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. |
Showing posts with label Kaiser treatment guidelines. Show all posts
Showing posts with label Kaiser treatment guidelines. Show all posts
Wednesday, January 21, 2015
Kaiser Cost a Man His Penis, He Claims
Thursday, December 12, 2013
Kaiser Settles Dialysis Patient Transport Payment Squabble
After years of scandals, it's becoming pretty clear that Kaiser Permanente prefers dead kidney patients to live ones.
Kaiser Settles Transport Payment Squabble
By PHILIP A. JANQUART
Courthouse News Service
December 06, 2013
(CN) - A stipulation agreement has led to the dismissal of claims that Kaiser Foundation Health Plan failed to pay a company that transported patients to dialysis.
ProTransport-1 LLC, which claimed to transport Kaiser patients with end stage renal disease, had filed the lawsuit under the False Claims Act in 2012.
It said that Kaiser takes hundreds of millions of dollars from the U.S. government to care for seniors and patients with special needs, but that it pockets the money and has contractors like ProTransport bill the California Medical Assistance Program, known as Medi-Cal, for services rendered. Claiming that the Medicare Act allegedly requires Kaiser to pay the company in the first instance, ProTransport said the insurer's conduct amounted to fraud.
The complaint spared no words in blasting Kaiser as an "unscrupulous" entity whose "greed" compels it to steal from and defraud the government.
This past August, U.S. District Judge William Orrick refused to let ProTransport advance claims that the alleged billing was part of Kaiser's plan to kill its patients.
The complaint had stated: "Of course, Kaiser knows very well that without dialysis, these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."
But Orrick had no patience for the "scandalous" allegation.
"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," he wrote.
ProTransport eventually dropped seven of its 10 claims.
The parties agreed to mediation in late August and ProTransport's attorney, George Azadian, of The Matthews Law Group in San Marino, Calif., revealed this week that they entered a stipulation agreement to dismiss the case.
Azadian stressed stipulation agreements are generally confidential and that he could not reveal the conditions of ProTransport's agreement with Kaiser.
Attorneys for Kaiser did not return a request for comment.
Orrick dismissed the case Tuesday.
See court order from August 2013 in this case.
Kaiser Contractor Can't Allege Schadenfreude
By JONNY BONNER
Courthouse News Service
September 03, 2013
(CN) - A federal judge sidelined "scandalous" allegations that Kaiser welcomes the death of its patients, but left room for amended claims under the False Claims Act.
In a 2012 complaint, ProTransport-1 LLC claimed that Kaiser Foundation Health Plan failed to pay for its services transporting patients with end stage renal disease to dialysis treatment.
The Oakland-based Kaiser allegedly required ProTransport to seek reimbursement from the California Medical Assistance Program, Medi-Cal.
ProTansport said it complained about the conduct and that Kaiser then retaliated by refusing to pay for any transports made by ProTransport and excluding ProTransport from bidding to provide future services to Kaiser.
Since the Medicare Act allegedly requires Kaiser to pay ProTransport in the first instance, the insurer's conduct amounts to fraud, according to the complaint.
Kaiser moved to dismiss the complaint and to strike references that it called "immaterial and improper," leading ProTransport to voluntarily dismiss seven claims. It wanted to preserve only its claims under the federal False Claims Act and California laws against retaliation and unfair competition.
ProTransport drew the court's ire with its claims that Kaiser welcomed, caused and profited from patients' death.
In its complaint, ProTransport said: "Of course, Kaiser knows very well that without dialysis these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."
U.S. District Judge William Orrick on Wednesday called the allegations "immaterial and scandalous."
"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," the ruling states.
Though Kaiser claimed that the False Claims Act claim was just a disguised attempt by ProTransport to obtain payment for its services, ProTransport insisted that it is trying to secure recovery for the United States.
Orrick agreed that "payments to ProTransport for services provided in the past are not at issue. Nor are payments that might be made in the future, as ProTransport was allegedly barred by Kaiser from bidding to provide future services."
