‘A Wasted Opportunity’

February 8th, 2010

 Angela Braly is in good spirits considering that her company seems to have narrowly avoided being converted into a public utility, if not destroyed outright. One gets the sense that she’s always in good spirits. After years of sustained political assault, the power of positive thinking probably helps.

 Mrs. Braly is the CEO and president of WellPoint, the largest U.S. commercial health insurer by membership. Her company’s affiliated health plans in 14 states cover 34 million people—or roughly one out of nine Americans. It contracts with 82% of the nation’s primary-care physicians, 84% of specialists and 94% of hospitals. That scale lands her on the most-wanted list in President Obama’s Washington, though it’s tough to imagine a less likely villain than the very Midwestern Mrs. Braly.

 ”It’s just not clear where we go from here,” says the highest ranking woman in the Fortune 500, sounding as astonished as anyone about Scott Brown’s victory. Merely days before this interview in WellPoint’s lower Manhattan offices at the edge of Ground Zero, Massachusetts voters effectively sent ObamaCare to its own death panel. The reflexive liberal response was to castigate the likes of Mrs. Braly. “I mean, to be fair, the status quo is working for the insurance industry, but it’s not working for the American people,” Mr. Obama said recently.

 To actually be fair, the insurance industry was a cheerleader for the plan, at least until the policy substance congealed sometime in September. “Obviously, we’ve been involved in this discussion for a while—more than a year—and if you think about it we came to the table early, early on and said we’re going to be advocates for responsible, sustainable health-care reform done right,” Mrs. Braly says. “We really do have to get at the underlying question of health-care costs.”

 That was the core promise of ObamaCare. Overall health costs for people insured by WellPoint increased by 8.9% in 2009 alone, and arresting this climb was the reason so many industry groups, not only the insurers, joined with the White House and Democrats. Nobody thinks the status quo is a success. But as Mrs. Braly notes ruefully, “The nature of health care is very complex, and sometimes the nature of politics is very simple.”

 The tragedy, as she sees it, is what “a wasted opportunity” it all turned out to be. “Health-care reform” soon became “health-insurance reform” exclusively. “It was a pivot that was—unfortunate,” she says, “because it is not going to solve the longer-term problem.”

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It’s hard to see how WellPoint could be to blame for surging health spending, Mrs. Braly says, when 85 cents out of every premium dollar or more “is paid out in the actual cost of care, doctors, hospitals, suppliers, drugs, devices

More – $$ Wall Street Journal – February 8, 2010

Trades Urge HHS To Delay Medicare Reporting Requirements

February 8th, 2010

Too many issues remain undecided for the federal government to ask workers’ compensation providers to start reporting on April 1 under the Medicare Secondary Payer mandatory reporting requirements, insurer trade groups told the U.S. Department of Health and Human Services in a letter.

The letter was written to HHS by officials of the American Insurance Association, the National Association of Mutual Insurance Companies, and the Self-Insurance Institute of America.

The new reporting provision was mandated under the Medicare, Medicaid, and the SCHIP Extension Act of 2007.

The issues detailed in the letter include the fact that the Centers for Medicare and Medicaid Services have yet to give final guidance on some issues, such as which entity has reporting responsibility, when due to risk-sharing arrangements more than one reporting entity has a share of the settlement.

Moreover, the insurance and self-insurance industries have “serious concerns” with the mandatory requirement to submit certain data elements, including beneficiaries’ Social Security numbers and heath insurance claim numbers, the groups said.

They also said that confidentiality and security of data issues have still not been addressed, and there has been an inadequate period for testing the proposed reporting system.

And with respect to enforcement, “we believe that the penalty provision of $1,000 per day, per claim, is excessive and, at the very least, should not be assessed on the first report submitted by any entity,” the groups said in their letter.

More - Property-Casualty – February 5, 2010

Wanted: Defense Against Online Bank Fraud

February 8th, 2010

Small businesses have been hit by a wave of cybercrimes. Here’s how to protect your accounts.

Cybercriminals have found a rich, new hunting ground: small businesses’ bank accounts.

Just ask Sign Designs Inc., an electric-sign maker in Modesto, Calif. The first sign of trouble was a morning phone call from Bank of Stockton, Sign Design’s community bank. It had just fielded a call from Chase Bank, whose anti-fraud team was questioning the legitimacy of a $9,670 electronic payment to a Chase customer in Michigan. Sign Designs confirmed it hadn’t set up the payment, and the banks halted the transaction.

Checking its account online, Sign Designs quickly discovered the problem was much bigger: Almost $100,000 had been sent to 17 mystery people, all added as payees the previous day. Although Bank of Stockton immediately notified all the banks that had received funds, some $48,000 had already been picked up by “money mules,” people recruited to shuttle money for online-crime groups, typically in Eastern Europe.

Bank of Stockton says it isn’t responsible for the losses because its systems were never breached. Hackers had planted a malicious program on the computer of Sign Designs’ controller and used it to steal his online-banking credentials. The California bank also says Sign Designs failed to take advantage of security measures that might have averted losses, such as requiring two staff members to sign off on every payment.

