By the way: CVS owned Aetna Medicare ad downgraded by federal gov as a bad plan.
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!
By the way: CVS owned Aetna Medicare ad downgraded by federal gov as a bad plan.
“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. NYT
Medicare for all would put all these scam artists out of business - why does the UFT support these crooks?
Mulgrew continuously whines about health care costs but the policies he espouses contributes to these costs.
One of these cited for defrauding the Medicare system will be a partner to the MLC in any new plan offered by the city for retirees. Let us point out that these same groups control the 20% senior plan for retirees but they ability to defraud is somewhat limited by Medicare rules.
And the entire working membership is under the
On Monday night at the Ex Bd Vinnie Gaglione declared MedAdv was just Medicare - Part C - in essence what's the big deal with it?
The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.
By Reed Abelson and Margot Sanger-Katz
The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.
Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan.
Soon, Half of Medicare Will be Privatized
Medicare Advantage is on track to enroll most Medicare beneficiaries by next year.
But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars.
The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.
As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.
Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits. And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to overdiagnose their customers crossed the line into fraud.
The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice.
In statements, most of the insurers disputed the allegations in the lawsuits and said the federal audits were flawed. They said their aim in documenting more conditions was to improve care by accurately describing their patients’ health.
Many of the accusations reflect missing documentation rather than any willful attempt to inflate diagnoses, said Mark Hamelburg, an executive at AHIP, an industry trade group. “Professionals can look at the same medical record in different ways,” he said.
The government now spends nearly as much on Medicare Advantage’s 29 million beneficiaries as on the Army and Navy combined. It’s enough money that even a small increase in the average patient’s bill adds up: The additional diagnoses led to $12 billion in overpayments in 2020, according to an estimate from the group that advises Medicare on payment policies — enough to cover hearing and vision care for every American over 65.
Another estimate, from a former top government health official, suggested the overpayments in 2020 were double that, more than $25 billion.
The increased privatization has come as Medicare’s finances have been strained by the aging of baby boomers. But for insurers that already dominate health care for workers, the program is strikingly lucrative: A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance.
Matthew Wiggin, a spokesman for the company, called the inspector general’s report “misleading.” He said the company uses diagnostic coding to improve patient care, and noted that the whistle-blower in the lawsuit had not worked for the company in nearly a decade. “Our chart review process complies with regulatory standards,” he said, adding, “Our robust compliance program also proactively seeks to identify fraud, waste and abuse in the system.”The company countered by suing Medicare, arguing that it wasn’t required to fix inaccurate records before regulations changed in 2014. It won at first, then lost on appeal. In June, the Supreme Court declined to hear the case.
Inaction at Medicare
Even before the first lawsuits were filed, regulators and government watchdogs could see the number of profitable diagnoses escalating. But Medicare has done little to tamp down overcharging.
Several experts, including Medicare’s advisory commission, have recommended reducing all the plans’ payments. Congress has ordered several rounds of cuts and gave C.M.S. the power to make additional reductions if the plans continued to overbill. The agency has not exercised that power.
The agency does periodically audit insurers by looking at a few hundred of their customers’ cases. But insurers are fined for billing mistakes found only in those specific patients. A rule proposed during the Trump administration to extrapolate the fines to the rest of the plan’s customers has not been finalized.
Some of the agency’s top leaders have had close ties to industry. Marilyn Tavenner, a former C.M.S. administrator, left in 2015, then ran the main trade group for health insurers; she was replaced by Andy Slavitt, a former executive at UnitedHealth. Jonathan Blum, the agency’s current chief operating officer, worked for an insurer after leaving the agency in 2014, then became an industry consultant, before returning to Medicare last year.
Ted Doolittle, who served as a senior official for the agency’s Center for Program Integrity from 2011 to 2014, said officials at Medicare seemed uninterested in confronting the industry over these practices. “It was clear that there was some resistance coming from inside” the agency, he said. “There was foot dragging.”
There are signs the problem is continuing.
“We are hearing about it more and more,” said Jacqualine Reid, a government research analyst at the Office of Inspector General who has analyzed Medicare Advantage overbilling.