He nevertheless dismissed the claim as inadequately pleaded.
"While the complaint cites to various statutes and regulations to argue that Kaiser's Medical Advantage plan is required to provide the same level of coverage required under Medicare and that medically necessary transports are covered by Medicare, the complaint does not identify which law, rule or regulation Kaiser undertook to comply with that 'is implicated in submitting a claim for payment,'" the 18-page ruling states. "Moreover, the complaint does not identify what 'claims' Kaiser submitted that were 'impliedly' false."
In dismissing a claim for retaliation under the California Health and Safety Code, Orrick noted that the law does not cover "a non-contracted transportation service provider."
ProTransport can allege retaliation unfairness under the unfair competition law, but it cannot claim a violation under the illegal prong of that law, according to the ruling.
Orrick reasoned that this claim is barred because it stems from the nixed allegations under the False Claims Act and Health and Safety Code.
Kaiser Settles Transport Payment Squabble
By PHILIP A. JANQUART
Courthouse News Service
December 06, 2013
(CN) - A stipulation agreement has led to the dismissal of claims that Kaiser Foundation Health Plan failed to pay a company that transported patients to dialysis.
ProTransport-1 LLC, which claimed to transport Kaiser patients with end stage renal disease, had filed the lawsuit under the False Claims Act in 2012.
It said that Kaiser takes hundreds of millions of dollars from the U.S. government to care for seniors and patients with special needs, but that it pockets the money and has contractors like ProTransport bill the California Medical Assistance Program, known as Medi-Cal, for services rendered. Claiming that the Medicare Act allegedly requires Kaiser to pay the company in the first instance, ProTransport said the insurer's conduct amounted to fraud.
The complaint spared no words in blasting Kaiser as an "unscrupulous" entity whose "greed" compels it to steal from and defraud the government.
This past August, U.S. District Judge William Orrick refused to let ProTransport advance claims that the alleged billing was part of Kaiser's plan to kill its patients.
The complaint had stated: "Of course, Kaiser knows very well that without dialysis, these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."
But Orrick had no patience for the "scandalous" allegation.
"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," he wrote.
[Maura Larkins' comment: In fact, Kaiser treatment guidelines include delaying diagnostic tests and ignoring test results. Kaiser seems to have a particular antipathy toward helping patients with kidney issues. At one point, Kaiser actually kept many of them off eligibility lists for transplants. These policies have resulted in quick deaths rather than long years of care, producing a huge amount of profit for Kaiser Permanente. Kaiser is interested in finding cheap treatments for common diseases, but it carefully picks and chooses when it comes to treating patients who have expensive problems.]
ProTransport eventually dropped seven of its 10 claims.
The parties agreed to mediation in late August and ProTransport's attorney, George Azadian, of The Matthews Law Group in San Marino, Calif., revealed this week that they entered a stipulation agreement to dismiss the case.
Azadian stressed stipulation agreements are generally confidential and that he could not reveal the conditions of ProTransport's agreement with Kaiser.
Attorneys for Kaiser did not return a request for comment.
Orrick dismissed the case Tuesday.
See court order from August 2013 in this case.
Kaiser Contractor Can't Allege Schadenfreude
By JONNY BONNER
Courthouse News Service
September 03, 2013
(CN) - A federal judge sidelined "scandalous" allegations that Kaiser welcomes the death of its patients, but left room for amended claims under the False Claims Act.
In a 2012 complaint, ProTransport-1 LLC claimed that Kaiser Foundation Health Plan failed to pay for its services transporting patients with end stage renal disease to dialysis treatment.
The Oakland-based Kaiser allegedly required ProTransport to seek reimbursement from the California Medical Assistance Program, Medi-Cal.
ProTansport said it complained about the conduct and that Kaiser then retaliated by refusing to pay for any transports made by ProTransport and excluding ProTransport from bidding to provide future services to Kaiser.
Since the Medicare Act allegedly requires Kaiser to pay ProTransport in the first instance, the insurer's conduct amounts to fraud, according to the complaint.
