Evan M. Lopez
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NOTE: This story has been altered since its original print publication.
On a cloudy day in August, tucked away in a quiescent library on the 17th floor of a drab, gray-and-brown skyscraper along 15th and Arch streets, where the city's law department resides, there is a stack of papers. Each one documents a case in which the city refused to reveal something to someone. There are, quite literally, hundreds of them, each offering a glimpse — but only a glimpse — into what our local government doesn't think we should know.
Take, for instance, the 911 tapes regarding the April 29, 2008, shooting of Dwight Dixon on West Thompson Street in North Philly: The public cannot hear them, the city has decided — not now, likely not ever. Same goes for the Police Department's procedures for investigating officers who've shot civilians, and the groundwater contamination records for a building on 1500 S. Columbus Blvd. Ditto for records showing which City Hall renovations from 1962 to 1977 may have involved asbestos, documents implicating the Board of Revision of Taxes in legal violations, video from surveillance cameras showing a car accident around Broad and Susquehanna on July 8, 2009, and many, many more.
In some cases, the city says the records simply don't exist. In others, the requested records did exist, but city officials destroyed them. In others still, the city asserts that the information is privileged because "a criminal investigation is not subject to disclosure" — not even 100 years after that investigation is fait accompli.
Sometimes, of course, secrecy has its merits: The government has an interest in protecting trade secrets, information that might endanger citizens, invasions of privacy and so forth. But in this land of Vince Fumo, where politicians have destroyed public documents and will likely do so again, and where government agencies too frequently try to bury information that might embarrass them, the default should be transparency.
And all too often, it's simply, undeniably, not.
And so you can't help but wonder: Which of these hundreds of denied records requests involve things we ought to know? And more importantly, why doesn't the city think we as taxpayers are entitled to them?
These questions and gaps in intelligence brew an intoxicatingly, frustratingly, even tantalizingly mysterious air around City Hall — an air that Mayor Michael Nutter promised to promptly clear when he entered office in 2008. That climate is bad for politics, after all.
But Nutter hasn't done any such thing. In fact, in the past two-and-a-half years, the fog has only grown thicker and darker.
CULTURE OF SECRECY
It's not supposed to be like this.
On Jan. 7, 2008, with an ebullient crowd in front of him and red-and-white poinsettias wrapped in crinkly paper behind, Nutter delivered his inaugural address. He spoke of "a renewal of Philadelphia." He got endearingly roiled in that classic Nutter way, declaring to criminals, "This is our city, not yours!" and "Enough is enough!" He made a bounty of promises that seem, for the most part, wildly optimistic and naïve today.
Evan M. Lopez
Terry Mutchler, executive director of the Pennsylvania Office of Open Records (CLICK IMAGE FOR LARGER VERSION) |
But then he said something that, even in this new decade of cynicism, seems viable: "There is nothing government does that cannot be done ethically and transparently."
For Brett Mandel, former executive director of good-government group Philadelphia Forward and a candidate for city controller in 2009, it was a galvanizing moment. "I thought, Yes! He gets it," says Mandel. "But that's not how he's chosen to act. Every administration holds their cards close to their vest, obviously, but the difference is this mayor came in saying, 'I'm not going to do what everyone else has done.' What's uncommon — what's appalling — is that the way he's acted strays so far from his campaign rhetoric."
But at the time, Mandel and other good-government wonks, lawyers, activists, journalists, techies, academics and curious laypersons across the city took Nutter's proclamation to mean that a politician was finally willing to halt Philadelphia's legendary culture of secrecy. Here was someone who would let the public in on the decision-making process and, perhaps most importantly, hand over more of those shielded documents sitting in the library at 15th and Arch.
