Written and edited by Norm Scott:
EDUCATE! ORGANIZE!! MOBILIZE!!!
Three pillars of The Resistance – providing information on current ed issues, organizing activities around fighting for public education in NYC and beyond and exposing the motives behind the education deformers. We link up with bands of resisters. Nothing will change unless WE ALL GET INVOLVED IN THE STRUGGLE!
Do No Harm
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if the damage outweighs the good sometimes we might pass on that treatment.
Likewise, a wiser mayor would have passed on the mandate, in this way,
But I do get the point - it's a race to the bottom for which is more incompetent - the UFT or DOE.
Shine a light and flush out the cockroaches
ICEUFT and Educators of NYC at 7:00 tonight will be on Zoom to speak out about conditions in the NYC schools. I'll bet Unity is sending spies so they can know what is actually going on in the schools -- they are so out of touch they are like the CIA in Afghanistan - [C.I.A. Admits to Losing Informants - The New York Times].
Over 100 registered. Stories will be shared. Anonymity guaranteed -- we
will have readers of stories that have been sent in along with live
readings.
I love those UFTers complaining about vax mandates.
Did they ever sit through a mandated faculty conference or a boring PD?
They are worse than sticking needles into your eye.
Give me ten vaccines to dull the pain.
But the hard line taken by de Blasio seems to be working - to some extent. I personally know of at least one unvaxxed supervisor who got the shot before the deadline. I don't think schools will be as unsafe as the unions are trying to make them seem. Shame on the UFT for using that bullshit but supporting the idea that unvaxxed should go into schools and make them unsafe.
Friday night a loud cheer went up in certain internet circles with this headline:
She spent last year HAMMERING teachers who chose to teach
remotely because they, we, had underlying health conditions! She claimed
we abandoned out students and SHE now decides to change her tune and
abandons her students? She's so full of shit. Inserting
something into her body that does not fall into line with her religious
faith? What faith? She's fucking Jewish. There is nowhere in the
Talmud, the Torah, or anywhere where it says that vaccines are
forbidden. Orthodox rabbis consider vaccinations a moral obligation.
I'm on a private twitter feed with about 40 teachers who seem to echo Peter's anger and frustration with those who don't want to get the vax. I feel they had the right but not to go into a school.
A comment on Peter's blog: "I just watched her on CNN. She is the biggest, fakest, blowhard of all
time. She uses the word, "Dedicated". She ain't dedicated to shit. She
is a poser teacher and everybody knows it. The DOE will be way better
off without her."
This seems to represent the sentiments of the majority of teachers -- increasing frustration and anger at the unvaxxed. People are sick of lockdowns, masks, etc and it is clear that if everyone got vaxxed we'd be close to being free.
MU- not a cow
Now I was at some of my doctors the other day and there is a feeling that in NYC at least we had so many cases and so many people vaxxed, we're getting into herd immunity territory - for adults. So the wild card are the kids - the unvaxxed kids -- Delta is looking for places to land and it won't be runway at Kennedy -- it may be your under 12 year old. As Dr. Osterholm keeps saying --- the virus is looking for wood to burn and here in NYC those are kids -- and schools are a danger point. So far we haven't seen too many wild outbreaks but Osterholm seesm to think we will see it happen within the next few weeks -- but if it doesn't we will be fairly hone free --- except for MU -- yes MU - a varian that seems to break through vaccines -- and my doc told me the Brazilian delegation to the UN last week brought us a gift of MU -- he said half the delegation was infected -- and his office is not far from the UN. Oy! But so far Delta seems to be kicking MU's ass -- but as some one said -- there are a lot of letter left in the Greek alphabet.
If non-vaxxed were in schools, imagine the sound of MUs.
James Eterno is not as caustic as Peter but has this report:
This headline expresses the increasing anger and generally pissed off feelings toward the unvaxxed. Especially those who threatened to pull their dues from the UFT -- and the leadership actually caved into them and backed the lawsuit.
on behalf of the rest of us, the ones who miss concerts,
restaurants and other people’s faces, the ones who are sick and tired of
living in pandemic times, here’s a word of response to those quitters:
Goodbye. And here’s two more: Good riddance.
I hadn't thought about what we have all been giving up and hoping we can end this soon and go back to normal. Guess who has been standing in the way of all of us?
Yet they whine about forced mandates. We have a million forced mandates every day --- if you don't want to stop at red lights, give up your right to drive. What I find funny is that just by taking the job of a teacher, you are facing enormous controls -- you can't say shit in the classroom without it appearing on the internet and facing 3020a charges.
You know there's a mandate that you have to stay in the classroom and teach even if you don't want to.
You're not an excellent teacher if you are willing to risk the health of your students --- We heard the line that the system was going to lose excellent educators -- not so excellent if willing to risk their students' health.
Their final plea was let them be remote -- I'm sure the vaxxed teachers going into schools would have been thrilled.
There is a lot of mocking of the leadership for supporting the extreme minority that is willing to go into schools --while the UFT itself will only allow 200 to meet for a DA and CL meeting in a room that holds 865 --- no 3 ft distance for UFT leaders. Monday night they held an Ex Bd meeting where proof of vax was required. Those meetings are supposed to be open to all UFT members. But they wouldb't allow the anti-vaxers they support to pass through those doors.
