Today, June 26, 2008, I spoke with Gerardo Cardenas of the AARP Illinois – Divided We Fail media relations office. I asked him if his employers had any mechanism in place by which individual members could provide input, preferably in person, with the principal people within the AARP - Divided We Fail network. (Cardenas formerly served as Illinois Governor Rod Blagojevich's Chicago Press Secretary and Hispanic Liaison.)
Initially he kept directing me toward the Divided We Fail web site, and the “Share Your Story” feature. I advised him that that was a nice way for AARP to get people to feel involved, but that I wanted to do something more than tell anecdotes. He also mentioned that AARP – Divided We Fail has both a My Space and a Facebook account. I told him that I was not calling to find a date.
He then said that there were numerous gatherings where individuals could provide input. After repeatedly asking him to give me some examples, he finally gave me two, however, the gatherings he referred to had not had anything to do with Divided We Fail other than Divided We Fail had been “invited to attend”.
Finally, he admitted that there is no way that an AARP - Divided We Fail member can meet “one on one” with an AARP - Divided We Fail employee (policy maker). I told him that a literal “one on one” meeting would be nice, but that I would also be interested in being able to speak with the policy makers via a group of other people, as long as the meeting was limited to AARP - Divided We Fail business. He told me that that was not possible, but refused to tell me why. Then he referred me back to the Divided We Fail web site and the “Share Your Story” feature, after which he then hung up on me.
Note-
I told Mr. Cardenas that I initially had been referred to Ms. Terri Worman, Associate Director, AARP Illinois, but that she had not responded to my voice mail messages or my email. I mentioned that I had searched her name via Google, and learned that her expertise is that of a community organizer for the GLBT community, especially for the senior citizens who are a part of that demographic. Cardenas interpreted my comment as being a personal attack on Worman. I explained to him that I was just repeating the information that praised Worman and that I had read on the Internet, but Cardenas insisted that it was a personal attack.
Next I called AARP's main number again and asked a very nice operator if there were any other offices that I could call to get my questions answered, since I was not having any luck with the Illinois office. She told me that she has been told to direct people only to their state offices, and that she did not have a number for a national office.
That means there are fifty state offices divided up amongst the US. I guess that "Divided We Fail" is an appropriate name for this organization.
According to AARP, "Divided We Fail (www.dividedwefail.org) is a national initiative led by AARP, Business Roundtable, Service Employees International Union and the National Federation of Independent Business, to give a voice to millions of Americans who are tired of letting Washington gridlock stand in the way of affordable, quality health care and long-term financial security. Common sense solutions are needed, and everyone – individuals, businesses and government – has a role and a responsibility in ensuring health and financial security for all."
AARP is the only organization that I am entitled to join.
Thursday, June 26, 2008
Wednesday, June 25, 2008
Another reelection campaign and another letter requesting Melissa Bean to be accountable for her House staff.
This letter was faxed to Melissa Beans House office in Washington DC on June 25, 2008. I will note here whether or not it renders a response.Update: What a surprise! As of October 1, 2008, I have not received a response from Melissa Bean to the aforementioned letter. However, I am certain that Melissa has been busy attending to her sore feet, the result of all of her parading around over the summer.
Email to Terri Worman, AARP Illinois Executive, regarding Divided We Fail
.JPG)
On June 20, 2008, I was informed by numerous AARP employees via my phone inquiries, that Ms. Terri Worman is the AARP employee who will answer any questions that I have about the AARP program, Divided We Fail.
I left a voice mail message for Ms. Worman last Friday, June 20. Her outgoing message stated that she was out of her office, but that she would be returning to her office and returning calls on Monday, June 23.
I mailed her the email posted above on Tuesday, June 24.
I have not heard from her yet.
Health care advocate/mercenaries get press in the Chicago Tribune
An article titled “Health-care advocates do the job if you have the money, Experts will guide you through tricky health-care maze” appeared on the front page of the June 22, 2008 edition of the Chicago Tribune. It was written by Tribune reporter, Judith Graham.
I once spoke by phone with Ms. Graham, in an attempt to tell her about my experience serving as a health care advocate on behalf of my folks.