In fact, all three tiers of government seemed to be coalescing around this open-government idea: On Feb. 14, 2008, Gov. Ed Rendell signed into law Pennsylvania's new Right-to-Know act — which hadn't been updated in 51 years — prompting groups like the Better Government Association and Investigative Reporters and Editors Inc., which had once ranked the old law as the second worst in the country, to believe that change was around the bend. Unlike the old law, the new one begins with the presumption that all records are public, and places the onus on the government to prove they're not. A new state agency — the Office of Open Records (OOR) — was created to help citizens access public documents, and the governor appointed former Associated Press journalist Terry Mutchler its executive director.
Early in 2009, President Barack Obama, too, weighed in, saying in a memorandum to the heads of his executive departments and agencies, "My administration is committed to creating an unprecedented level of openness in government. ... In the face of doubt, openness prevails."
But it never did, at least not to the extent it was promised. In the Obama administration's first year, The Washington Post reported in January, more than 300 individuals and public interest groups have sued the White House seeking records — and "in case after case, the plaintiffs say little has changed since the Bush administration years, when most began their quests for records."
In Harrisburg, the open-government ideal was clouded by a bad start. In March 2009 — three months after Pennsylvania's new open records law went into effect — Mutchler sent Rendell a dismaying letter: "I know that you appreciate candor and I cannot be more candid than this. Some agencies, apparently at the direction of [the governor's lawyers], are using the Right-to-Know law as a shield with which to block information rather than a tool with which to open records of government."
She detailed how the governor's lawyers had instructed representatives of state agencies to not answer her calls and asserted that these agencies openly defied the new law; she wondered if "that open-government position" that Rendell touted was "shared by others further down [his] chain-of-command."
Since then, Mutchler says in an interview, she's seen state and local agencies take egregious steps to keep their secrets: One wrote in response to a records request, "None of your business." Others have illegally backdated their denial letters so that requesters can't appeal those denials to OOR. In some cases, the agencies ignored record requests altogether.
In the city, too, the rhetoric of transparency has far outpaced the reality.
GADGETRY
Records obtained by City Paper indicate that the press isn't the only group trying to peer under the city and state governments' lids: Lawyers, corporations, researchers, amateur slueths from Media and everyone in between are filing right-to-know requests en masse. For instance, from 2008 to 2009 — when the new law went into effect — the number of requests to the state's Department of Corrections shot up almost threefold, from 397 to 944; of those, more than half came from prisoners, wondering about everything from how often they'd be getting new socks to the name of the cop who shot them.
In theory, strong open records laws empower the little guy — those without the clout of a press badge or the resources to hire a lawyer. "The more scrutiny that we have on the government, the better it's going to behave," says Mutchler.
Ed Goppelt, the citizen journalist who ran the now-defunct hallwatch.org, once put it another way: "It's no accident that Philadelphia ranks near the bottom of the country when it comes to jobs and schools. ... If the public can't see what kind of job their officials are doing, officials have no incentive to do a good job."
Both Nutter and Chris DiFusco, the city's head open records officer, declined interview requests. Instead, the administration referred questions to outgoing spokesman Doug Oliver, who will soon depart for a marketing post at Philadelphia Gas Works.
Evan M. Lopez
Jonathan H. Bari, president of the Constitutional Walking Tour of Philadelphia (CLICK IMAGE FOR LARGER VERSION) |
Asked how Nutter has lived up to his campaign promises of open government, Oliver points to the city's new 311 line, PhillyStat — the troubled database on city agencies, which has been inoperable since July — and the fact that the city now places more information online, including contract opportunities and weekly revenues.
"Transparency isn't always, you know, 'Mr. Mayor, I want to see what's on your desk,'" says Oliver. "It's often about how you make people feel about their government and how their tax dollars are spent, so we've taken a very broad approach to transparency."
But has the city changed any official policies?
"No," says Oliver.
Of the 20 or so lawyers, city workers, laypersons, reporters and good-government advocates interviewed for this story, almost all congratulate Nutter on making tech-friendly moves. However, some argue that gadgetry-as-transparency is merely a distraction.
"People think that just because there's a flow of Twitter information out there, that's openness," says Mutchler. "That's not openness, that's effusiveness."