Where there may have been some level of sympathy for those who fear the vaccine, there is none for those proclaiming their libertarian right to refuse a vax. I've seen comments from the overwhelming majority of vaxed UFTers saying "good riddance - we don't want to work with people so willing to risk our and the children's health."
Fall on the sword. I do not disagree with the libertarian view totally about not wanting to be forced but don't force me to be in the same space as you. If I weren't willing to get vaxed I would still try to be very cautious around others --- and I'd take a leave of absence. These are schools, not isolated offices.
If you are so against getting vaxed take a leave - you still keep your health care -- and I saw some angry comments from women with children who were pissed they are getting health care while they had to go back to work so soon.
Bill Maher who has vax issues pointed out he took one for the team.
So there are more and more angry if less vocal publicly UFTers. This will last way past the pandemic --- they may be treated like strikebreaking scabs in the future -- how dare they endanger our health?
One of the latest arguments from the unvaxed is that the system will lose so many excellent educators -- they are not excellent if they are so willing to put their students at risk.
They will debate this and hold multiple positions, but never a forum on something like union democracy or class size solutions... A NYC teacher
She and Leo Casey said the same thing about Bill
Gates – saying it’s always good to discuss and bring people to the
table. I agree with that. But not give them a public forum to transmit their toxic ideas! That’s completely different.... Parent activist
Randi working with the Open Schools Movement people - and a guy who said teachers dying was the acceptable cost of opening schools. The message to him should be FUCK OFF! But she is saying FUCK OFF to teachers risking their health in overcrowded schools.
She wants dialogue with our enemies but ignores the progressive voices in her own union. 90% vaxed but she and Mulgrew cater to the resisters. There's an entire resistance movement in the UFT but too progressive for Randi and crew --- she may be the Kyrsten Sinema of our union. I put her closer to Joe Manchin than Bernie Sanders.
...on Friday, some 100 retirees had a die-in press conference
at City Hall where they dressed as the Grim Reaper and mimicked choking
to death in protest of the plan. Sarah Shapiro, a retired teacher with the Cross Union Retirees
Organizing Committee, said they are being thrown “under the bus after
decades of service to this city. We are in the midst of a pandemic. We have frail and sickly retirees who are in the middle of cancer treatments,” she said..... NY Post
Question of the day - or year - or decade:
Why does the UFT leadership oppose Single payer, medicare for all plans and promote privatized MedAdv plans with its profits, high salaries and lower level of service?
Norm's commentary:
There is a bunch of news around the joint union/city attempt to move 225k retirees out of Medicare and into a privatized version known as Medicare Advantage. A law suit by retirees and a law suit by the losing bidder, Aetna - both reported on below my commentary.
There is an option to opt out and remain in traditional Medicare, which an increasing number of people are taking but at a cost -- it will cost me and my wife around $4500 a year for the same thing we've been getting for free. An extortion plot hatched by our union leaders. The more you know about Medicare Advantage, the more you want to vomit.
Our vote total went up to 30% in the retiree chapter election in April when many retirees had not yet heard of the change. With a general UFT election coming this March-May and the retiree vote crucial for Unity Caucus control of the UFT, another 10 point slippage might put the election in play for the first time. (Already retirees are asking to be added to the oppositon slate.) Add this to the general unhappiness with the UFT by working members over school safety and their support for the minority of unvaxed teachers, this election can be interesting.
I reported on recent events, some organized by a cross union group that included Retiree Advocates --- We had a great Die-in on Friday near City Hall with hundreds of people --- people in hospital gowns were "examined" by doctors - some of them real docs - and rejected, upon which they "died" on a mat while the grim reaper stood over them. (There were also concurrent Taxi and Climate protests in the same area- a perfect day for protests.)
We were out in force at the Sept. 22 UFT chapter leader meeting, which ironically was limited to 200 people in Shanker Hall which seats 850 -- ironically because the UFT seems OK with sending its members into crowded schools with little social distancing. Monday night there was an Ex bd meeting in person where everyone had to show proof of vax. I'm wondering if the UFT has a must vax order for its own employees.
The Aetna lawsuit has a better chance of halting things before Jan. 1 than the members vote -- I didn't join as a plaintive but wish them luck. Aetna is pissed because they lost out and are claiming the people who won out are incompetent at managing these type of plans. I join Retiree Advocate in opposing all private insurance and wanting a medicare for all, single payer system. Yes, it's socialized medicine -- but Medicare has basically proved that it works. Below the break are details of the lawsuits:
We
don't feel safe in our community anymore. We love our school and know
it can be better. We want a safer school and we do not want additional
COVID outbreaks.
.. Clara Barton HS staff members
UFT claims not allowing unvaxed into schools makes them unsafe while seemingly OK with letting them in and threatening COVID spread? WTF
Staffs are going to war with each other over masking and vaccines. Talk about a threat to the union. Where is the UFT? I have an idea -- threaten to stop paying dues and watch how fast you get a meeting and a response.
