Kreidler reaction to Supreme Court upholding health care reform law

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler expressed great relief with the U.S. Supreme Court’s decision upholding the Affordable Care Act and said Washington state is now well ahead of most states in reforming its health care system.

 

Many reforms are currently in place, but key benefits and programs take effect in 2014, including Washington’s new Health Exchange, federal subsidies to help 477,000 people afford health insurance, an expansion of Medicaid for 328,000 poor childless adults and the ban on insurance companies from denying people coverage if they’re sick.

 

“I’m very pleased the Supreme Court chose to uphold the Affordable Care Act,” said Kreidler. “We’ve been busy for two years now implementing the reforms and have made great progress, but there’s a lot left to do before 2014. With the court decision out of the way, we can continue our focus on where it should be – bringing relief to families struggling to find quality, affordable health insurance.”

 

The millions of Washington state consumers benefitting from the Affordable Care Act’s early reforms include:

 

• More than 2.4 million people who no longer face lifetime caps on their health benefits.
• More than 52,000 young adults up to age 26 who have stayed on their parents’ health plans.
• More than 1.2 million people who now have coverage for preventive care with no co-pays or deductibles.
• More than 60,000 people in Medicare who have saved hundreds on their prescription drugs.

 

Washington state also leveraged millions in federal funds available under the Affordable Care Act to create:

 

• Public access to health insurance rate requests. 
• A new marketplace in Washington state for health insurance in 2014 – called an exchange – where people can shop for health plans, compare their options and apply for subsidies.
• A temporary health insurance program (PCIP-WA) for people with pre-existing health conditions.

 

“The Affordable Care Act is not perfect, but it moves us in the right direction and is the only meaningful reform that’s passed in decades,” said Kreidler. “The debate was clearly contentious, and I’m grateful to have it behind us. But, now it’s time to focus on the work ahead – more than a million uninsured people in our state are counting on us.”

SCOTUS on PPACA (ObamaCare) June 28, 2012

Live blog while watching the decision on Scotusblog.

PPACA (ObamaCare) is upheld and will go forward! Individual mandate deemed constitutional.

I will blog later with more details.
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Well, that was an interesting morning and for many a bit of a surprise. The Supreme Court ruled that the individual mandate to purchase health insurance coverage is considered a "tax" and not a "penalty" and, as such, falls under Congressional authority and is constitutionally legal.

Undoubtedly there will be many announcements, blogs and video responses from the various parties with regard to this decision.

Below is a link to the PDF of the court's decision (all 67 pages):

SCOTUS Decision

Dave
www.an-insurance.com

Cease and desist order issued against Lenovo

Insurance Commissioner Mike Kreidler has issued a cease-and-desist order against computer maker Lenovo, barring the company from continuing to sell illegal service contracts in Washington state.

From May 2008 to May 2012, Lenovo (United States) Inc. is believed to have sold $153,415 worth of service contracts in the state. The plans, which covered repair or replacement of damaged Lenovo products, can only be sold to Washington residents by a licensed insurer or a registered service contract provider. Lenovo is neither.

Kreidler also ordered the company to mail a copy of the cease-and-desist order to all its Washington customers within 10 days.

Nothing in the order prevents the company from fulfilling the terms of the service contracts or from issuing a refund, if requested.

The company’s unauthorized sale of service contracts was initially disclosed by Lenovo itself when it applied for registration as a service contract provider in April 2011. At that point, the company said, it had already sold 855 contracts for $90,630.

When Kreidler’s staff reviewing the application sought more information, the company failed to respond, and later withdrew its application (December 2011). Lenovo later said it had sold a total of 1,327 contracts worth $153,415 to Washingtonians (May 2012).

The company has a right to demand a hearing. The order takes effect immediately.

iPhone Apps for Insurance Companies

Over the last year mobile applications for smart phones have begun to pop up amongst the different insurance companies that Fey Insurance represents. It started with Travelers and Progressive and has expanded into Safeco, Chubb and now Cincinnati Insurance Company. The applications all allow you to view your current policies and auto ID cards. They help give you contact information to report claims as well as advice on what to do during a claim. Some of the applications actually allow you to report the claim directly from the mobile device.

So how do you get your insurance carriers mobile application? First go to your most recent insurance policy declaration page for either your home or auto insurance. Double check which company you have. Once you know which company you have your insurance with then pull up the applications icon on your iPhone. In the search box type the company name. Once you have located the insurance company's application be sure to download it to your device. Some of the applications will allow you to setup your account right in the app but others may require that you first go to the insurance companies website and create a login.

When you are all finished creating a log in you are then set to use the app and have your personal insurance information handy at any time. Each app also has a button you can press to give us a call directly for more detailed assistance. Try it out today.

Theft charges for medical worker who submitted $4 million in bogus bills, sometimes claiming to be a doc

We're going to post a news release soon about this case:


A medical worker submitted at least $4.1 million in bogus bills to insurers, sometimes while falsely claiming to be a doctor or physician’s assistant, has pleaded guilty to theft.

Kenneth R. Welling, 45, of Lake Forest Park, pleaded guilty Thursday in King County Superior Court. The charges -- all of which are felonies -- include one count of first-degree theft and six counts of second-degree theft.

“This was a pretty audacious scam,” said state Insurance Commissioner Mike Kreidler. “We were tipped off to it when a patient contacted us, saying that Welling billed her insurer $89,000 for six surgeries that never happened.”

Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither.

Kreidler’s investigators also found numerous instances in which Welling billed for surgeries that never happened. Sometimes he would include post-operative reports, listing himself as the surgeon.

No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.

“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.

In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.

From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.

“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”

The investigation also showed that some patients were complaining to their insurers.

“I am angry!” one woman wrote to her insurance company in 2011. “Here is yet another fraudulent claim. Can’t you people help me to stop this? I never had surgery on Aug. 27, 2009. I never met or had anything to do with Ken Welling.”

A sentencing date is expected to be scheduled soon.

Kreidler statement on Regence's proposed 14.7 percent rate hike

Regence BlueShield, one of Washington state's largest health insurers, is proposing an average 14.7 percent hike in premiums for its customers who buy coverage on their own.

Even with that increase, the company says it would also face a loss of $4.5 million from its surplus, which currently exceeds $1 billion.

Here's state Insurance Commissioner Mike Kreidler's statement on the proposal:

“We’ve just received this request. It will undergo a rigorous review by our actuaries.

“Regence contends that even with this increase, it would lose $4.5 million from the company’s surplus. To put that in perspective, that’s less than half of 1 percent of the company’s $1 billion surplus.

“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus.

“A similar request by a sister company, Regence BlueCross BlueShield of Oregon, sought a 6.4 percent increase, starting August 1, 2012. But after our review and objections, it withdrew the request today. Any future rate request will face the same thorough scrutiny.”

Martin Vs. Blue Shield CA (The Next Feller-Freed)

After the Feller-Freed and Serencsa-Lichtman class action settlements with Anthem Blue Cross (Blue Cross of California) I assumed it would simply be a matter of time before similar action was taken against Blue Shield of California. That action was announced by Consumer Watchdog last week.

Blue Shield recently announced (and I blogged) the closure of the majority of their current individual health plans to be replaced by new plans July 1,2012.

Until this case is settled there really isn't a lot to talk about. I will blog when we get information regarding any potential settlement with Blue Shield and the plan migration choices that might be available to those on closed or closing individual plans.

Dave
www.an-insurance.com