The Justice Department has brought or joined 12 of the 21 cases that have been made public. But whistle-blower cases remain secret until the department has evaluated them. “We’re aware of other cases that are under seal,” said Mary Inman, a partner at the firm Constantine Cannon, which represents many of the whistle-blowers.
But few analysts expect major legislative or regulatory changes to the program.
“Medicare Advantage overpayments are a political third rail,” said Dr. Richard Gilfillan, a former hospital and insurance executive and a former top regulator at Medicare, in an email. “The big health care plans know it’s wrong, and they know how to fix it, but they’re making too much money to stop. Their C.E.O.s should come to the table with Medicare as they did for the Affordable Care Act, end the coding frenzy, and let providers focus on better care, not more dollars for plans.”
The UFT contract committee will meet with the city for the first contract negotiations on October 13th.Mayor Adam’s would like 1 to 2 percent raises max per year according to our sources at other unions.He has shown very little willingness to even sit down with the entire unionized city workforce that has expired contracts.According to our brothers and sisters in DC 37 - one of the largest city worker unions, he is asking for high premiums for healthcare- in other words pay into health care which would offset any raise and actually mean a large pay cut for our members.The UFT position is clear : premium free, quality healthcare and substantial raises because of inflation.We must have improvements in our working conditions and our students’ learning conditions - safe schools so our youngest can learn , schools with AC as temperatures rise is way past due, class size compliance with the new legislation and more attention to special education to ensure that the city is actually serving our kids who need the most help.We have to understand going into contract negotiation 2 major points:1. Contract negotiations are built on back and forth- compromise- we get some of what you want, the city has to get some of what they want.2. In order to get even some of what we want, we need leverage- what do we hold over the city’s head that will actually bring them to the table and help us get some or even a majority of what we want?That is a question the union leadership has to answer, the contract committee has to answer, and each and everyone of you has to answer.What can you do, what can we do, what should we do to get what we want, what our students need? What are you going to do in your chapter that you want all chapters to do?With inflation gone crazy, can we afford to live in NYC and the surrounding areas without a substantial raise? Can the city keep a work force without one?If you look at workers across the country right now; from Amazon, to Starbucks, now Apple, and Trader Joe’s - they have had to make sacrifices, they organized, they spent their free time after work, before work, on lunch breaks- risking their jobs to form unions, to have what we have now- a certified union that can collectively bargain for salary and conditions.Some workers have been fired, other have had hours cut, many have had to hire lawyers and spend countless hours in court, while you walked into a job with a union already formed, but 50 years ago our brethren made those same same sacrifices- you have what thousands, if not millions of workers want right now- a union- nearly 200,000 strong.We can’ttake that for granted.In Seattle and Ohio this past year teachers had to go on strike, they had to make the ultimate sacrifice of giving up pay, salary, food on their table, healthcare for their children, in order to get what they wanted -and they won.I’m not saying a strike is inevitable- what I am saying is that we have to be willing to fight for what we want, we will have to sacrifice, we will have to show the city and public our demands are real and fair.So we need to ask you, the person in the mirror, if we ask you to wear blue will you do it? If we ask you to call local elected officials and the mayor will you do it? If we ask to join a rally before or after school will you do it? If we ask to join a march in the city to the steps of city hall will you do it?To show this mayor we mean business, what are you willing to do? And yes, if we ask you to withhold your labor, stop working, go on strike as a last resort, so we can retain our healthcare , get the raises we need and have the schools our children deserve, will you do it?
Healthcare and the UFC election complaints dominated the Ex bd meeting, both causing those of us texting during the meeting some double LOL moments.
The uft leadership new solution to healthcare is to form an in-service health-care committee similar to the bogus retiree health committee loaded with Unity Caucus shills. Watch the new committee endorse whatever mess they are going to make of healthcare for working members in the upcoming contract. Maybe throw a silver sneaker or two at them. As one astute observer of UFT said: GHI is dead - it will be all managed care and choice will cost you.