The UFT leadership is so focused on the minority unvaxxed, they are losing sight of the real threat to the union, with the overwhelming majority vaxed and masked and getting more and more pissed off. Religious exemptions? Don't dare try using Jewish as an excuse. The other real threat is future refusals to get vaxxed for anything and wild measles and other outbreaks to come. We are going back to the dark ages and the UFT is paving the way.
I'm hearing this from other schools -- There is a Zoom on Wednesday at 7PM for people to tell their stories, anonymously if they want.
Such stories are rolling in and ignored by the UFT leaders which is focusing its attention on due process for the unvaxed. Do the vaxed get due process for their health conditions?
We
are a group of constituents from the Clara Barton HS community in
Brooklyn. We have sent the following to our principal but we have not
seen any substantial change in our community. We have staff calling out
and rumors are flying it's for undisclosed COVID cases. Students are in
quarantine. There was a nasty fight this past week and nothing is being
done to control students from unmasking in the halls. We do not feel
safe at all. Please help us! We have contacted the press.
Anonymous
Dear Dr. Forman:
We
are a group of staff from the CBHS community who are really concerned.
We have brought concerns to the UFT reps to take to consultation. But we
feel that nobody is doing anything.
While you hide in your office we have observed the following in Barton:
1. Teachers and paras not wearing masks around children during class time.
2. Deans and aides not masking in the Deans' Office.
3. Students smoking weed communally during class time in Stairwell E And F.
4. Large groups of faculty in the auditorium meeting without social distancing on Sept 9
5. Classrooms with no open windows or purifiers.
6. Staff and students who have said: "COVID is a lie produced by the media and masking/vaccines don't work."
7. No social distancing or ventilation in the cafeteria
8. Faculty unmasking in meetings
We
don't feel safe in our community anymore. We love our school and know
it can be better. We want a safer school and we do not want additional
COVID outbreaks.
If our
needs are not addressed promptly the media and the City will be
notified. We do not want negative attention to our community. We just
want a safer work environment and a safer learning environment for the
kids.
Who: We
are the Cross-Union Retiree Organizing Committee (CROC) composed of
retirees from NYC's municipal labor unions. We oppose the City's move to
save money by endangering the healthcare coverage of vulnerable
seniors.
I'm heading back into the city for this well-thought out event that includes reps from many municipal unions. I'm not the grim reaper and I'm not laying down because I won't get up so I am handing out leaflets. COME ON DOWN!!!
Media Advisory: Municipal Worker Retirees Plan Protest To Halt Healthcare Changes
What: NYC municipal union retirees will stage a "Die-In"
at City Hall Park to protest the life-threatening danger faced by
250,000 retirees as the City prepares to switch their traditional
Medicare coverage to a privately managed Medicare Advantage plan
beginning Jan. 1, 2022. At a mock "Medicare DisAdvantage Clinic"
overseen by the Grim Reaper, participants will enact the potentially
fatal consequences of restricting healthcare for seniors.
The protest comes on the heels of a lawsuit filed by Aetna charging the City and its Office of Labor Relations of bid-rigging in awarding the health coverage contract.
When: Friday, September 24, 2021, rain or shine
Time: 4:00 p.m. to 5:00 p. m.
Where: The Broadway side of City Hall Park (between Murray & Park Sts.)
Who: We
are the Cross-Union Retiree Organizing Committee (CROC) composed of
retirees from NYC's municipal labor unions. We oppose the City's move to
save money by endangering the healthcare coverage of vulnerable
seniors.
Time: Participants arrive at 3:15pm
for a rehearsal. The action takes place from 4:00pm-5:00pm.
Where: on Broadway next to City Hall Park between Murray Street and
Park Place
The point
of the “Die-In” is to publicize the inadequacies of the NYC Medicare Advantage
switch-over by Mayor de Blasio and to pressure the new mayor to scrap the plan.
There will be a Medicare Dis-Advantage health clinic on the
Broadway side of City Hall between Murray Street and Park Place. Some participants
will play sick patients waiting in two patient feeder lines to be examined by
other participants dressed up as doctors and nurses. These mock doctors and
nurses will theatrically examine three or four patients for 30 seconds. Then
the patients will be determined ineligible for treatment. To communicate this,
the doctors and nurse will hold up “No Authorization” signs. Patients will then
walk over to the death mat and die in whatever way they like for 30 seconds
while a drum rolls and the Grim Reaper approaches. Patients can get back in
line to be examined and die multiple times. Protesters with signs will stand on
the sidelines. We cannot block the sidewalk! A picket march down Broadway and
through City Hall Park will take place once there is a large enough crowd of
protesters. We are hopeful that a few politicians will attend, and if they do,
we will pause the action for a few minutes in order for them to speak. We
expect some press to be there too.
Chapter Leader Meeting on Wednesday Sept 22 at 3:30pm
We'll
be outside the first CL Meeting at the UFT at 52 Broadway starting at
3:30 to let our working educator brothers and sisters know what happened
to our health care and to warn them that negative changes are also in
store for them. Help us greet them with smiles and informational fliers.
