Whistleblowers: United Healthcare Hid Complaints About Medicare Advantage
By Fred Schulte
Kaiser Health News
July 28, 2017
United Healthcare Services Inc., which runs the nation’s largest private Medicare Advantage insurance plan, concealed hundreds of complaints of enrollment fraud and other misconduct from federal officials as part of a scheme to collect bonus payments it didn’t deserve, a newly unsealed whistleblower lawsuit alleges.
The suit, filed by United Healthcare sales agents in Wisconsin, accuses the giant insurer of keeping a “dual set of books” to hide serious complaints about its services and of being “intentionally ineffective” at investigating misconduct by its sales staff. A federal judge unsealed the lawsuit, first filed in October 2016, on Tuesday.
The company knew of accusations that at least one sales agent forged signatures on enrollment forms and had been the subject of dozens of other misconduct complaints, according to the suit. In another case, a sales agent allegedly engaged in a “brazen kickback scheme” in which she promised iPads to people who agreed to sign up and stay with the health plan for six months, according to the suit.
Though it fired the female sales agent, United Healthcare concluded the kickback allegations against her were “inconclusive” and did not report the incident to the Centers for Medicare & Medicaid Services, according to the suit.
Asked for comment on the allegations in the suit, United Healthcare spokesman Matt Burns said: “We reject them.”...
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NAPA, Calif. (CN) - An
elderly patient's penis eroded because Kaiser would not let care
providers remove his catheter, he claims in Napa County Superior Court.
Rupert Collins sued Kaiser Foundation Health Plan, Inc. for elder abuse, negligence and unfair business practices.
In his lawsuit, Collins says he was a patient at nonparty Napa Valley Care Center when he developed problems with his catheterized penis.
On July 21, 2013, a nurse sent a fax to Collins' insurer, Kaiser, according to the complaint.
"The fax stated that Rupert's penis was red and swollen with what was described as a cut. Rupert had a Foley catheter inserted into his penis. Monica's fax said: 'May we have a trial of no Foley to give the area a rest.' Despite this request, Kaiser denied the request to remove the Foley. Despite the fact that Kaiser was notified that Rupert's penis was red and swollen and cut, there is no documentation to show that any physician from Kaiser ever bothered to personally examine Rupert's penis," the complaint states.
"As a direct result of this reckless neglect by Kaiser, the Foley was left in Rupert's red and swollen and cut penis, and his penis began to erode further and further each day," it continues.
Two days later, there was a care conference about Rupert Collins' care, but no Kaiser representative showed up, according to the complaint.
"As a direct result of Kaiser's failure to participate, there was no meaningful communication or ongoing assessment and the dire need to remove the catheter from Rupert's eroding penis continued to be ignored," the complaint states.
On July 30, another nurse sent another fax to Kaiser requesting permission to remove the catheter, but the request was again denied, according to the complaint.
The next day, Collins' daughter had a look, according to the complaint.
"When Diana examined Rupert's penis, she was horrified at what she saw. Rupert's penis was split completely in half from the tip of his penis all the way down to the scrotum sac," the complaint states.
Collins' daughter had a third nurse contact Kaiser, but Kaiser told the nurse, "The penis erosion is normal and will heal on its own," the complaint states.
Collins' daughter pressed the issue and got him seen by a Kaiser urologist on Aug. 2. The doctor "stated that if Rupert had been treated earlier, the penis could have been saved but that the penile erosion was now complete, Rupert's penis would never heal and that reconstructive surgery was not a viable option," the complaint states.
"Rupert's penis and urethra is permanently eroded away and Rupert has suffered permanent genital mutilation," it continues.
Collins blames Kaiser's business practices for his injuries.
"The conduct of defendants is part of a general business practice at Kaiser conceived and implemented by Kaiser and Does 1-10, inclusive. This practice exists in part because defendants unreasonably expect few adverse consequences will flow from their mistreatment of their elderly, demented, disabled and vulnerable clientele, and said defendants made a considered decision to promote profit at the expense of their moral, legal and ethical obligations to their resident-patients," the complaint states.
Rupert Collins seeks general and special damages, treble damages, attorneys' fees and costs, restitution of all funds paid to Kaiser on his behalf and injunctive relief. He is represented by Rebecca J. Freeman of Freeman & Freeman in Santa Rosa.
Rupert Collins sued Kaiser Foundation Health Plan, Inc. for elder abuse, negligence and unfair business practices.
In his lawsuit, Collins says he was a patient at nonparty Napa Valley Care Center when he developed problems with his catheterized penis.
On July 21, 2013, a nurse sent a fax to Collins' insurer, Kaiser, according to the complaint.
"The fax stated that Rupert's penis was red and swollen with what was described as a cut. Rupert had a Foley catheter inserted into his penis. Monica's fax said: 'May we have a trial of no Foley to give the area a rest.' Despite this request, Kaiser denied the request to remove the Foley. Despite the fact that Kaiser was notified that Rupert's penis was red and swollen and cut, there is no documentation to show that any physician from Kaiser ever bothered to personally examine Rupert's penis," the complaint states.
"As a direct result of this reckless neglect by Kaiser, the Foley was left in Rupert's red and swollen and cut penis, and his penis began to erode further and further each day," it continues.
Two days later, there was a care conference about Rupert Collins' care, but no Kaiser representative showed up, according to the complaint.
"As a direct result of Kaiser's failure to participate, there was no meaningful communication or ongoing assessment and the dire need to remove the catheter from Rupert's eroding penis continued to be ignored," the complaint states.
On July 30, another nurse sent another fax to Kaiser requesting permission to remove the catheter, but the request was again denied, according to the complaint.
The next day, Collins' daughter had a look, according to the complaint.
"When Diana examined Rupert's penis, she was horrified at what she saw. Rupert's penis was split completely in half from the tip of his penis all the way down to the scrotum sac," the complaint states.
Collins' daughter had a third nurse contact Kaiser, but Kaiser told the nurse, "The penis erosion is normal and will heal on its own," the complaint states.
Collins' daughter pressed the issue and got him seen by a Kaiser urologist on Aug. 2. The doctor "stated that if Rupert had been treated earlier, the penis could have been saved but that the penile erosion was now complete, Rupert's penis would never heal and that reconstructive surgery was not a viable option," the complaint states.
"Rupert's penis and urethra is permanently eroded away and Rupert has suffered permanent genital mutilation," it continues.
Collins blames Kaiser's business practices for his injuries.
"The conduct of defendants is part of a general business practice at Kaiser conceived and implemented by Kaiser and Does 1-10, inclusive. This practice exists in part because defendants unreasonably expect few adverse consequences will flow from their mistreatment of their elderly, demented, disabled and vulnerable clientele, and said defendants made a considered decision to promote profit at the expense of their moral, legal and ethical obligations to their resident-patients," the complaint states.
Rupert Collins seeks general and special damages, treble damages, attorneys' fees and costs, restitution of all funds paid to Kaiser on his behalf and injunctive relief. He is represented by Rebecca J. Freeman of Freeman & Freeman in Santa Rosa.