My head is spinning over the misinformation at the ex bd last night. Eterno has the raw facts: OCTOBER 3 EXECUTIVE BOARD REPORT as does Nick Bacon: Healthcare, Healthcare, Healthcare – UFT Executive Board Minutes, 10/3/2022
Ilona Nanay, Ex bd HS: I stand in favor of the resolution (in opposition to the privatization of Medicare). A year ago my mother died of breast cancer and she was on a medicare advantage plan. It was virtually impossible for her to obtain care. I think it is one of the reasons that she passed. It is still extremely frustrating – every time I hear [Mulgrew] talk about the program. I would love a breakdown of why the NY Health Act hurts us as members of the union. UFT supported the NY healthcare in 2015. Why is NY Health Act antithetical to us? It would expand healthcare across the community. I can't understand why we are opposed to it....
The response from Gaglione was along the lines of - she just picked the wrong MedAdv program. -- Double lack of sensitivity for Vinny. And then later, an upset Ilona was approached by some Unity people who wanted to share how their family members also had cancer -- the very people who voted against the reso -- did they have the right MedAdv insurance?
And this-----
Gee - someone might leave a comment in the chat that might contradict the lies and lines Unity puts out. These people must control every means of communication.
Chat room began meeting as enabled but as soon as some people began to post it was disabled.
Just a flavor of the Oct. 3 UFT Ex Bd meeting. --Some more flavors from anonymous comments from observers:
The most fucked-up moments were... When Aqeel interrupted Ilona talking about her dead mother to complain about something that had been happening all along...When Vincent said “unfortunately you need to look at what you’re buying” after Ilona talked about how her mother’s poor healthcare contributed to her death from cancer...When people who had voted against the resolution came over to a crying Ilona to tell her about their dead and metastatic relatives...Then Melissa Williams told them off
More OMFG moments brought to us by DISUnity... Fake news moment when MM said the UFT doesn’t want to organize actions “bc they don’t want to tell members what to do/boss them around,” when really by my recollection of having been at times the only member of 193K+ to show up to the actions the UFT “organized” this summer, in truth, they are simply not able to do so...When asked by Lydia at Exec Board meeting yesterday about what is union doing to inform members they can attend Ex Bd meetings: Sill cracked jokes and asked Lydia what she’s doing to get folx involved?... He pulled that line twice. Once with Lydia and again with another speaker. They got "Silled" ... It’s pre-planned gaslighting Playbook... The Secretary and Assistant Secretary make close to a half a million dollars combined. They can at least show fidelity to our constitution which says ex bd meetings are open. Asking a full time teacher and Exec Board volunteer to do their work is patronizing.
Tuesday, Oct. 4, 2022
A real healthcare debate broke out at the Ex Bd meeting last night as UFT/Unity spun double talk about healthcare costs and solutions, plus the report on the election complaints.
Mulgrew bad omen: We have to push back against rising costs and how do we do it? We find ways to work with the city to save money ---
Where those savings actually come from is left fuzzy. UFC Ex Bd people challenged the Unity line with a resolution that pushed back.
Here's a piece from Nick Bacon's notes during the question period:
Ibeth Mejia: According to Article 3G1, “ The Board agrees to arrange for, and make available to each day school teacher, a choice of health and hospital insurance coverage from among designated plans and the Board agrees to pay the full cost of such coverage.” Why are we discussing limiting FREE plans when a choice of free plans is in our contract?
Response: We are championing choice.
Ibeth: Don’t we already have two not premium free plans, GHI and HIP?
Sorkin: We are looking to preserve good ‘premium free options.’
Ibeth: Presses.
Sorkin: Notes rises costs. Would love to pass costs on to members. So we need to see what else is out there. We have dictates from decades of negotiations over healthcare.
Ilona: DC37 sent out a letter to members stating bluntly that if healthcare isn’t ‘fixed’, their raises won’t keep up with inflation. In other words, if they don’t agree to lower the quality of their healthcare, one can infer that they’ll see other parts of their quality of life be reduced – income, perhaps housing, etc. In the past year or so, we’ve heard similar threats from UFT. Does the UFT leadership agree with this assessment from DC37? How will pattern bargaining affect us? And what can retirees and in-service members expect will happen to the quality or access to healthcare in the future? Will we only receive raises if we cut our benefits? Or will we fight for both.
Sorkin: Familiar with letter – speaking of cost savings not reducing healthcare. Can’t speak to UFT’s role in not negotiating until healthcare. There’s no talk of reducing benefits – just the cost.
Lydia Howrilka: Clarifying question regarding Ibeth’s question. Why has the UFT allowed the change in Administrative code 12-126.