Street Theatre Die-In on Friday Sept 24 at 4 pm
NYC municipal retirees present A
Street Theatre “Die-In”onBroadway
in front of City Hall Park between
Murray
&
Park
Sts. to publicize
the life-threatening danger faced by 250,000 retirees as the City
prepares to switch their traditional Medicare coverage to a privately
managed Medicare Advantage plan on Jan 1, 2022.
Produced
by: CROC
(Cross-Union Retiree Organizing Committee
We still need "actors" for this event. No experience necessary. Please send an email to : retireequestions@gmail.com if you are interested
“There’s definitely some fishiness going on. This contract doesn’t
make any sense,” said Marianne Pizzitola, president of the FDNY’s EMS
Retirees Association and a rep for the New York City Organization of
Public Service Retirees, whose groups are affected by the contract.
Pizzitola said retirees were “kept in the dark” on the deliberations
and raised the appearance of a conflict with Teamsters’ head Floyd
sitting on the board of the winning bidder.
“How is that not fishy?” she said.
This may be a biggie -- let's be clear -- we don't want Aetna either. No Med-Disadvantage plans -- but if this screws the pooch -- go at it.
New York’s largest private Medicare administrator is suing the Big
Apple and its local union leaders for allegedly awarding a $34 billion
“tainted” contract to an unqualified rival bidder.
Insurance giant Aetna’s bombshell lawsuit against New York City and
the Municipal Labor Committee alleges that the bidding process was fixed
to favor Alliance, a consortium that includes Emblem Health and
Anthem/Blue Cross Blue Shield, to operate the Medicare Advantage Plus
program, which administers health benefits to 250,000 retired city
workers.
“OLR [the city’s Office of Labor Relations] has selected an
inexperienced and unqualified bidder through a procurement process that
violated New York Procurement law, lacked transparency, and violated
principles of public trust and fairness for a procurement that could
last up to a minimum of five or as many as eleven years and generate $34
billion dollars in claims revenue,” Aetna alleges in its suit filed in Manhattan Supreme Court earlier this month.
Aetna and Alliance were the two finalists that city officials and
union leaders considered for the whopping contract, which is anticipated
to save the Big Apple about $3 billion over five years, or roughly $600
million a year.
Aetna is asking the court to nix the contract, which takes effect Jan. 1.
Retired city workers are eligible for Medicare, the federally run
program that provides health insurance for people who reach 65 — but
their union contract also calls for the Big Apple to pick up the cost of
their monthly premiums for Medicare Part B, which covers outpatient
care as well as other supplemental services not covered by Medicare.
Gregory
Floyd, president of Teamsters Local 237, is associated with Alliance
partner Emblem Health, who was awarded the city’s Medicare program
contract over Aetna.
Aetna is arguing that it has more experience than Alliance in
handling such matters. And even city officials have acknowledged that
Aetna, the nation’s third largest health-insurance provider, was clearly
the more experienced bidder in running Medicare Advantage programs
across the country.
One of the criteria in the proposal was that bidders had to have provided service to a client with at least 50,000 subscribers.
Aetna currently runs New Jersey’s Medicare Advantage program for
196,577 retirees, the United Auto Workers Retiree Medical Benefits Trust
with 140,305 members, the Ohio State Teachers Retirement System with
96,106), the Pennsylvania Employees Benefit Trust Fund with 75,369
members) and Verizon with 73,176 members, according to the lawsuit.
Aetna alleges that Alliance failed to meet even this “low bar.”
Alliance has noted that one of its partners, Indiana-based Anthem,
ran the Medicare Advantage program for the Colorado Public Employees
Retirement system with 50,000 members. But Aetna claims that Anthem’s
contract only covered 43,000 retirees, which should disqualify the
Alliance bid for the city work.
Other concerns raised in the lawsuit involved:
Costs: Aetna claimed its prescription-drug plan was at least $30
less expensive per worker monthly than Alliance’s plan and offered free
prescriptions for certain generic medications. It also said its plan
premium was $366 lower per year for every worker than the advertised
Alliance rate.
Breach of confidentiality: The insurer said a
city evaluator wrongly disclosed some of its cost proposals at a meeting
with union members, which “tainted” the selection process by alerting
rival Alliance to its figures.
Arbitrator/familiarity: The city
and labor unions turned to a state arbitrator to help resolve an impasse
over the selection of a winning bidder — a decision that was not
mentioned as part of the procurement process.
During the early evaluation process, city officials
favored Aetna because of its experience running Medicare Advantage
programs, the suit says. But union leaders preferred the Alliance
because partners GHI/Emblem Healthand Blue Cross had more of a history providing medical benefits to city workers, according to the papers.
The parties asked arbitrator Martin Scheinman —
who recently ruled that religious exemptions can be granted from COVID
vaccine requirements for public-school teachers — to be brought in to
issue a recommendation on which final bidder the city and the unions
should choose. At the time, Scheinman chaired a city panel to find
health-care savings.
Scheinman chose Alliance, arguing that its “familiarity” with
providing benefits to the city workforce trumped Aetna’s superior
experience in running Medicare programs, the documents say.
Sanitation Department workers collect garbage near 675 Central Avenue in Brooklyn on March 10, 2021.