Indeed, there's a sense among open-government advocates that the city has continued in the wrong direction during Nutter's tenure: They point to the armed security guard who prevented the press from entering a budget meeting in 2008; the fact that Superintendent Arlene Ackerman first refused to disclose the criteria for her $65,000 bonus, then blocked access to the school district's payroll system from all but two city employees; and the 2010 budget process, which was downright mysterious compared to 2009's, when the public was able to weigh in at budget workshops.
"Philadelphia has gotten worse and worse in terms of filling [Right-to-Know] requests," says Dawn Fallik, a onetime Inquirer reporter who is now an assistant journalism professor at the University of Delaware. In 2006, she requested and got information on how frequently Philly conducts restaurant inspections, which revealed the city was performing fewer inspections than its own regulations require.
But when she sought the same thing this August? The city denied her. "I was told that looking at that was like letting somebody look at your personal medical records. That [attitude] scares me," she says.
"Like most things the mayor talks about, it's form over substance. There's a tradition in the city that says you don't put mistakes in writing," adds Leon King, the former Philadelphia Prison System commissioner and current civil rights attorney. He says that city police and prisons are especially secretive, often claiming that investigations should be kept confidential on unjust grounds. "When I was commissioner, I used to put up a fight, say that investigations were sensitive," he says. "Very rarely was that true."
Since then, says King, nothing's changed.
WANTON DISREGARD
There's no cut-and-dried way to quantify the city's transparency, or lack thereof. But by looking at the cases in which the city is fighting the state Office of Open Records' rulings, we can see what information the city is willing to go to court — and spend taxpayer money — to keep secret.
The system works like this: If the city denies a record request, the requester can appeal to OOR, which then makes a legally binding final determination — it can deny, grant, withdraw or dismiss the request. If either the city or the requester disagrees with OOR's decision, they can appeal to the Philadelphia Court of Common Pleas and, from there, up the judicial food chain.
Earlier this year, Jonathan Bari, president of the Constitutional Walking Tour of Philadelphia, asked for the meeting minutes of the Independence Visitor Center Corp.'s (IVCC) Board of Directors, on which Nutter sits, for the past six years. Bari suspects that the mayor is cutting deals with his business contacts at IVCC — he notes that Rendell also serves on the nonprofit's board — such as Ride the Ducks. (This year's state budget allocated $5 million to IVCC in Redevelopment Assistance Capital Program funds.)
The city denied Bari's request, arguing that because IVCC isn't a city agency, the public isn't entitled to know what happens at its board meetings. OOR overruled the city, noting, "If a public official serves on a private board in an official capacity, the public has a right to know the extent of that service and see records associated with it."
Instead of heeding OOR's ruling, the city took Bari to court. (The IVCC is fighting the request, as well.) "What we don't want is an unintended consequence where people say, 'OK, let's not put the mayor on this board because now our information is public,'" Oliver says.
Bari requested related documents, too — the correspondence between the mayor and IVCC's chairman, and records related to IVCC's operations at the City Hall Visitors Center — and was denied.
It's doubtful the meeting minutes are as damning as Bari suspects. Nonetheless, the city "knows it's supposed to give this information to [Bari], and will lose eventually," says Mandel. "But by taking him to court, it sends a message. You scare other people from having this battle in the future."
That case is currently tied up in the Court of Common Pleas, as is Inquirer reporter Jeff Shields' request for the past daily calendars of the mayor and City Council members, which Shields hoped might shed light on private meetings with lobbyists and other public officials. It followed the same course as Bari's request: The city denied Shields; OOR ordered that it provide the records; and the city appealed.
The city claims it's a safety issue: "Release of the mayor's daily schedule, including past schedules, would be reasonably likely to result in a substantial and demonstrable risk to the personal security of the mayor," Police Commissioner Charles Ramsey wrote to OOR.