Sign Designs President David Johnston argues that Bank of Stockton should cover the losses because it didn’t flag the highly unusual account activity nor did it bar two computers—the controller’s and hacker’s—from accessing the account with the same credentials at the same time. “I don’t think they should offer a service that is not safe,” Mr. Johnston says. “Do you expect I’m going to solve this? I’m going to take on these Russian thieves? Clearly I’m not going to [be able to] do it.”

Sign Designs is among a growing number of small businesses whose bank accounts have been drained in increasingly sophisticated hacker attacks over the past two years. Losses have climbed into the hundreds of millions of dollars in the past year or so as more organized-crime groups, emboldened by the success of fellow criminals, move online, says Shawn Henry, assistant director of the Cyber Division at the Federal Bureau of Investigation, which issued a public warning about the problem in November.

Small businesses are proving a rich target for hackers because they—and the smaller regional banks they often use—tend to have fewer technical and financial resources to stop attacks. And unlike consumers, they lack legal protections from identity fraud, so they typically are forced to absorb the losses.

More – $$ Wall Street Journal  – February 8, 2010

Obama Budget Would End FECA Benefits at Retirement

February 8th, 2010

Waging Battle

Tucked away in President Obama’s fiscal 2011 budget blueprint is a proposal that reignites a decades-old debate over whether the government should impose an age cap on compensation to federal employees with job-related illnesses or injuries.

The administration estimates that it can save more than $400 million during the next decade by overhauling the 1916 Federal Employees Compensation Act, which provides federal workers up to 75 percent of their basic pay, adjusted for inflation, if they are injured on the job, or suffer from a job-related illness — unless or until they recover. In exchange, employees give up the right to sue the government for certain damages, such as pain and suffering. Private sector workers’ compensation claims and benefits differ by state.

The Terminations, Reductions and Savings volume of Obama’s budget plan includes a recommendation to end full FECA benefits for future recipients when they reach retirement age; instead the government would provide them retirement annuity-level benefits. Other proposed reforms include streamlining claims processing and allowing the government to recover compensation costs from third parties involved in the injury. It does not appear that the proposal would affect current retirement-age FECA recipients.

Lawmakers and other government officials long have criticized the lack of an age limit on FECA benefits, claiming the system is supposed to replace lost wages, not provide money for retirement. Current law provides a strong incentive for recipients to avoid retirement and instead continue collecting FECA payments, long after they would have otherwise retired, critics maintain.

More – govexec.com – February 4, 2010

Stopping a silent killer: New law requires carbon monoxide detectors in nearly every NY dwelling

February 5th, 2010

Syracuse Deputy Fire Chief Stephen Cavuto remembers the day rescue crews saved the lives of two city residents overcome by carbon monoxide.

The man had stopped breathing, and the woman was semi-conscious, poisoned by fumes from a car left running in an attached garage at their home, on Eastview Avenue. Like many residences, the house had no carbon monoxide detector to alert residents to deadly levels of the odorless gas that can kill in a matter of minutes, Cavuto said.

Beginning Feb. 22, a new state law requires carbon monoxide detectors to be installed in nearly every house and apartment in New York.

Amanda’s Law requires property owners with homes built before 2008 to have at least one functioning carbon monoxide detector on the lowest level with a bedroom. The law is more rigid for newer homes.

The only dwellings exempt are those without gas sources, such as a home powered entirely by electricity, and with no garage, Cavuto said.

More – Syracuse.com – February 5, 2010

Sen. Chuck Schumer wants war on auto insurance scams

February 5th, 2010

Sen. Chuck Schumer vowed to clamp down on auto insurance fraudsters in New York – and around the country.

“Until we tackle this problem head on, insurance rates will continue to rise,” Schumer said yesterday.

His congressional push to enact new federal penalties on swindlers came after the Daily News found suspected auto insurance fraud cases had spiked 33% over the past three years.

In many cases, experts say, accidents are staged and corrupt medical clinics submit fraudulent claims for treatment that was either not performed or not medically necessary.

Experts say the scams are pervasive in and around the city, particularly in the Bronx and Brooklyn.

As the scams soar, drivers have been forced to pay about 6.3% more for auto insurance.

More – NY DailyNews – February 5, 2010

No-fault insurance fraud skyrocketing

February 5th, 2010

Industry advocates warn Senate panel that bogus claims cost motorists $229M last year

Almost two dozen representatives from New York insurance associations warned a Senate panel Thursday that no-fault insurance fraud is a growing problem in the state.

The cost of fraudulent no-fault claims is skyrocketing and is hitting honest drivers with higher insurance rates, said Robert Hartwig, head of the Insurance Information Institute. Fraud, including staged accidents, runs deep and trickles down through criminal organizations and corrupt medical providers, he added.

New York’s auto insurance system “is currently under siege,” Hartwig said.

