at or near the bottom of all states in terms of doctors, nurses and other health-care workers per capita the report said.

What's more, since 2005, Nevada has ranked last in the number of current medical school students per 100,000 population in the U.S.

Also in 2007 the CDC and the Merck Company Foundation ranked Nevada as the worst state in terms of smoking prevalence among older adults and its seniors are twice as likely as those in other states to be binge drinkers.

The Sun is reporting that Governor Gibbons has been contacted by two medical groups concerned over a story also by the Sun which reported on September 30 that multiple employers in Las Vegas -- immigrant physicians themselves -- have systematically abused the so-called J-1 program, which is designed to place foreign doctors in medically underserved areas -- usually, clinics in rural or poor urban neighborhoods.

Instead, the bosses divert physicians to more affluent areas, where they can bring more money to the practice. In some cases, the employers violate contracts and federal law by failing to pay the foreign doctors their wages. Many of the foreign doctors also complain of being overworked to the point of exhaustion, jeopardizing patient care.

Nevada was built on corruption, bribes, and short cuts and is unjustly proud of its history of abuse. It's no wonder that in a state dedicated to taking away someone else's money, that our professional class of lawyers, politicians, physicians, developers, etc. are some of our most talented crooks. It is also egregious that most corruption stories seem to be broken by the L.A. Times first and not the Review Journal, and most cases investigated by the F.B.I. and not Metro.