BigIns Whistleblower speaks to the EXACT RICO/Fraud crime performed by the BigIns
Mort Zuckerman
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Subject: BigIns Whistleblower speaks to the EXACT RICO/Fraud crime
performed by the BigIns
Date: Jan 20, 2010 11:50 AM
ARTICLE BELOW
===========================================
Here, Potter talks about how
insurance companies are writing
treatment guidelines. And we
know that they are because of
the Blumenthal RICO, where Kaiser
-Permanente is central to the
Lyme RICO, being partnered with
the CDC patent profiteers:
http://www.actionlyme.org/JUNE_13_2005_LETTER_TO_SPITZER.htm
in an entity called the ALDF.com
and later, IDSociety.org.
Of course, they got it catastrophically
wrong:
http://www.youtube.com/user/SvenVonErick#p/a/u/0/m4jGRhmMKIk
Now, the DemoFairies, being fairies
who always look for a way not to
be retaliated against (which they
call "bipartisanship" or "reaching out
across the isle") in the way of
Paul Wellstone, Cynthia McKinney or
JF Kennedy, run away from their job
of PROSECUTING CRIME, which, here,
clearly Wendell Potter is directing
the sentient among us to read between
the lines.
It is a RICO, or a racket, where
BigInsurance, as MD trainers:
http://www.actionlyme.org/OPMC_CORRUPTION.htm
(See ^^^ the attorney, Ansel Marks
talk about how "the Lyme experts" are
trained by Kaiser @ NYMC.edu.)
At one time, the average cost to treat
Lyme was known/projected to be $200,000
per year, because it is a chronic
meningitis. And we know that to be
true from the treatment failure of
syphilis, as well, reported by
Yale/ALSF/IDSA:
http://www.actionlyme.org/CHP_9_IDSA_REVIEWS.htm
http://www.actionlyme.org/RICOCHRON.htm
http://www.actionlyme.org/BRAIN_PERMANENT.htm
The NYT is not going to cover the
story because The Gray Lady is a dead
ho (and death becomes her.)
Because it is predictable that the
Dems and the DOJ will not do their
jobs, the people I am addressing do
not claim US citizenship. And they
have been listening to me for years.
This could have an effect on what
remains of US Commerce, which, as we
now all (better!) know, is the global
projection of fascism.
Crimes against Americans tend to assure
that the plans or the success of the Fascist
Bigs will be short-lived. They can
carry on like this, abusing Americans,
but already they lost, globally, MEDICINE.
KMDickson
http://www.actionlyme.org
http://www.relapsingfever.org
============
http://rawstory.com/2010/01/whisteblower-reveals-health-insurers-game-insurance-bill/
Potter cautioned that legislators need to keep an eye on how insurance
companies define medical and administrative expenses. And he said that
legislation should require companies to explain what they’re spending
money on and what percentage in dollar amounts they’re spending.
“You can set the medical-loss ratio, but you need to make sure that
it’s clearly understood what the components of the administrative
expenses are,” Potter explained. “Because they can shift stuff around
from one bucket to another and claim that what they’re actually
spending is beneficial to the patient when it may not be.”
For example, he said they can easily meet an 85% standard if the
definition enables them to categorize such items as disease management
programs as paying for medical care. Currently, money spent on disease
management programs is counted toward administrative costs.
Potter also noted that insurance companies have kept the issue of the
medical-loss ratio -- something little understood by the American
public -- “pretty much just a conversation between them, their
shareholders and the analysts who cover them. They don’t talk about it
anywhere else.”
Potter raised this complex but critical issue during his Senate
testimony in June.
“Every decimal point makes a big difference,” he added. “We’re talking
in the billions.”
=====================
Whisteblower reveals how health insurers can game new insurance bill
By Brad Jacobson
Wednesday, January 20th, 2010 -- 10:42 am
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Whisteblower reveals how health insurers can game new insurance
billThough Senate bill cuts 'pre-existing conditions,' it still allows
insurance companies to create 'pre-existing' categories to raise rates
The Democrats' healthcare overhaul, billed as a monumental game-
changer for Americans' health insurance coverage, provides numerous
loopholes for health insurance companies which will allow them to
raise rates to protect profit margins, a health insurance
whistleblower says.
Wendell Potter, a twenty-year veteran of the insurance industry and
former vice president of communications for Cigna, warns that current
healthcare legislation does nothing to prevent the insurance industry
from continuing its ongoing practice of increasingly shifting
healthcare costs to consumers.
A form of bait-and-switch, such practices often set up individuals,
families and small businesses for inadequate or unaffordable access
and a continued looming threat of financial ruin. The overlooked
element, Potter says, is that insurance companies will be able to
claim they are reducing premiums by forcing more Americans to pay
higher deductibles and offering less coverage.
“We talk a lot about affordability, and we talk about affordability of
insurance premiums,” Potter told Raw Story in a nearly hour-long
interview. “But when you talk about affordability, you need to talk
about affordability of premiums plus out-of-pocket expenses.”
Story continues below...
He said that there’s been a lot of discussion on how the Congressional
Budget Office scored this legislation and what it says this
legislation will cost the country in the long run, but little to no
focus on how the legislation will directly impact individual
Americans.
Potter pointed out, for example, that many plans -- even after
consumers received proposed government subsidies to help pay for them
-- would come with high deductibles that prohibit people from using
their insurance or cause them the kind of financial hardships that
healthcare reform was purported to prevent.