James Keivom
His voice helped tip the award to the Alliance, the suit says.
But Aetna argues in the court documents that “the Solicitation and
applicable procurement law did not provide for this action … and
Arbitrator Scheinman’s recommendation was based on a new criterion
mentioned nowhere in the procurement documents.”
Aetna also claims that Alliance reps were afforded the opportunity to discuss matters with Scheinman, while its people weren’t.
Aetna received the highest scores during the early phases of the evaluation process, the suit says.
Other sources familiar with the negotiations said it appeared that
Alliance had an inside track because of its connections to labor
leaders. Teamsters Local 237 President Gregory Floyd, for example, sits on the board of Alliance partner Emblem Health.
Some advocates for retirees joined Aetna in questioning the granting of the contract.
First
responders arrive at a construction site in Hudson Street to Vandam
Street in Manhattan after a man fell 20 feet into a shaft on September
14, 2021.
William Farrington
“There’s definitely some fishiness going on. This contract doesn’t
make any sense,” said Marianne Pizzitola, president of the FDNY’s EMS
Retirees Association and a rep for the New York City Organization of
Public Service Retirees, whose groups are affected by the contract.
Pizzitola said retirees were “kept in the dark” on the deliberations
and raised the appearance of a conflict with Teamsters’ head Floyd
sitting on the board of the winning bidder.
“How is that not fishy?” she said.
Nicholas Paolucci, a rep with the city Law Department, told The Post
in an e-mail, “The City is committed to selecting providers that are in
the best interest of the City and it’s retirees. We’ll review the case.”
Meanwhile, union leaders in the Municipal Labor Council dismissed Aetna’s lawsuit as the desperate gambit of a sore loser.
“We got it done. It was fair and right to the point. I haven’t heard
anything wrong with that particular contract, the way it was done.
Everything was done to the T,” said Harry Nespoli, chairman of the
Municipal Labor Council and president of the Sanitation workers’ union.
“To me it sounds like sour grapes. Aetna had their shot at it. It
does save money for the city of New York. What’s wrong with that? I
thought it was a spectacular deal. I still think it is,” he said.
Teamsters Local 237 President Floyd said his role sitting on the
governing board of bidder Emblem Health didn’t pose a conflict. He voted
to award to Emblem/Anthem-Blue Cross.
“It’s only a conflict if I was the only union leader voting or if I
had the most influential vote. It wasn’t the case. I had one vote — that
was it,” Floyd said.
“This a stupid lawsuit. Aenta put in a bid, and they lost the bid. They’re a sore loser.”
Harry
Nespoli, president of the Sanitation workers’ union, argues insurance
company Aetna is acting “like sour grapes,” with their city lawsuit.
William Farrington
Noting that Aetna is one of the country’s largest private health-insurance companies, Floyd said, “How greedy can you get?”
Floyd said contracts expire and that there will be opportunities for
future business — but he added that Aetna is burning its bridges.
“I have a long memory,” Floyd said.
He said Aetna currently administers prescription-drug benefits to his
members, who work as security officers in schools, homeless shelters
and NYCHA complexes.
In that case, Aetna replaced HIP/Emblem Health because the union
didn’t like the latter’s performance, and Aetna is doing a “good job,”
the Teamsters boss said.
There is no question that Medicare Advantage is unsustainable in the long term. It’s driving up Part B
premiums, eroding the Medicare trust fund, and costing taxpayers tens of
billions a year more than traditional Medicare. The plans are also taking a toll on federal coffers, due to overpayments and disenrollments in the final year of life,
among other factors. “The
current state of quality reporting in [Medicare Advantage] is such that
the Commission can no longer provide an accurate description of the
quality of care......
UFT Plays 3 card monte with our health
Audits Of Some Medicare Advantage Plans Reveal Pervasive Overcharging
Our union leaders are leading us into the Med Adv Mob. Some might take the attitude that they don't care if the medicare system is ravished into oblivion. I don't. We need a fraud proof Medicare for all system and Med Adv profit makers are the opposite direction. Mulgrew can tell us till the cows come home how Med Adv is as good as traditional medicare --- except for the scams profit making companies are willing to pull. It's not just about them making money over cutting services but also about scamming Medicare and ultimately making it untenable for anyone.
The DOJ Says A Data Mining Company Fabricated Medical Diagnoses To Make Money
The Justice Department has accused an upstate New York health insurance plan for seniors, along with amedical analytics company the insurer is affiliated with, of cheating the government out of tens of millions of dollars.
The
civil complaint of fraud, filed this week, is the first by the federal
government to target a data mining company for allegedly helping a
Medicare Advantage program to game federal billing regulations in a way
that enables the plan to overcharge for patient treatment.
The
lawsuit names as defendants the medical records review company DxID and
Independent Health Association, of Buffalo, which operates two Medicare
Advantage plans. Betsy Gaffney, DxID's founder and CEO, is also named in
the suit. DxID, which shut down in August, is owned by Independent
Health through another subsidiary.