However, Graham was not interested. I had explained to Graham that I was not seeking publicity, but that I wanted simply to convey my experience. The aforementioned article is a good example of why I thought that a reporter would be interested in learning about the wrongdoing that I have encountered.
There is not really a “health-care maze”. If I was able to figure it out, then any reasonably intelligent person should be able to figure out how to handle any health care issue. Doing so is time consuming, but not that complicated.
The problems that I ran into were not due to a “maze”, but rather because my folks' Medicare managed care provider used deceit to dodge the Medicare managed care regulations. The regulations are supposed to be enforced by the Centers for Medicare and Medicaid Services; they have been established to prevent the Medicare managed care policyholders and providers from placing their bottom lines above the well-being of the beneficiaries. In our case, CMS has given the provider its approval for dodging the regulations.
According to Graham, “The field is known as "health-care advocacy”, and services typically assist with everything from resolving insurance disputes to researching treatment options to connecting people with medical resources.” This is all done for a fee, ranging anywhere from “$395 a year” at one company, to “$200 an hour” at another.
One of the companies mentioned is “an upscale solution, serving as the health-care equivalent of an exclusive, high-end private banker for more than 3,600 clients.” Graham writes that, “Today, at least 20 families on Forbes' list of the richest Americans are clients, paying from $10,000 to upward of $50,000 a year for a PinnacleCare membership.”
Graham provides an example of a man who purchased the services of PinnacleCare for his wife and three adult children. She writes, "Late last year it cost $41,000 a year for a VIP package for himself and his wife, ensuring that a top-notch physician would oversee all their medical needs; $30,000 a year for a package focused on healthy living for his three adult children and their families; and $21,000 for a one-time fee to compile comprehensive electronic medical records for everyone.
In all, that's $92,000 paid on health-care advice by this 66-year-old entrepreneur before a dollar was spent on medical services actually delivered."
These companies advocate because they make money doing it. I advocate because it is my folks that need the help. I do not know what PinnacleCare does that I have not done, but I sure would like to find out what they do for $50,000 a year.
I wonder if my folks had been wealthy, if that would have made a difference in how the provider chose to abide by, and how CMS chose to enforce, the CMS regulations.
If Graham had bothered to take a little bit of time to learn about my experience as a health care advocate, she might have wondered the same thing.
-----
Note:On June 22, I sent an email to Ms. Graham, in which I reminded her that I had tried to tell her about some of my experiences, but that she had not been interested. She wrote me back almost immediately, and stated that she has talked with a lot of people, and that she was sorry if she had offended me.
I once spoke by phone with Ms. Graham, in an attempt to tell her about my experience serving as a health care advocate on behalf of my folks.
However, Graham was not interested. I had explained to Graham that I was not seeking publicity, but that I wanted simply to convey my experience. The aforementioned article is a good example of why I thought that a reporter would be interested in learning about the wrongdoing that I have encountered.
There is not really a “health-care maze”. If I was able to figure it out, then any reasonably intelligent person should be able to figure out how to handle any health care issue. Doing so is time consuming, but not that complicated.
The problems that I ran into were not due to a “maze”, but rather because my folks' Medicare managed care provider used deceit to dodge the Medicare managed care regulations. The regulations are supposed to be enforced by the Centers for Medicare and Medicaid Services; they have been established to prevent the Medicare managed care policyholders and providers from placing their bottom lines above the well-being of the beneficiaries. In our case, CMS has given the provider its approval for dodging the regulations.
According to Graham, “The field is known as "health-care advocacy”, and services typically assist with everything from resolving insurance disputes to researching treatment options to connecting people with medical resources.” This is all done for a fee, ranging anywhere from “$395 a year” at one company, to “$200 an hour” at another.
One of the companies mentioned is “an upscale solution, serving as the health-care equivalent of an exclusive, high-end private banker for more than 3,600 clients.” Graham writes that, “Today, at least 20 families on Forbes' list of the richest Americans are clients, paying from $10,000 to upward of $50,000 a year for a PinnacleCare membership.”
