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;
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 MedicareJordan 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.
(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.
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.