This excuse, however, is belied by the Nutter administration's own actions: Every weekday afternoon, the mayor's office sends reporters an e-mail detailing Nutter's itinerary for the following day. If there were a legitimate safety risk, one imagines, it would be at these well-publicized appearances, not at private meetings with lobbyists.
Indeed, Fallik, who also requested the mayor's calendar, doesn't buy it, either. She points out that The New York Times published Timothy Geithner's schedule from 2007 to 2009, when he was president of the Federal Reserve Bank of New York.
"So that information is public at the federal level, but not here in Philadelphia?" asks Fallik.
And then there's the case involving the ACLU of Pennsylvania, which requested records from the Philadelphia Police Department (PPD) involving stop-and-frisk practices and officers' interactions with undocumented immigrants. After asking the ACLU for a 30-day extension, PPD simply didn't respond; when the ACLU appealed, OOR ordered the police department to hand over the information.
"For the record, the OOR finds the PPD's behavior a willful and wanton disregard for the [Right-to-Know law]," the state agency wrote in its final determination.
PPD simply ignored OOR, too. It took the ACLU filing a petition with the Court of Common Pleas for the PPD to disclose those records.
Howard Maniloff, a board member of the ACLU's Philadelphia chapter, says he's "never seen an agency less open" than the PPD.
DISRUPTIVE
One barometer of a government's openness is how well it keeps records of, well, records.
Asked for the number of record requests the city has received, granted and denied since Nutter took office, DiFusco declined, saying that many of them are informal and thus impossible to measure. He allowed City Paper to examine what he called a "representative sample" of these requests. DiFusco also turned down a request for the same information about past administrations.
State agencies have figured out how to track this information: Pennsylvania's Department of Labor and Industry, for instance, reports that it received 201 requests in 2009, and 188 in 2008. And OOR keeps track of how many people appeal the city's denials — 102 since 2009. (Comparatively, 17 people have appealed Pittsburgh's decisions.)
Of these 102, OOR sided with the city 19 times. In 24 cases, OOR overruled the city's denial, at least in part — information that included everything from records of sheriff's foreclosure sales to questions the School Reform Commission asked Ackerman about budget recommendations and legislative needs. (The rest were either withdrawn, dismissed, consolidated or are pending.)
But these numbers don't speak to those who never bothered to appeal to OOR, because they lacked time, were afraid of getting swept up into a costly legal battle, or simply didn't know they could. (In at least one case, for instance, the Sheriff's Office failed to inform a requester that he could appeal to OOR, though it must do so by law.) These factors, say good-government advocates, give agencies the upper hand in the appeals process. They argue that to tip the scales, there must be stricter punishments for violating the Right-to-Know law. Currently, the court may not exceed a penalty of $1,500.
"That's budget dust for most governments," says Tim Potts, Democracy Rising Pa.'s co-founder and president. "In states that take their open records more seriously, repeat offenders of the law can be fired."
Robert Freeman, executive director of New York state's Committee on Open Government, condemns other aspects of Pennsylvania's law, in particular the provision that allows agencies to deny requests deemed "disruptive."
"It's difficult to draw the line between the person who the government thinks is disruptive and the hero in the eyes of the world," he says. He also criticizes the fact that criminal investigations, even decades after they're completed, are not considered public records.
But poor law is only part of the problem. After all, the law only lays down the baseline for what governments must do; there's nothing stopping Nutter from ordering his department heads to adhere to the standards of openness he promised during the campaign.
Thus far, he hasn't.
The Nutter administration, meanwhile, insists that the mayor is keeping his campaign promises. "This government certainly isn't trying to obstruct access to any information," Oliver says.
The stack of hundreds of denied record requests warehoused in the 17th floor of that drab Center City skyscraper suggests otherwise.
NOTE: In the print edition of this story, we incorrectly stated that the city took down an online database of restaurant inspection violations. In fact, the database moved to the state’s Department of Agriculture site. City Paper regrets the error. The online version of this story has been altered to reflect this correction.