“What worries me,” he said, “is people who are forced to buy coverage
and all they can afford to buy is a high deductible. And if they get
really sick then they have to pay so much out of their own pockets
that they’re going to be filing for bankruptcy and losing their
homes.”
In the Senate bill, in particular, Potter noted, some people will be
buying insurance that will only cover roughly 60 percent of their
medical costs if they get sick.
“There are a lot of people who don’t have insurance now because they
can’t afford premiums,” he said. “They certainly couldn’t afford
premiums plus the out-of-pocket expenses in today’s market.”
Potter asserted that the current legislation will, in large part,
simply move millions of people from being uninsured to underinsured,
or from insured to underinsured. Citing a 2007 study by the
Commonwealth Fund, he said there are already over 25 million Americans
who fall into the category of the underinsured.
Potter also noted the deleterious effect of cost shifting on small
businesses. Many small business owners will earn just enough to be
denied subsidies.
“After a certain income level, there are no subsidies,” Potter
explained. “But you still have to buy coverage. And I’m concerned that
after you get above the median level of income, you’ll find that a lot
of people who don’t get subsidies will probably be forced to buy
coverage. But the only coverage they’ll be able to buy will make them
underinsured.”
There’s also no prohibition in the legislation against insurance
companies moving more and more people into high-deductible plans. Such
plans, Potter argued, will help insurers' bottom lines because fewer
policyholders will actually avail themselves of their insurance.
“When you have a benefit plan that requires people to pay a lot out of
their own pocket, a lot of these people will never get to the point of
using their insurance because they won’t go to the doctor or pick up
their medicines to satisfy the deductible,” Potter told Raw Story.
“I see nothing in this legislation that essentially would protect
people from losing their homes or filing for bankruptcy,” he added.
How insurance companies can still game the system
While prohibitions on such practices as denying healthcare to people
with pre-existing conditions remain in the legislation, Potter noted
that the Senate bill, in particular, provides the insurance companies
with “all the flexibility they need” to more than make up for any
profits lost due to new reform measures and to prevent people from
accessing coverage.
He pointed out, for example, that “health factors” such as chronic
diseases and age would continue to play into how much individuals can
be charged in premiums and how many of them may be forced into high
deductible plans.
“What they will be doing, what they can in the Senate bill, is charge
people significantly more if they have certain health factors,” Potter
said. “And it would be pretty much up to the industry to decide what
those health factors are. You could have high blood pressure, high
cholesterol, diabetes. You could be overweight, have a history of
tobacco use. There definitely would be a wide range of things that the
insurance industry would be able to look at and determine whether or
not to charge you more.”
He also noted that the Senate bill would allow insurance companies to
charge people who are older up to three times as much as those who are
younger and, in the House bill, two times more than a younger person.
“And of course when people get older they develop more health
factors,” Potter said. “So that is another way to get around the loss
of revenue. Plus, of course, they would be able to get new revenue
coming in from people who are younger and don’t have health factors
that they charge more for.”
Moreover, he said, “They still would be getting a new revenue stream
from people who are younger. So they’ll be getting significantly more
in revenue. And those people are quite profitable too because they
don’t file many claims.”
To justify this practice, Potter explained, insurers would claim that
they’re providing lowered or discounted premiums to healthier people.
But, in reality, premiums across the board are set so high that
healthier people wouldn’t actually be receiving anything that could be
considered a discount.
“Healthier people would be paying pretty much a standard rate at the
end of the day,” said Potter, while the chronically ill and the aged
would be paying exceptionally more on top of the already pricey
standard rate.
Medical-loss ratio
The former insurance executive also says another element of the
healthcare overhaul is receiving too little attention: the medical-
loss ratio, which determines what percentage of health insurance
premiums are spent on actual medical costs. The difference of just a
few percentage points can mean billions of dollars to the insurance
industry.
“We’re talking about big-time money here,” said Potter. “The insurance
industry doesn’t want to have any restrictions on the medical-loss
ratio. So they’ll be doing all they can to keep it from being enacted
if possible.”
Some members of Congress, led by Sen. Al Franken (D-MN), proposed an
amendment to require that 90 percent of consumer premiums go to
medical costs, but Potter doesn’t think that’s likely to happen and
said insurers will fight tooth-and-nail to set any minimum as low as
possible. The Congressional Budget Office said that the 90 percent
figure was too high and would basically drive insurers out of
business, recommending 80-85 percent instead. Democrats are expected
to embrace the lower figures in their final bill.
Potter cautioned that legislators need to keep an eye on how insurance
companies define medical and administrative expenses. And he said that
legislation should require companies to explain what they’re spending
money on and what percentage in dollar amounts they’re spending.
“You can set the medical-loss ratio, but you need to make sure that
it’s clearly understood what the components of the administrative
expenses are,” Potter explained. “Because they can shift stuff around
from one bucket to another and claim that what they’re actually
spending is beneficial to the patient when it may not be.”
For example, he said they can easily meet an 85% standard if the
definition enables them to categorize such items as disease management
programs as paying for medical care. Currently, money spent on disease
management programs is counted toward administrative costs.
Potter also noted that insurance companies have kept the issue of the
medical-loss ratio -- something little understood by the American
public -- “pretty much just a conversation between them, their
shareholders and the analysts who cover them. They don’t talk about it
anywhere else.”
Potter raised this complex but critical issue during his Senate
testimony in June.
“Every decimal point makes a big difference,” he added. “We’re talking
in the billions.”
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