Medicare Advantage plans are paid more for sicker patients
The Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage plans
using a complex formula called a "risk score," which is intended to
render higher rates for sicker patients and less for those in good
health. The data mining company combed electronic medical records to
identify missed diagnoses — pocketing up to 20% of new revenue it
generated for the health plan.
But the Department of Justice
alleges that DxID's reviews triggered "tens of millions" of dollars in
overcharges when those missing diagnoses were filled in with
exaggerations of how sick patients were or with charges for medical
conditions the patients did not have.
In an email, Frank Sava, a spokesperson for Independent
Health, stated: "We are aware of the DOJ complaint filed late [Monday]
and will continue to defend ourselves vigorously against the
allegations. Because this is an open case I cannot comment further."
Gaffney's lawyer did not respond to requests for comment.
The DOJ complaint expands on a 2012 whistleblower suit
filed by Teresa Ross, a former medical-coding official at Group Health
Cooperative in Seattle, one of the nation's oldest and most prestigious
health plans. Among the entities Ross sued were Group Health, DxID and
Independent Health.
Ross alleged in that suit that Group Health hired DxID in 2011 to
boost revenues. The company submitted more than $30 million in new
disease claims — many of which were not valid, according to Ross — to
Medicare on behalf of Group Health for 2010 and 2011.
A patient with an "amazingly sunny disposition" gets a label of "major depression"
For
instance, Ross alleged that the plan billed for "major depression" in a
patient described by his doctor as having an "amazingly sunny
disposition." Group Health, now known as the Kaiser Foundation Health
Plan of Washington (a company unrelated to Kaiser Health News or the
Kaiser Family Foundation), denied wrongdoing. But in November 2020, the
insurer settled the case by paying $6.3 million.
Now the Justice Department is taking over the case and
targeting DxID for its work on behalf of both Group Health and
Independent Health. The department alleges that DxID submitted thousands
of "unsupported" medical condition codes on behalf of Independent
Health from 2010 to 2017.
"Hopefully the case sends a message
that coding companies that exist only to enrich themselves by violating
many, many CMS rules will face consequences," said Max Voldman, an
attorney who represents Ross.
Timothy Layton, an associate
professor of health care policy at Harvard Medical School who has
studied Medicare Advantage payment policy, said he has not seen the
government take legal actions against data analytics companies before.
"They
are often the ones doing a lot of the scraping for [billing] codes, so I
wouldn't be surprised if they came under more scrutiny," Layton said.
" 'Trolling' patient medical records to gin up ... 'new' diagnoses"
In
the legal complaint filed Monday, the Justice Department alleges that
Gaffney pitched DxID's revenue-generating tools as "too attractive to
pass up."
"There is no upfront fee, we don't get paid until you
get paid and we work on a percentage of the actual proven recoveries,"
she wrote, according to the complaint.
The 102-page suit
describes DxID's chart review process as "fraudulent" and says it
"relied on 'trolling' patient medical records to gin up, in many cases,
'new' diagnoses exclusively from information derived from impermissible
sources."
The complaint cites medical conditions that it says
either were exaggerated or weren't supported by the medical records,
such as billing for treating chronic depression that had been resolved.
It also cites allegedly unsupported claims for renal failure, the most
severe form of chronic kidney disease. The suit alleges that Gaffney
said these cases were "worth a ton of money to IH [Independent Health]
and the majority of people (over) 70 have it at some level."
The
complaint says that CMS would have tried to recover money paid to the
health plan improperly had it known about DxID's tactics and "has now
done so via this suit."
The Justice Department is seeking
treble damages in the False Claims Act suit, plus an unspecified civil
penalty for each violation of the law.
While popular with seniors, Medicare Advantage has been the target of multiple government investigations, Justice Department and whistleblower lawsuits and Medicare audits. One 2020 report estimated improper payments to the plans topped $16 billion the previous year.
At
least two dozen whistleblower cases, some dating to 2009, have alleged
fraud by Medicare Advantage plans related to manipulating patient risk
scores to boost revenues.
In July, the Justice Department consolidated six such cases against Kaiser Permanente health plans. In August, California-based Sutter Health agreed to pay $90 million to settle a similar fraud case. Previous settlements have totaled more than $300 million.
Kaiser Health News
is a national, editorially independent newsroom and program of the
Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
UPDATE NOV. 30 - After a packed Bat Mitzvah a few weeks ago in a tent at 38 degrees with over a hundred unmasked people - I got the Moderna booster two days later with no side affects at all - in fact I was juiced up for weeks -- give me one every month.
Happy Yom Kippur -- Sept. 16, 2021 - I'm fasting - my wife hid all the bags of chips and that's all I want to eat. Tonight will be hog heaven without the hogs. Many Jews only use daity to break the fast and I've got my eyes on the herring in cream sauce.
My son is a biologist
doing cutting edge genetics research. He advises us to hold off on a
booster until they develop one for the upcoming variants that will avoid
the mRNA protection.
Breakthrough for Delta means you can catch it if you have the mRNA in your body, but it will not harm you.
This protection will not wane after 8 months
The current push for boosters vs Delta is a sales pitch.