Graham provides an example of a man who purchased the services of PinnacleCare for his wife and three adult children. She writes, "Late last year it cost $41,000 a year for a VIP package for himself and his wife, ensuring that a top-notch physician would oversee all their medical needs; $30,000 a year for a package focused on healthy living for his three adult children and their families; and $21,000 for a one-time fee to compile comprehensive electronic medical records for everyone.
In all, that's $92,000 paid on health-care advice by this 66-year-old entrepreneur before a dollar was spent on medical services actually delivered."
These companies advocate because they make money doing it. I advocate because it is my folks that need the help. I do not know what PinnacleCare does that I have not done, but I sure would like to find out what they do for $50,000 a year.
I wonder if my folks had been wealthy, if that would have made a difference in how the provider chose to abide by, and how CMS chose to enforce, the CMS regulations.
If Graham had bothered to take a little bit of time to learn about my experience as a health care advocate, she might have wondered the same thing.
-----
Note:On June 22, I sent an email to Ms. Graham, in which I reminded her that I had tried to tell her about some of my experiences, but that she had not been interested. She wrote me back almost immediately, and stated that she has talked with a lot of people, and that she was sorry if she had offended me.
Monday, June 23, 2008
Medicare Rights Center anything but
From the Medicare Rights Center website as of June 18, 2008:
“History
The Medicare Rights Center National HMO Appeals Hotline, in operation since September 1997, provides direct assistance to older and disabled people who have had necessary care denied, reduced or terminated by their Medicare HMO. From September 1999 through August 2000, MRC's HMO Appeals Hotline handled 709 cases, secured much needed care for our clients, and saved them over $360,930 in out-of-pocket costs.
The Appeals Process
Our counselors guide callers through the HMO appeals process and, when necessary, intervene on their behalf with Medicare HMOs. After getting basic information about the problem, MRC staff either provide clients with information about how they can handle their own appeal or intervene directly on behalf of clients with their HMOs. In the typical case in which MRC intervenes on the client's behalf, hotline staff telephone the HMO to gather information and to advocate informally for our client.
When informal advocacy fails, MRC may write a letter to the HMO asking it to reconsider its denial. These letters contain facts, regulations and supporting documents pertaining to the case. MRC routinely sends a copy of this letter to the appropriate Health Care Financing Administration regional office, since we believe it is important to keep HCFA apprised of individual problems in a particular HMO as well as systemic problems that we observe when a large number of our callers run into the same difficulty.”
(The Health Care Financing Administration, or HCFA, became the Centers for Medicare and Medicaid Services in 2001)
One would think that an organization claiming to “institute more consumer protections for people enrolled in private Medicare plans”, would welcome well documented testimony about the wrongdoing perpetrated by a major private Medicare plan, with the blessing of the Centers for Medicare and Medicaid Services.
Furthermore, one would think that such an organization would post on its website, the criteria required in order to receive its assistance.
Neither is the case.
For at least a decade, my folks’ Medicare managed care HMO has referred its beneficiaries to the Medicare Rights Center for assistance in filing appeals. (This is true as of June 18, 2008.)
However, we have been repeatedly refused such assistance by MRC. The reasons have varied.
In 2003, the first time that I called MRC’s hotline on my folks’ behalf, a recording advised me to leave my name and number, and I received a phone call shortly after, but I was told by that individual that she did not know how MRC could help us. I had called MRC because my (late) mother’s Medicare provider had failed to provide her with medical services that her medical history, including the opinions of the specialists who had seen her, deemed necessary.
I called MRC again in mid 2004, on behalf of both my stepfather and mother for the same reason, and according to the Centers for Medicare and Medicaid Services website:
“Your Medicare Appeal Rights:
You have the right to appeal any decision about your Medicare services. This is true whether you are in the Original Medicare Plan, a Medicare managed care plan, or a Medicare prescription drug plan. If Medicare does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal.”
This time I was told via a phone call with MRC’s former Director of Client Services, Rina Kitazawa, that MRC only assists residents of New York State. I informed Kitazawa that in my stepfather’s case, I had found out that the Medicare provider had lied to us about the reason he had been denied a service, but she told me that there was nothing that she could to assist us.
Inexplicably, on or about the fall of 2004, I received a phone call from somebody at MRC saying that somebody was going to be getting in contact with me regarding my stepfather’s case. As it turned out, nobody contacted me.