In September, insurance company AmeriChoice brings trucks to blighted neighborhoods in New York City and gives away coupons for "free chickens" as an incentive for the underprivileged to switch their Medicare coverage. New York state senator Carl Kruger files a complaint with the state attorney general. The 101 Dumbest Moments In Business 2003 EDITION - April 1, 2003 Apr 1, 2003 ... Just don't tell him about the "Chinese health balls." ..... In September, insurance company AmeriChoice brings trucks to blighted ... New York state senator Carl Kruger files a complaint with the state attorney general..... Falling on his sword, Welch announces he'll give up most of the perks,...2009 and 2010 $120,000 from your tax dollars.
Philadelphia PA Mayor Nutter received two years in a row $60,000 checks to help keep open and operate the city swimming pools. These checks came from AmeriChoice Health and on the surface seems like fine gifts. Yet, they are Bribes non the less, these checks come from a company who receives all its money from the Federal Government as a vendor for Medicare Medicaid services is not allowed to offer bribes kickbacks and money gifts of any kind in order to promote its share or induce its share of the market place. This is not allowed as a use of your taxpayers dollars, yet it happens.What does it really cost the City of Philadelphia to receive this money? Americhoice Health has a long history of corruption over the years yet seems to be protected by those who are responsible to over see their actions why is that? PS... Did the Mayor send for Chicken Man or was he approached by Chicken Man? The Mystery Widens! Can Chicken Man save the Liabraries?
CEO of AmeriChoice Health Bolts.. Was that Chicken Man? John J. Kirchner - Director, Operations John Kirchner joined Healthfirst in May 2010 with over 25 years experience in health care management. Mr. Kirchner’s background includes responsibility for health plan P&L, strategic planning and operations, and government and regulatory affairs. Mr. Kirchner will be responsible for supporting all aspects of NJ health plan operations. Prior to joining Healthfirst, Mr. Kirchner held a variety of positions at AmeriChoice of New Jersey serving as President from 2007 through 2009.
Will this mystery man or woman or chicken ever be caught? Will the "secret eggs" given out to housing authority officers Clinics, Doctors and whoever, make it into through that crispy crust prepared by their Home Office Line Chefs?. Will the Doctors who collected all those extra eggs for sharing thier patients recipes with the Home Office Line Chefs ever really be rewarded? Will the Great Head Chef Chicken Man or whomever that directed and approved all to avoid, overlook the rules, laws and regulations Menu, ever be really compensated for their true worth or will Salmonella remain the dish served for Medicare and Mediciad Industry.
PS Is the Chicken Man a Blues Brothers Wanna B??? HEALTH INSURANCE COMPANY PROFITS IN 2007:A Whole lot Of Chicken
UnitedHealth Group — $ 4.654 BILLION. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company ans a lot of others.
Confronting Health Care 'Demons' Anthony Welters Took an Unlikely Route to Head AmeriChoice, an HMO for the Poor
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The Washington Post
May 27, 2002
By Bill Brubaker
Anthony Welters grew up in a one-room tenement in Harlem, sleeping behind a curtain with his three brothers, he says.
Today, he lives in a five-bedroom, seven-bathroom house on five acres in McLean. He has a 75-acre farm in the Blue Ridge Mountains. For a change of pace, there is a 5,000-square-foot house in Aspen, Colo., recently assessed at $3 million.
Welters, 47, made his fortune in health insurance, serving a specialized market.
The market is the poor.
Federal and state audits concluded in the early and mid-1990s that ineffective oversight by Pennsylvania officials had enabled Welters and his partners to make too much money from their taxpayer-supported business.
The audits said the Welters group had paid itself millions of dollars in management fees -- paid to other companies they controlled -- and millions more in bonuses.
Welters's health-insurance business expanded to New York in 1994 and New Jersey in 1996. In both states, the HMO was known as Managed Healthcare Systems (MHS).
In New York, state investigators discovered something was not right about two clinics that MHS retained to serve patients in the borough of Brooklyn.