Pete Farruggio, PhD Associate Professor, Bilingual Education (retired) University of Texas RGV
History
repeats. As with the 1918-20 flu epidemic, the waning of the first wave
of viral spread induced a premature relaxing of caution (e.g.
reopening unsafe schools), which caused a second larger wave. This
pattern caused a third wave through 1920. Instead
of vaccines, what ended the epidemic was the killing off of the more
susceptible, as in previous plagues (herd immunity).
I don't want to be one of the susceptibles and was ready to take the booster in 3 weeks. But what if there is a new vax that provides more protection from variables in a few months. Do you get a 4th shot? My doc says hold off.
So I'm rethinking getting the third booster shot. Pete's
advice correlates to that of my primary doc. Friends have been to
him in the past few days and here is what he told them:
Our doctor does not believe in over vaccinating. He is testing for my antibody
levels. When or if they are low then he recommends the booster. If they reconfigure the vaccine to deal with the variants then we can have a further discussion about boosters ... from a friend
We use the same doctor - for the past 20 years and have gotten many of our friends to go to him too, so there is a lot of trust. Last spring he told us to not get the shingles shot yet because he felt
we might need a booster in the fall. My friends did the antibody test and found they had sufficient immunity at this
point. Doc says retest in 3 months.
[ MORE info from patient with same doctor - Sept 17 --- Our
doctor told us that each lab determines the antibody count in their own
way so you can`t compare numbers from lab to lab. The lab where MY
results will come from has 200 as the magic number of normal. Anything
OVER 250 will just come back as over 250 but no further number will be
given. I asked him about the benefit of
having a LOT of antibodies--way higer than normal--from getting the
booster now. He said that a lot of learning is going on now about all
of these things but one thing that MAY be true is that too many
antibodies could interfere with the T cells and keep them from being
effective at what they need to do. He said that it MAY be the case that
LESS is more in this situation! He also
said that if the booster was comprised with more ability to fight the
Delta variant than it might be wise to get the booster sooner, but since
it is NOT comprised any differently than what we already have in our
systems you are not getting more of an ability to fight Delta (as long
as your antibody count is normal). We will wait another 3 months and
retest. When our number goes below normal is when we will take the
booster. ]
Interesting. One of the right wing criticisms of Biden and vax mandates is that those who had COVID have antibodies too --- and they argue that they should not be forced to be vaxed. There is a point and I wonder if you present an anti-body test result, that counts as vaxed.
There are outbreaks in Israel which is highly vaxed with third shots. Covid seems like a raging fire which no matter what we do will find places to burn until it burns itself out --- herd immunity.
Look at the south as cases begin to come down after their wave and now we in the northeast escaped, we will be facing a surge, based on back to work and open schools.
You know the case they make for those who are vaxed as being safe from hospitalization or getting real sick even if you get it -- it will be mild. But I don't even want a mild case due to stories of long covid which hits 30% in some cases. I know people who are still very affected even a year and a half later. I don't need to spend the rest of my life battling issues I didn't need to battle.
If people want to risk death, must we stop them? What if their risks affects the rest of us? Do people have the personal right to drive recklessly? Why is risking the health of others and over taxing the hospital systems any more dangerous than reckless driving?
I might also ask -- are the economics driving De Blasio to open schools a risk that touches on the same risky behavior of the unvaxed?
By the way, I was walking past a testing truck in Manhattan on Friday and got tested for the first time - not rapid but the nose swab - and had the results the next evening. Others standing there with me needed a test for travel before they could fly. Oh my, those damn governament regulations. I'm outraged every time I have to show my drivers license when I have to fly - and why can't I carry a box cutter onto planes?
So you might take the position of fuck em - if they want to risk death.
Now imagine someone ready to jump off a building. Do you say fuck em? Or do you try your best to talk them out of it? Or do you get together with others and hold a blanket to try to catch them? Do you care about their pain? Or is it that you don't give a shit about them but are worried they might fall on you and kill you?
Well, there are versions of all these arguments in the vax vs anti-vax angst.
Biden's new toughness is resonating with most people who are fed up with the anti-vax personal freedom bullshit from people who have given up so much personal freedom in so many ways. Chris Wallace questioned the gov of Nebraska yesterday, who is outraged at Biden, about the loss of freedom to choose over about 10 Nebraska vax mandates in order to go back to school. The response was those vax's are tested. No more tested than the current vaccines.
So let's talk about the freedoms Biden is taking away and the over the top Republicans politicizing this. I heard George Will on NBC and Chris Christie talking about how Biden is violating the constitution - and stopping him is a higher priority than stopping people from dying. That's like telling people to jump and pulling away the blanket to catch them like Lucy does with the football.
Like we are not in an emergency that is not only killing people but the economy. Would they worry about the constitution if it were Ebola? Didn't they suspend all airline flights for weeks after 9/11? Like a 1000 times more people have died from COVID than on 9/11. This is not an emergency?
I was frustrated that Stefanoplis and Chuck Todd didn't bring up how Lincoln threw out the constitution during the Civil War emergency. Or how FDR pushed the boundaries during the depression.