Sorkin: Because we want to preserve choice and we want to make sure the MLC has a voice.
Alex Jallot: Mulgrew did support national healthcare. So are we only going to endorse federal candidates who support universal healthcare?
How are they reducing costs and offering us a choice only if we pay $400 a month per couple? Oh wait -- reducing costs for the city, not for us.
Ibeth- Responds to Mr. Gaglione. Supports choice. We need free choice. It would cost almost $400 a month for a retired married couple to keep what they have now. We need Medicare for all.
Another A-plus for Ibeth -- short and succinct.
No wonder Unity was desperate to keep UFC off the ex bd. Instead of rubber stamp meetings ending at 6:30 - this one ran until 8PM. I was on the zoom due last remnants of covid but that helped me notice things - with the assistance of people texting from inside.
Mulgrew: Medicare Advantage is only one piece of what has been going on, which is why we need an in-service committee. We go to the doctors more than any other employees of the City....
Is Mulgrew chastising teachers for going to doctors so often? Like I wonder why teachers go to doctors so often? Do you think working conditions? My first two years I was sick all the time being exposed to roomfulls of children.
Mulgrew: ‘Medicare Advantage’ is still part of Medicare. We have the right to do this, so why not make our own? We want good quality premium free healthcare.
Bacon: Endorses resolution in opposition to the privatization of Medicare. It was said earlier by Mulgrew that UFT supports a national single payer public option. Indeed we as a union have passed resolutions to this effect. It stands to reason that Medicare, the only current public option, which such a system would be modeled after, must be preserved. Therefore, we must resist privatization of Medicare. Medicare Advantage will get cost savings through privatization that limits access to care for our retirees (and future retirees) who dedicated their careers in service to our City and students. It will add to administrative costs and add barriers to care like prior authorizations. Medicare Advantage is much like charter schools, which we as a union also resist. Charter Schools offer to do the same as public schools but ‘better’ and often ‘cheaper’ through privatization. They erode public education by doing this. Medicare Advantage does the same to Medicare. Given our own obvious analogy in education, our own precarious situation relative to privatization, we must argue for salvaging our public Medicare. And we owe it to the workers who have retired and one day will retire.
Sworkin: Stand in opposition. States things thee says things that are false and is misguided. ‘Sometimes we need to make tough decisions.’
Yeah, Jeff, your tough decision will end up screwing us.
Only the 7 vote and Mike Schirtzer in favor of the resolution. Unity votes down resolution.
The complaint charged that UFC delegates had been shut out of making resos at the DA. Leroy reported: It is false that non-Unity members have not been allowed. November: (Bacon), Daniel Alicea (had on agenda), January (Strivers), various motions to amend also noted.
Simply want to clarify that it’s unfair to say UFC was called on in resolutions. When I was called, I was a member of Unity. UFC did not clearly exist yet. When Daniel was called up his resolution had been put on the docket the previous school year, well before UFC existed. It had been on the docket so long that it was moot when he brought it up, hence him taking it off the agenda. All other members discussed did not bring up original resolutions. They simply called up amendments or other points of order, which they don’t need to be called on by Unity-elected officers in order to do.
I just wanted to express my gratitude for all you have done in just 2 executive board meetings.
You have brought school based, member issues to the leadership of our union, it is important that the folks leading our union hear from working members so they are aware of what is going in our classrooms.
I know some of you may be disappointed the reso didnt pass, but the debate around it was great and meaningful.
Resos brought by opposition will not pass unless it is run by adcom (officers) first- but it still serves at least two purposes.
1. It redirects or changes the conversation-even when it doesnt pass- i would expect at the next contract meeting there will be talk about school based actions-this only happens because of your reso.
2. it serves a political purpose, I hope all your groups send out to your members the reso you brought forth and the rationale for it and share the minutes of the meeting from nick and eterno-it is important that members see what theyre votes resulted in-a group of representatives bringing members' interests forward to our leadership. I also hope you share the ex bd meeting notes with your chapterThe tone and meaning of these meetings have already changed, the talk is about member issues and member concerns-your very presence at these meetings makes it better. It is important that our leaders are accountable to the members they serve-you are there holding their feet to the fire.At any rate, every member has a better union, a more responsive union, because of your presence and action at these meetings.