They determined that from 1995 to 1997 the clinics were being staffed largely by "unsupervised physician assistants or nurse practitioners," New York state Attorney General Eliot Spitzer announced in May 2000.
The investigation also found that patients were "consistently complaining that they were having difficulty getting services or being seen by a doctor."
MHS "failed to take any corrective action or properly oversee" the clinics.
Spitzer announced a settlement in which MHS repaid more than $2 million to the Medicaid program for services the clinics never provided.
In October 2000 MHS changed its name to AmeriChoice of New York.
Anthony Welters, Chairman of AmeriChoice Corp.:
"What [should] a person who takes a $200,000 investment and turns it into a billion-dollar company . . . receive? I don't know. But I know this: I'm not going to apologize for it."
Comment: Medicaid's chronic under-funding threatens access to care for the low-income individuals covered by this program primarily because many providers will not participate at rates that frequently do not even pay overhead expenses. Several state governments have turned over their Medicaid funds to private corporations to administer these programs. Mr. Welters exemplifies how well these plans fulfill their corporate responsibility to their shareholders and executives.
In 2002 we are already spending over $5500 per capita for health care in the United States. Pool that into a single fund, eliminate the middleman thieves, establish a program of public administration, and we would have affordable, comprehensive care for everyone.
Until we do that, those of us that sit back and do nothing must concede the wisdom of the words that William Shakespeare assigned to Puck: "Lord, what fools these mortals be!"
Felix Schwarz, MA, MPH, Executive Director of the Health Care Council of Orange County, comments on Dr. Munoz's article on mental health carve outs:
For years we have been fighting for "parity" for mental health coverage. I am now telling my mental health advocate friends, as forcefully as I can, that we should no longer seek parity in a broken health care system. We should try to fix the system as a whole -- to include mental health coverage in a universal, single payer, fair and rational system that does not try to "carve out" mental health, or carve up the patient population to leave out those whose needs for health care are greatest!
Most of Bill Thompson's "financial consulting" clients are not revealed on his Board of Ed disclosure forms. The most disturbing one that Thompson did list, however, was Managed Healthcare Systems Inc., where he earned a total of $65,000 in 1997 and 1998, according to his tax returns. A black-owned HMO whose principals worked at the highest levels of the Reagan administration, the company is shrouded in scandal.
Last year, New York Attorney General Eliot Spitzer forced the MHS, which specializes in recruiting Medicaid recipients for its HMO, to repay the state $2 million for Medicaid services that patients never received. Spitzer also put Jean Moise Millien, the director of an MHS clinic, in jail for up to three years after he pled guilty to stealing $275,000 from Medicaid. Spitzer's press release revealed that MHS knew for years that Millien's clinic, Stuyvesant Heights Medical Group, was largely run by "unsupervised physician's assistants and nurse practitioners" and that patients "were consistently complaining that they were having difficulty getting services."
Yet, said Spitzer, the company "failed to take corrective action or properly oversee its subcontractor." MHS portrayed itself as "a victim" of the clinic when they settled with Spitzer.
The State Health Department also revoked Millien's physician's assistant license in November 2000, finding that he'd run the clinic since 1991—four years before the MHS contract began—without on-site supervision by a licensed M.D. The Department also found that the clinic corporation had been dissolved by state officials for tax delinquency reasons in 1994 and that Millien had a prior criminal record. Spitzer said a doctor from Pennsylvania came to the clinic once a week "to sign charts" for a while, but "eventually stopped coming altogether."