I wrote a December 12, 2004, letter to Kitazawa asking her to clarify the requirements needed to receive assistance from MRC. I received a letter dated January 14, 2005 that was completely void of fact. Instead of answering my question, for some reason Kitazawa had decided to claim that MRC had carefully examined our case and had determined that we had nothing to appeal!
Earlier, I had provided Kitazawa with documents and testimony that showed that my stepfather’s surgeon (who was employed by the Medicare managed care provider) had requested that my stepfather be given acute physical therapy in my stepfather’s HMO network hospital (which was owned by the Medicare managed care provider) after my stepfather had neck surgery.
I had been told at that time that my stepfather had been evaluated to determine whether he was a candidate for acute physical therapy, and that it had been determined that he was not a candidate.
However, later I found out that he had never been evaluated because according to the Medicare managed care provider, the Medicare managed care HMO would not approve the service because it was “out of network”. (This was a service denial, and thus subject to appeal.) This information had been withheld from his medical records.In her letter to me, Kitazawa knowingly took a position based on the Medicare managed care provider’s deception. Kitazawa refused to acknowledge the documents that showed that a service had been denied.
I have had no further correspondence with Kitazawa. She is no longer at MRC.
The Medicare managed care HMO continued to list MRC as a resource for beneficiaries to use for assistance in filing appeals, and in late 2006, I spoke via a phone call with Paul Precht, MRC’s Director for Policy and Communications in Washington D.C.
Precht informed me that the Medicare managed care HMO was in error for referring its beneficiaries to MRC, but he refused to put that in writing, nor would he allow me to record our conversation.
There are many people, especially those affiliated with MRC, who believe that there is a statute of limitations regarding accountability. I have written to Robert Hayes, President and General Counsel MRC, requesting an explanation, and I have never received a response.
In June 2008, I phoned one of the foundations that grants funds to MRC. I spoke with Barbara Geenburg, President of The Philanthropic Group in New York. According to its website she “designed the grantmaking strategy for the Helen Andrus Benedict Foundation, and directs its grantmaking program.”
I started our conversation by telling her that I was concerned about the manner in which MRC advertised itself. Instead of responding to my concern directly, she asked me why I was talking about something that happened some years ago. I told her that it was because MRC was still allowing the HMO to use its name as a source for assistance. She then told me that she did not think that MRC could get the HMO to stop. I told her that that was ridiculous. She then asked me, as if she were his assistant, if I wanted Hayes to call me. I gave her my phone number, however, I still have not heard from him.
MRC’s promotion of itself has been very successful. Scores of other organizations have also referred me to MRC for assistance with appeals. Some individuals have insisted that I must be mistaken about MRC’s refusal to assist us. One of the reasons MRC’s lack of integrity is harmful is because there are so many people who believe its hype!
In our case, I wasted valuable time contacting and waiting for responses from MRC, because I believed their hype too. There is a need for legitimate resources to be made available to people like us.
The information that MRC offers via its website is available elsewhere on the Internet on sites such as those belonging to WebMD and CMS.
I believe that MRC’s principals hope to keep the donations and grant money coming in by continuing to make false claims about the scope of their assistance to Medicare and Medicare managed care HMO beneficiaries. There is no other reason for them not disclosing the limitations that they have personally disclosed to me.
(MRC’s most recent IRS 990 forms are available for free at GuideStar . Registration is required, but there is no cost to examine the forms.)
“History
The Medicare Rights Center National HMO Appeals Hotline, in operation since September 1997, provides direct assistance to older and disabled people who have had necessary care denied, reduced or terminated by their Medicare HMO. From September 1999 through August 2000, MRC's HMO Appeals Hotline handled 709 cases, secured much needed care for our clients, and saved them over $360,930 in out-of-pocket costs.
The Appeals Process
Our counselors guide callers through the HMO appeals process and, when necessary, intervene on their behalf with Medicare HMOs. After getting basic information about the problem, MRC staff either provide clients with information about how they can handle their own appeal or intervene directly on behalf of clients with their HMOs. In the typical case in which MRC intervenes on the client's behalf, hotline staff telephone the HMO to gather information and to advocate informally for our client.