The Takeaway: New contract will be the same as the old one with some minor tweaks.
The UFT Cone of Silence has descended on those who attended today's contract committee meeting with a new twist. The Cone has been electrified to zap anyone who repeats even a few words of what was discussed. I experienced this first hand as people who tried to call me with the latest info on the upcoming sell-out had their phones go dead to the sounds of loudly screaming their final words: And then Mulgrew said....... SILENCE --
Before the blackouts hit I managed to hear that the event was very well managed by the Unity machine. See, they haven't lost their mojo at what they do best - managing the membership. If the Negotiating committee '22 is made into a movie, the screenplay may win an Oscar.
It's appropriate the play version is being performed on Broadway and is up for a Lower Broadway Tony - the only show in that part of town. The magic in making the cast of 500 actually believe what they had to say counts is a miracle of UFT/Unity PR.
As for delivering a contract with real gains --- no worries - just vote NO now.
Ed Notes has covered The Cone over the years:
Today is the birthday of the composer George Gershwin, born Jacob Gershvin in Brooklyn, New York (1898). He was the middle child in a tight-knit family of recent Russian Jewish immigrants. When his father bought a piano for his brother Ira, George sat right down on the bench and started to play. At 15, he left school to work on Tin Pan Alley as a song plugger, a sort of house musician for the music companies. Gershwin had an ear for arrangement, and before long, he was writing his own songs. His first one earned him just $5, but soon he was turning out hits such as “Swanee,” which sold in the millions.
Encouraged by this early success, Gershwin partnered with his brother Ira and began composing full Broadway operas. The two produced popular musicals, including Funny Face (1927) and Strike Up the Band! (1930). At the age of 25, Gershwin premiered his “Rhapsody in Blue,” and later “An American in Paris,” which featured accompaniment written for taxi horns. These compositions became orchestral standards. In 1935, he composed his folk-opera, Porgy and Bess, which features such classic songs as “Summertime” and “It Ain’t Necessarily So.” In 1936, at the end of its original run in Washington, D.C., the cast successfully protested segregation at the National Theatre, leading to the venue’s first-ever integrated performance.
“The schism in the union over radical politics [is] a major reason for stalling the growth of a teacher union for decades.” Revolutionary politics and ideology take center stage, as the original Teachers Union becomes a battlefield, pitting leftist against leftist and splitting the union.Clarence Taylor's "Reds at the Blackboard" focused on the old Teachers Union which disbanded in 1964 after suffering from anti-left attacks.
According to a press release issued by the Gates Foundation, the AFT and the Thomas B. Fordham Institute, these three have entered a ground-breaking partnership to evaluate teachers utilizing the drone technology that has revolutionized warfare in Iraq, Afghanistan, and Pakistan. A bird-size device floats up to 400 feet above a classroom and instantly beams live video of teachers in action to agents at desks at Teacher Quality Inspection Stations established by the AFT and the Thomas B. Fordham Institute.
When asked if the drones were authorized to drop bombs on teachers who exhibit inadequacy, Chester E. Finn, Jr., president of the Thomas B. Fordham Foundation, replied, "Don't be ridiculous. Gates money puts other methods at our disposal."
Randi Weingarten, president of the 1.5-million-member American Federation of Teachers said the powerful union has signed on to the drone project...
More at SubstanceNotice the balding guy in Odd Couple. Not Laurence Olivier.
After many meetings and debates, the Chicago delegation succeeded in working with the New York United Federation of Teachers, Local 2 (UFT) to push the AFT to take stronger stands on charter school accountability and school closings — though many delegates from Chicago would have liked the language to have been even stronger.
Generally speaking, the New York delegation represented organizing charters as the best model for handling their role in reshaping unions, despite the fact that according to many reports few charter schools in New York have been organized as is the case in Chicago. This logic is the same touted by the Progressive Caucus of the AFT. The few that have been organized are a part of the UFT local though they have separate contracts negotiated with the help of UFT. The Chicago delegation reflection the mindset that allowing new charters to continue to proliferate while attempting to organize existing charters is an end game in which public schools and the union lose.
Jen Johnson, CTU, Local 1 in Substance