An MHS affiliate left a similar trail of complaints in Pennsylvania—where it became the subject of Philadelphia Inquirerexposés in 1996 and 1997, before and during Thompson's employment. According to one study, it was three times as likely to refuse to pay for days of hospital care as the state's next most stingy HMO. The "focus of six special state and federal audits" and a onetime target of a Pennsylvania grand jury, according to the Inquirer,the company took a reported $119 million in profits and executive bonuses from its Pennsylvania Medicaid work alone in the early '90s, making it the "most profitable HMO" in the state. Anthony Welters, the principal owner of AmeriChoice, the Virginia-based parent of MHS, was a top Reagan transportation official, gave $20,000 to Pennsylvania GOP governor Tom Ridge, and has given over $56,000 in recent years to Republican candidates and committees across the country. Clarence Thomas is the godfather of one of his children. Thelma Duggin, another top executive, worked in the Reagan White House and at the Republican National Committee under Lee Atwater, the engineer of the Willie Horton campaign. Thompson said he'd known Welters and Duggin since 1992, when they started trying to do business in Brooklyn, and that he "bumped into Tony" in 1997 and Welters offered him a consulting job that started that June. Charged with "reaching out and helping them obtain business," Thompson said he "spoke to community organizations." Though he says he "never visited an MHS clinic"—including the Stuyvesant Heights one near his home—he insists that MHS is "a good company." While Thompson's tax returns indicate that AmeriChoice paid him $35,000 in 1998, his disclosure forms report no income from the company.
Date: Monday, August 25, 2003, 4:31pm EDT - Last Modified: Tuesday, August 26, 2003, 1:33pm EDT
Jefferson Health System of Philadelphia has sued AmeriChoice of Pennsylvania Inc. alleging the managed-care company has failed to reimburse Jefferson hospitals for more than $9 million in care provided to the plan's Medicaid and Medicare members. In its lawsuit, Jefferson is seeking punitive damages in excess of $90 million to "punish AmeriChoice for its past practices and to defer future misconduct." AmeriChoice officials said they are hopeful the matter can be resolved before it reaches a courtroom. "We've been negotiating these issues with Jefferson and we regret they felt that had to take this action," said company spokesman Steven Matthews. "We continue to believe that both sides can reach an accommodation before the case goes to trial. If not, we will present a vigorous and effective defense that we are confident will prevail in court."
Also named as a defendant in the suit filed Aug. 22 at Philadelphia Court of Common Pleas is AmeriChoice's parent company, UnitedHealth Group Inc. of Minnetonka, Minn. UnitedHealth acquired AmeriChoice last year. AmeriChoice has more than 1 million Medicaid and Medicare members in 12 states including Pennsylvania and New Jersey. The company has about 150,000 members in the Philadelphia region. According to the suit, Jefferson's arrangement with AmeriChoice became "beset with problems" over the past few years. The health system, the suit states, "began to detect systematic patterns involving AmeriChoice's refusal to pay for medical ... Jefferson Health System of Philadelphia has sued AmeriChoice of Pennsylvania Inc. alleging the managed-care company has failed to reimburse Jefferson hospitals for more than $9 million in care provided to the plan's Medicaid and Medicare members. In its lawsuit, Jefferson is seeking punitive damages in excess of $90 million to "punish AmeriChoice for its past practices and to defer future misconduct." AmeriChoice officials said they are hopeful the matter can be resolved before it reaches a courtroom.
"We've been negotiating these issues with Jefferson and we regret they felt that had to take this action," said company spokesman Steven Matthews. "We continue to believe that both sides can reach an accommodation before the case goes to trial. If not, we will present a vigorous and effective defense that we are confident will prevail in court." Also named as a defendant in the suit filed Aug. 22 at Philadelphia Court of Common Pleas is AmeriChoice's parent company, UnitedHealth Group Inc. of Minnetonka, Minn. UnitedHealth acquired AmeriChoice last year. AmeriChoice has more than 1 million Medicaid and Medicare members in 12 states including Pennsylvania and New Jersey. The company has about 150,000 members in the Philadelphia region. According to the suit, Jefferson's arrangement with AmeriChoice became "beset with problems" over the past few years. The health system, the suit states, "began to detect systematic patterns involving AmeriChoice's refusal to pay for medical care provided by Jefferson hospitals. AmeriChoice often simply refused to pay, or would pay incorrect and lower amounts, for medical treatment afforded to its members." Jefferson alleges in its suit that "these improper business policies and practices were and are being undertaken to inflate the financial profitability of AmeriChoice."