When informal advocacy fails, MRC may write a letter to the HMO asking it to reconsider its denial. These letters contain facts, regulations and supporting documents pertaining to the case. MRC routinely sends a copy of this letter to the appropriate Health Care Financing Administration regional office, since we believe it is important to keep HCFA apprised of individual problems in a particular HMO as well as systemic problems that we observe when a large number of our callers run into the same difficulty.”
(The Health Care Financing Administration, or HCFA, became the Centers for Medicare and Medicaid Services in 2001)
One would think that an organization claiming to “institute more consumer protections for people enrolled in private Medicare plans”, would welcome well documented testimony about the wrongdoing perpetrated by a major private Medicare plan, with the blessing of the Centers for Medicare and Medicaid Services.
Furthermore, one would think that such an organization would post on its website, the criteria required in order to receive its assistance.
Neither is the case.
For at least a decade, my folks’ Medicare managed care HMO has referred its beneficiaries to the Medicare Rights Center for assistance in filing appeals. (This is true as of June 18, 2008.)
However, we have been repeatedly refused such assistance by MRC. The reasons have varied.
In 2003, the first time that I called MRC’s hotline on my folks’ behalf, a recording advised me to leave my name and number, and I received a phone call shortly after, but I was told by that individual that she did not know how MRC could help us. I had called MRC because my (late) mother’s Medicare provider had failed to provide her with medical services that her medical history, including the opinions of the specialists who had seen her, deemed necessary.
I called MRC again in mid 2004, on behalf of both my stepfather and mother for the same reason, and according to the Centers for Medicare and Medicaid Services website:
“Your Medicare Appeal Rights:
You have the right to appeal any decision about your Medicare services. This is true whether you are in the Original Medicare Plan, a Medicare managed care plan, or a Medicare prescription drug plan. If Medicare does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal.”
This time I was told via a phone call with MRC’s former Director of Client Services, Rina Kitazawa, that MRC only assists residents of New York State. I informed Kitazawa that in my stepfather’s case, I had found out that the Medicare provider had lied to us about the reason he had been denied a service, but she told me that there was nothing that she could to assist us.
Inexplicably, on or about the fall of 2004, I received a phone call from somebody at MRC saying that somebody was going to be getting in contact with me regarding my stepfather’s case. As it turned out, nobody contacted me.
I wrote a December 12, 2004, letter to Kitazawa asking her to clarify the requirements needed to receive assistance from MRC. I received a letter dated January 14, 2005 that was completely void of fact. Instead of answering my question, for some reason Kitazawa had decided to claim that MRC had carefully examined our case and had determined that we had nothing to appeal!
Earlier, I had provided Kitazawa with documents and testimony that showed that my stepfather’s surgeon (who was employed by the Medicare managed care provider) had requested that my stepfather be given acute physical therapy in my stepfather’s HMO network hospital (which was owned by the Medicare managed care provider) after my stepfather had neck surgery.
I had been told at that time that my stepfather had been evaluated to determine whether he was a candidate for acute physical therapy, and that it had been determined that he was not a candidate.
However, later I found out that he had never been evaluated because according to the Medicare managed care provider, the Medicare managed care HMO would not approve the service because it was “out of network”. (This was a service denial, and thus subject to appeal.) This information had been withheld from his medical records.In her letter to me, Kitazawa knowingly took a position based on the Medicare managed care provider’s deception. Kitazawa refused to acknowledge the documents that showed that a service had been denied.
I have had no further correspondence with Kitazawa. She is no longer at MRC.
The Medicare managed care HMO continued to list MRC as a resource for beneficiaries to use for assistance in filing appeals, and in late 2006, I spoke via a phone call with Paul Precht, MRC’s Director for Policy and Communications in Washington D.C.
Precht informed me that the Medicare managed care HMO was in error for referring its beneficiaries to MRC, but he refused to put that in writing, nor would he allow me to record our conversation.
There are many people, especially those affiliated with MRC, who believe that there is a statute of limitations regarding accountability. I have written to Robert Hayes, President and General Counsel MRC, requesting an explanation, and I have never received a response.