Last year, fraudulent no-fault claims cost state motorists $229.1 million, up from $120.4 million in 2007 and just $1.7 million in 2005, he said.

Hartwig and other insurance-industry research groups outlined the causes of the spike and proposed solutions before the Senate hearing led by Sen. Neil Breslin, D-Bethlehem, the chair of the chamber’s Standing Committee on Insurance.

Suggestions for reform include:

Lowering the current $50,000 payout threshold for no-fault claims to de-incentivize fraud.

Passing a New York version of an “anti-runner” bill that would specifically criminalize the act of recruiting others to participate in staged accidents.

Strengthening decertification laws that penalize medical providers convicted of fraud.

Mandatory arbitration of no-fault disputes to expedite cases and clear court dockets.

More – TimesUnion – February 5, 2010

Talk Of Swapping Oversight Committee For Flood Program

February 5th, 2010

Rep. Barney Frank, D-Mass., chairman of the House Financial Services Committee, wants another House committee to take jurisdiction over the troubled and controversial National Flood Insurance Program.

A spokesman for the National Association of Professional Insurance Agents (PIA) voiced “skepticism” over Mr. Frank’s comments, saying he doesn’t see how “switching committee jurisdictions will adequately address the underlying problem, which is that Congress needs to set for itself a reasonable schedule to consider a comprehensive NFIP reform bill that includes a five-year reauthorization.”

Mr. Frank made his comments yesterday to a lobby group, saying he will seek another short-term reauthorization of the National Flood Insurance Program before it expires at the end of this month, and wants to kick oversight of the troubled—but critical—program to the House Transportation and Infrastructure Committee.

National Underwriter obtained a summary of what was discussed at the meeting, a breakfast gathering of the Democratic Congressional Campaign Committee held with its Business Council unit, which consists of Washington-based lobbyists and lawyers.

Currently, the NFIP is operating on its fourth extension since its authorization originally expired Sept. 30, 2009.

Another renewal is being delayed because of disagreements between the House and Senate over whether wind damage coverage should be added to the program, whether the program’s current $20 billion deficit should be paid off by the government, and how the program should be reformed and modernized.

But, at the same time, Rep. Frank told representatives of the business community that he is seeking to “engineer” a jurisdictional trade with the Transportation Committee.

More – Property-Casualty – February 5, 2010

N.Y. Insurers Outline Remedies For No-Fault System Problems

February 4th, 2010

A New York insurers’ group plans to tell a legislative panel that bogus medical mills and unscrupulous medical providers, mostly in the New York City area, are inflating no-fault auto insurance costs.

The New York Insurance Association Inc. will say in testimony it will deliver to a Senate Insurance Committee hearing in Albany, N.Y., tomorrow that the no-fault system’s “costs are spiraling out of control to nearly unprecedented heights.”

Meanwhile, Robert Hartwig, an economist and president of the Insurance Information Institute, issued a statement estimating that,  “Fraud and abuse in New York’s no-fault auto insurance system cost consumers and insurers nearly $230 million in 2009, constituting a “fraud tax” of $1,561, or 22 percent of every no-fault claim.”

NYIA said Phony medical operations are billing for treatments that were never performed, unnecessary or excessive, NYIA President Ellen Melchionni is due to testify.

Speaking on behalf of auto insurance companies doing business in New York State, she will say that extensive and comprehensive legislative and regulatory solutions need to be put into place to even begin to address the moving target of no-fault fraud.

“The state needs to be committed to truly cracking down on criminals committing fraud if there is going to be any real impact in decreasing the rampant abuse of the no-fault system in the state,” her statement says.

More – Property-Casualty – February 3, 2010

Keep Antitrust Exemption, Insurer Groups Urge House

February 3rd, 2010

Insurance trade groups are asking the House to reject proposed legislation that would end the antitrust exemption afforded health and medical malpractice insurers by the McCarran-Ferguson Act.

A group of 10 trade groups, nine representing property and casualty and medical liability insurers and the National Association of Insurance and Financial Advisers, sent the letter Friday in anticipation that the House will soon vote on the legislation.

The bill would also give the Federal Trade Commission the authority to prepare studies and reports on the entire insurance industry.

According to industry officials and congressional staff, the legislation will not include language protecting joint industry activities, for example, compilation of historic loss data.

The letter noted that medical liability insurance is not a health insurance product, but is in fact “a property/casualty insurance liability product, underwritten by property/casualty companies for medical professionals and facilities.”

In fact, the letter said, “the only thing even health-related about medical malpractice insurance is simply its name and the fact that the medical profession and medical facilities purchase it.”

Moreover, the letter said, “Its inclusion in legislation to repeal McCarran-Ferguson for health insurance is misplaced.”

It also cited a recent Congressional Research Service study that repealing the antitrust exemption afforded medical liability insurers could result in “many lawsuits challenging some insurer-cooperation practices.”

More - Property-Casualty – February 2, 2010