I understand the fear of some people about vaccinations. I don't love them. I avoided the flu shot for years until my wife and my doctor scared me into them. I still don't have the shingle shot and want to get it but my doc told us to not pump too many vaccines into us in a short period of time. He told us that in May when we asked about shingles and he said we would probably need a booster in the fall. The other day he told someone to hold off on the booster as long as possible. He is wary of over vaxing. This is at least rational advice. I do want to take the booster at 8 months which for me is Oct. 10. What about the flu shot and when?
Meanwhile, watch out for the freedom from government control people when crossing the street. Stop lights are too much government control.
Is de Blasio and his partner Mulgrew risking lives in opening schools
fully (the former) and supporting people who don't want to be vaxed
(the latter)?
If you are a fan of the Osterholm weekly podcast, he just
stopped short of putting De Blasio in that frame as he mocked the 3 feet
distance rulings -- and said the CDC people would one day have an
accounting over that issue. He also put the learning loss argument on
trial. And masking too - the least effective barrier to the disease. If
he had a choice between ventilation and Hepa Filters or masks, he would
choose the latter. Oh, and testing once a week is a joke. He also raised the issue of economic pressure leading to bad decisions - and we can pretty much say that is the situation here in NYC ---
He said that
NYC with back to school would be a bellweather for the nation.
Oy! Good
luck DeB and Mulgrew. Anyway - a must listen.
This week, Dr. Osterholm provides insight
on the state of the pandemic in the US and internationally, the
importance of keeping children safer as schools go back in session, and
the risk of outdoor events for fully vaccinated individuals.
You know that bogus Einstein quote about the definition of insanity:
doing the same thing over and over and expecting different outcomes.
One thing never tried it a total boycott of UFT elections.
Sunday, Sept. 12 -- I keep asking myself this question every single election cycle. What's the point of running if you are bound to lose? Over 30 years the best the opposition could do was once win 13 Ex Bd seats (1991) and win the 7 high school seats most of the rest of the time. History counts -- the vote totals on all the elections are pretty consistent.
Why is this year different/ (I know, it's Yom Kippur coming up, not Passover.)
Well, there is the always eternal hope that there will be a head to head confrontation between a united opposition and Unity -- which we had (sort of) in 2016. Then there is the unpopularity of Mulgrew. Then there is the mishandling of the pandemic by the UFT on so many fronts. Then there is the union's turning off so many retirees, the lifeblood of Unity, by taking away their medicare. Then there was the OT/PT functional chapter revolt where MORE swept the chapter leader and delegate positions, a sigificant event. Then there is word from other functional chapters. Then there were the school chapter elections last year where anti-Unity voices made some headway. Then there is Educators of NYC run by Daniel Alicea who actually voted for Unity in 2019 but has become a strong critical independent voice. I bet there are a bunch of people out there like Daniel.
Then there is ...... PLEASE STOP TRYING TO CONVINCE MYSELF TO PUT ANY TIME OR EFFORT INTO ANOTHER UFT ELECTION.
There is the history of elections where no matter how I get my hopes up the outcome is pretty much the same.
I was deeply involved in UFT elections in 2004, 07, 10 (ICE), 13, 16 (MORE). I was out of the 2019 elections as I was in the process of being purged from MORE for publicly disagreeing with the faction in control of MORE that engineered the decision not only to not run with other groups but to purposely run in a way to not contend for any winnable positions - A minimalist campaign for what purpose I still can't figure out. Ed Notes covered the contradiction in their position in March, 2019.
My final words to the MOREs was to either run with everyone in a serious manner to maximize the anti-Unity vote with the aim of winning the high schools and taking a serious shot at the middle schools or not run at all but use the election (which occupies a great deal of time) time saved as an organizing tool for the caucus. I told the MOREs that an election is like a high stakes test for a caucus. At the very least it must hold its own in vote totals but most people other than hard core organizers (like I was) get discouraged if these numbers don't grow. I can't tell you how many people I saw pass through the groups I was in over these 50 years.
I have been urging boycotts of UFT elections in every election since 2010 to emphasize the undemocratic nature of the UFT itself where winning an election is almost impossible. Why run of the outcome is pre-decided? John Lawhead from ICE and now Solidarity Caucus came up with the idea of uncaucusing for the elections and focusing on issues of concern to the members without engaging in the cumbersome and often distracting election process. Behind my idea was to leave the membership with no options on the ballot other than Unity as a wake-up call. I know that prospect actually scares the Unity people because it exposes them. If there were no opposition running Unity would make one up.
I was overruled every time and ended up throwing myself deep into the elections. I ran the petitioning campaigns for MORE in 2013, 2016 along with Ellen Fox. The MORE decision in 2019 relieved me of all that work and sitting out the election was a relief.
Now we are upon yet another UFT election cycle for 2022 and we are in the same position - will the opposition come together this time with a united front challenge to Unity? So far most of the various caucus and uncaucus groups have spoken as Retiree Advocate, ICE, Solidarity, New Action, Educators of NYC - and even this lonely spot - Ed Notes - have endorsed that idea with rumors that MORE was taking a membership vote that ended Friday on a positive note.
The hard part would be to put everyone together in a room and lock the doors. The best thing about this election is that I will be outside that room blocking the exits.