In June 2008, I phoned one of the foundations that grants funds to MRC. I spoke with Barbara Geenburg, President of The Philanthropic Group in New York. According to its website she “designed the grantmaking strategy for the Helen Andrus Benedict Foundation, and directs its grantmaking program.”
I started our conversation by telling her that I was concerned about the manner in which MRC advertised itself. Instead of responding to my concern directly, she asked me why I was talking about something that happened some years ago. I told her that it was because MRC was still allowing the HMO to use its name as a source for assistance. She then told me that she did not think that MRC could get the HMO to stop. I told her that that was ridiculous. She then asked me, as if she were his assistant, if I wanted Hayes to call me. I gave her my phone number, however, I still have not heard from him.
MRC’s promotion of itself has been very successful. Scores of other organizations have also referred me to MRC for assistance with appeals. Some individuals have insisted that I must be mistaken about MRC’s refusal to assist us. One of the reasons MRC’s lack of integrity is harmful is because there are so many people who believe its hype!
In our case, I wasted valuable time contacting and waiting for responses from MRC, because I believed their hype too. There is a need for legitimate resources to be made available to people like us.
The information that MRC offers via its website is available elsewhere on the Internet on sites such as those belonging to WebMD and CMS.
I believe that MRC’s principals hope to keep the donations and grant money coming in by continuing to make false claims about the scope of their assistance to Medicare and Medicare managed care HMO beneficiaries. There is no other reason for them not disclosing the limitations that they have personally disclosed to me.
(MRC’s most recent IRS 990 forms are available for free at GuideStar . Registration is required, but there is no cost to examine the forms.)
Sunday, June 22, 2008
Congresswoman Melissa Bean (D-IL, Eighth District) needs to be accountable for herself as well as her congressional staff.
From Congresswoman Melissa Bean’s (D-IL., 8th District) Campaign Web Site: As part of her ongoing efforts to increase accountability and transparency in congress, Congresswoman Melissa Bean announced a congressional Accountability Initiative at a downtown Chicago press conference Thursday May 28 [2008].
I do not know for whom Congresswoman Bean was doing a favor when she hired Nicholas Jordan to be her Director of Constituent Services, but she was not doing one for herself, and she was certainly not doing one for her constituents. (Jordan worked for Senator Richard Durbin prior to working for Bean.)
In February 2005, on behalf of my stepfather and now deceased mother, I provided Jordan with scores of written testimony and annotated documents, which showed how a Medicare managed care organization had circumvented numerous Medicare regulations with the blessings of Health and Human Services and the Centers for Medicare and Medicaid Services. The fact intensive information that I gave to him was not complicated, but there was a lot of it, and I offered to meet with him if he needed assistance in understanding its significance. Jordan was not enthusiastic about meeting with me, and he did not have an understanding of what a Congressional caseworker may do on behalf of a constituent.
My knowledge of the guidelines for Congressional caseworkers comes from the US House Ethics Committee, as well as other US government publications. This information is readily available via the Internet.
The following statements are from the US House Ethics Committee (Committee on Standards of Official Conduct).
Members and staff of the House often assist constituents in their dealings with administrative agencies by acting as facilitators or "ombudsmen". Members may properly communicate with agencies on behalf of constituents:
* to request information or status reports;
* to urge prompt consideration of a matter based on the merits of the case;
* to arrange for appointments;
In February 2005, on behalf of my stepfather and now deceased mother, I provided Jordan with scores of written testimony and annotated documents, which showed how a Medicare managed care organization had circumvented numerous Medicare regulations with the blessings of Health and Human Services and the Centers for Medicare and Medicaid Services. The fact intensive information that I gave to him was not complicated, but there was a lot of it, and I offered to meet with him if he needed assistance in understanding its significance. Jordan was not enthusiastic about meeting with me, and he did not have an understanding of what a Congressional caseworker may do on behalf of a constituent.
My knowledge of the guidelines for Congressional caseworkers comes from the US House Ethics Committee, as well as other US government publications. This information is readily available via the Internet.
The following statements are from the US House Ethics Committee (Committee on Standards of Official Conduct).