Because of AmeriChoice's alleged failure to pay the proper amounts for care provided by Jefferson hospitals to the plan's members, Jefferson moved to terminate its contracts with AmeriChoice in April 2002. Jefferson rescinded its termination notice after AmeriChoice promised to undertake a good faith review of claims submitted by Jefferson, and to pay Jefferson amounts owed to it, the suit states. As part of its effort to induce Jefferson not to terminate its contracts, the suit states, AmeriChoice advanced $2 million to Jefferson to partially offset what the health system was owed -- which the system believed was "far more" than $2 million at the time. In June of last year, AmeriChoice announced it had entered into an agreement to be acquired by UnitedHealth for more than $500 million. Jefferson negotiated a new contract with AmeriChoice in November. AmeriChoice then began to assert, according to the suit, that the $2 million should be used to offset claims on a going-forward basis. "Not only did AmeriChoice renege on its agreement to review and pay past due accounts, it was now asserting that the $2 million could be used as an excuse not to pay new claims, as they came due for payment," the suit states. The hospitals owned by Jefferson Health System, all in the Greater Philadelphia region, consist of Thomas Jefferson University Hospital and its Methodist Hospital division; Main Line Health's Lankenau Hospital, Paoli Memorial Hospital, Bryn Mawr Hospital, Bryn Mawr Rehabilitation Hospital; Frankford Hospital, including its Bucks County, Frankford and Torresdale divisions; Albert Einstein Medical Center and Magee Rehabilitation Hospital.
Obtained from reliable sources and yes it's true Aliens have decided to cast their vote for the Tea party.The greys have reviewed the political issues of all the party's and have agreed that those who have the tea party's viewpoints are less likely to present issues that conflict with their globle view obstructions. Sometime soon after the midterm elections they will make themselves knowed but in the intermin they have left their sexuality concerns and viewpoints in sacred trust with the earthling Sara. All other concerns about the future have been stored in the secret and private volts of the A1 Limo service. Since my retirement my personal advisor in matters of this importance have been rendered to me from Horhay who is also a friend and my special ranch weed grower. Sincerely, your friend George
Jeffrey Skilling, the former Enron Corporation president, has one last, good chance to get out of prison soon. The Fifth U.S. Circuit Court of Appeals in Houston will hear arguments today about how many, if any, of the 19 felony counts on which Mr. Skilling was convicted in 2006 should be overturned as a result of the landmark Supreme Court decision in his case. Please don't worry Election Year Medicaid Medicare Inducement issues left open for November not openly discussed.Politics have gone from heated to man on fire thoughts. Also the Judicial dilemmas, since all are offically allowed to bear arms again, the big city Mayors are concerned about how the poor will be able to rearm themselves, and are looking for some type of financial relief from Federal State Medicaid programs to maintain their status quo.The higher courts face tough issues this term since making honest fraud legal, there agenda now turns toward making honest kickbacks and honest bribes equally as legal. This topic remains high as a shared issue by the medicaid medicare enrollment providers since they are looking to expand inducements past the complicated pregnancy stage.
The DOJ has serious concerns that if legalized marijuana in California for medical reasons could be used as a inducement or inticement to help secure new enrollments for the Federal State Medicare Medicaid programs.The State of California is concerned that if the Feds step up their effort in killing off the marijuana crops it could cause higher tax problems that effect Medicaid currently under consideration by the State 'marijuana tax control board'. Limo drivers cancel their planned Medicaid Cuts DC rally and leave for California to protect this years crop. Wow, don't think I would like to be in Politics for this years elections. Govenor Schwarzenegger indicated that if the Tea Partys membership keeps holding their rallies at our Marijuana burning fields they will have to be taxed for their free use of inhalants, prior to having them bused back to Arizona. Senator McCain wants the deportation of illegal Mexicans to stop immediatley claims their State has gone to POT and insists California return his landscapers at once.