Members and staff of the House often assist constituents in their dealings with administrative agencies by acting as facilitators or "ombudsmen". Members may properly communicate with agencies on behalf of constituents:
* to request information or status reports;
* to urge prompt consideration of a matter based on the merits of the case;
* to arrange for appointments;
* to express judgment on a matter (subject to ex parte communication rules); and/or* to ask for reconsideration, based on law and regulation, of an administrative decision.
The failure of a regulatory agency to enforce its regulations obviously fits into the category of what issues “Members” may inquire about. However, Jordan inexplicably told me that he could not even express judgment about the matter to me, let alone HHS/CMS.
One of the specific violations that I reported to Jordan was that CMS and the Medicare managed care provider had repeatedly denied my stepfather and mother, in a variety of ways, their right to make Appeals, expedited (fast) and otherwise (i.e. due process).
Initially, Jordan was unable to grasp that the issue was not about a judicial matter that I wanted Bean to intervene in. He had trouble understanding that there was no judicial matter because we had been denied access to the regulatory judicial process!
I had told Jordan that I would not turn down any offer of assistance in resolving the matter. However, I also told him that my goal was to convey the wrongdoing that I had encountered to Bean via her staff. I had hoped that somebody in her office would have taken the time to look at the material that I provided to them, and understood what the HMO and CMS had done that was wrong. I thought that this was important, because Bean was going to be voting on Medicare related bills. The Appeals process is the most important safeguard that has been established to protect beneficiaries from having their healthcare compromised by the bottom line of the Medicare managed care insurer and its provider. I had hoped that Bean and her staff would be interested in learning about how CMS was allowing the regulations regarding the Appeals process to be violated. That hope turned out to be wishful thinking.
Jordan eventually mailed a "letter of inquiry” regarding the issue, but:
The failure of a regulatory agency to enforce its regulations obviously fits into the category of what issues “Members” may inquire about. However, Jordan inexplicably told me that he could not even express judgment about the matter to me, let alone HHS/CMS.
One of the specific violations that I reported to Jordan was that CMS and the Medicare managed care provider had repeatedly denied my stepfather and mother, in a variety of ways, their right to make Appeals, expedited (fast) and otherwise (i.e. due process).
Initially, Jordan was unable to grasp that the issue was not about a judicial matter that I wanted Bean to intervene in. He had trouble understanding that there was no judicial matter because we had been denied access to the regulatory judicial process!
I had told Jordan that I would not turn down any offer of assistance in resolving the matter. However, I also told him that my goal was to convey the wrongdoing that I had encountered to Bean via her staff. I had hoped that somebody in her office would have taken the time to look at the material that I provided to them, and understood what the HMO and CMS had done that was wrong. I thought that this was important, because Bean was going to be voting on Medicare related bills. The Appeals process is the most important safeguard that has been established to protect beneficiaries from having their healthcare compromised by the bottom line of the Medicare managed care insurer and its provider. I had hoped that Bean and her staff would be interested in learning about how CMS was allowing the regulations regarding the Appeals process to be violated. That hope turned out to be wishful thinking.
Jordan eventually mailed a "letter of inquiry” regarding the issue, but:
• He mailed it to the wrong place,
AdminiStar Federal, a company that has a contract with the Federal government to oversee the policies of beneficiaries enrolled directly in Medicare• He misidentified the issue.
• He failed to provide us with the "answers" that he claimed to have received.
Jordan had told me that he was going to send a letter to AdminiStar Federal. I then had advised Jordan that instead he should direct any correspondence to Matthew Brown, who at that time was the CMS Congressional Liaison in Washington. I explained to him that my stepfather and my mother were Medicare + Choice (now Medicare Advantage) beneficiaries, and CMS itself oversees those policies. Jordan chose to ignore me.
Jordan misidentified the issue as being about the quality of “health care” that had been delivered. It is difficult to understand how Jordan made this error, because I had repeatedly told him that the issue was that Federal regulations had been violated. Bean is not a doctor, and I did not ask her office to become involved in a medical issue.
(By definition, any issues involving the CMS Appeals process will have origins in medical procedures, but I stated in writing to Jordan that I was not asking him to address that issue.)
Because Jordan misidentified the issue as being about the quality of healthcare, AdminStar Federal forwarded the letter from Bean/Jordan to my parents’ Medicare + Choice HMO (the insurer) that had a contract with the Medicare managed care provider). Quality of care issues are formally called Grievances, and at that time were handled internally by the HMO.
Everything that took place next is based on hearsay, as written by Jordan, and his story is absurd. (That is what happens when people do not tell the truth.) He claims that an (as yet) unidentified person or persons at the HMO then voluntarily forwarded the letter to an (as yet) unidentified person or persons at an (as yet) unidentified location at “CMS”. According to Jordan, he then received a phone call from an (as yet) unidentified person or persons from CMS, advising him that the “answers” were the same. Jordon refused to specify what the answers were, or what questions these “answers” were in response to. He won't identify the concerned parties either.
I voiced my concern about this via a phone call with John Gonzalez, Bean’s Chief of Staff, on June 30, 2005. Gonzalez told me that he would look into the matter and get back to me after the Fourth of July holiday, but I did not hear from him again.
It might be unreasonable for Bean to be held accountable for the actions of her caseworker, but she has to be accountable for her chief of staff. Unfortunately, Bean has not been made accountable for much of anything. If Congresswoman Bean is concerned about congressional accountability, she should start by being accountable for herself and her congressional staff.
If our votes count, then Bean should be concerned about losing ours.
(By definition, any issues involving the CMS Appeals process will have origins in medical procedures, but I stated in writing to Jordan that I was not asking him to address that issue.)
Because Jordan misidentified the issue as being about the quality of healthcare, AdminStar Federal forwarded the letter from Bean/Jordan to my parents’ Medicare + Choice HMO (the insurer) that had a contract with the Medicare managed care provider). Quality of care issues are formally called Grievances, and at that time were handled internally by the HMO.
Everything that took place next is based on hearsay, as written by Jordan, and his story is absurd. (That is what happens when people do not tell the truth.) He claims that an (as yet) unidentified person or persons at the HMO then voluntarily forwarded the letter to an (as yet) unidentified person or persons at an (as yet) unidentified location at “CMS”. According to Jordan, he then received a phone call from an (as yet) unidentified person or persons from CMS, advising him that the “answers” were the same. Jordon refused to specify what the answers were, or what questions these “answers” were in response to. He won't identify the concerned parties either.
I voiced my concern about this via a phone call with John Gonzalez, Bean’s Chief of Staff, on June 30, 2005. Gonzalez told me that he would look into the matter and get back to me after the Fourth of July holiday, but I did not hear from him again.
It might be unreasonable for Bean to be held accountable for the actions of her caseworker, but she has to be accountable for her chief of staff. Unfortunately, Bean has not been made accountable for much of anything. If Congresswoman Bean is concerned about congressional accountability, she should start by being accountable for herself and her congressional staff.
If our votes count, then Bean should be concerned about losing ours.
---
Note:
The House Ethics Committee has changed its site since I posted this, and I have updated the link.
Illustrations
1. I dropped off the testimony and documents at Bean's office in February 2005, and I faxed this follow up letter to Bean's district office manager in March 2005.
2. The June 16, 2005 letter from Bean with the result of the "letter of inquiry".
3. Nicholas Jordan mailed the "letter of inquiry" to the wrong place (Administar Federal) and misidentified the issue as being about "[health] care".
4. The response letter from Administar Federal to Bean. Because Jordan misidentified the issue as being about the quality of care received by my folks, Administar Federal correctly forwarded it to the insurer. A complaint about the quality of care is a Grievance, and at the time was handled internally by the insurer. Yet, the letter refers to "services" not delivered which is an Appeals issue. If anything, the letter shows that thanks to the people involved, the system consists of nothing but weak links.
If Jordan had correctly identified the issue as being about CMS' failure to enforce its regulations, Administar Federal might have forwarded the letter to the correct location, the office of the Congressional Liaison, in Washington DC.
5. In October 2005, I requested copies of all of the correspondence that had been generated by Jordan's letter of inquiry. I received this letter along with the two previous ones linked to in items 3 and 4. Jordan still would not specify the "answers" that he claimed to have received ex parte from the unnamed person or persons at CMS.
Subscribe to:
Posts (Atom)