Kaiser moved to dismiss the complaint and to strike references that it called "immaterial and improper," leading ProTransport to voluntarily dismiss seven claims. It wanted to preserve only its claims under the federal False Claims Act and California laws against retaliation and unfair competition.
ProTransport drew the court's ire with its claims that Kaiser welcomed, caused and profited from patients' death.
In its complaint, ProTransport said: "Of course, Kaiser knows very well that without dialysis these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."
U.S. District Judge William Orrick on Wednesday called the allegations "immaterial and scandalous."
"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," the ruling states.
Though Kaiser claimed that the False Claims Act claim was just a disguised attempt by ProTransport to obtain payment for its services, ProTransport insisted that it is trying to secure recovery for the United States.
Orrick agreed that "payments to ProTransport for services provided in the past are not at issue. Nor are payments that might be made in the future, as ProTransport was allegedly barred by Kaiser from bidding to provide future services."
He nevertheless dismissed the claim as inadequately pleaded.
"While the complaint cites to various statutes and regulations to argue that Kaiser's Medical Advantage plan is required to provide the same level of coverage required under Medicare and that medically necessary transports are covered by Medicare, the complaint does not identify which law, rule or regulation Kaiser undertook to comply with that 'is implicated in submitting a claim for payment,'" the 18-page ruling states. "Moreover, the complaint does not identify what 'claims' Kaiser submitted that were 'impliedly' false."
In dismissing a claim for retaliation under the California Health and Safety Code, Orrick noted that the law does not cover "a non-contracted transportation service provider."
ProTransport can allege retaliation unfairness under the unfair competition law, but it cannot claim a violation under the illegal prong of that law, according to the ruling.
Orrick reasoned that this claim is barred because it stems from the nixed allegations under the False Claims Act and Health and Safety Code.
Wednesday, October 23, 2013
Kaiser wants the public to know the truth about Kaiser quality. So do I.
Here it is straight from the horse's mouth: Kaiser wants the public to have more information about the quality of medical care provided by Kaiser.
I'm happy to help with this blog. Of course, I agree that Covered California should post ratings of insurers. I'd also like to suggest that the California exchange public Kaiser's treatment guidelines and those of other insurers.
The desire for openness is a big change in attitude for Kaiser, a company that usually wants to keep secrets.
Kaiser faults California’s exchange for lack of quality ratings
Chad Terhune
Los Angeles Times
Oct. 22, 2013
Healthcare giant Kaiser Permanente and two other insurers say California’s insurance exchange is withholding crucial information from consumers by not posting quality ratings alongside health plan rates.
The insurance companies said “there has never been a compelling reason to deny this information to consumers…. On this issue, Covered California has surrendered its ‘pace car’ status.”
Sharp Health Plan in San Diego and Western Health Advantage in Sacramento joined Kaiser in criticizing the state’s position in a letter sent Monday to Covered California, the state health exchange. Some consumer advocates have also urged the state to reconsider, saying any delay rewards lower-performing insurers.
Thousands of people have been shopping for coverage at the state’s website at www.coveredca.com since enrollment opened Oct. 1 under the Affordable Care Act, also known as Obamacare.
Covered California ignited this debate in August when it backed off earlier plans to include insurance company ratings in its online enrollment system.
This came as a surprise because state officials had touted the idea of consumers choosing coverage based on the overall value, combining price and quality measures.
At the time, the exchange said it reversed course because the latest state rankings examine performance from 2011, and they don’t reflect many of the new health plans and provider networks being offered for the first time under the federal healthcare law.
Major insurers such as Blue Shield of California and Health Net Inc. have offered narrower networks for some exchange policies to help lower premiums. In contrast, Kaiser and its full provider network are often more expensive.
State officials have discussed including ratings for some health plans, such as Kaiser, that are using their current network and labeling newer products as “not yet rated.” Covered California’s five-member board is expected to consider the matter at a regularly scheduled meeting Thursday.
In their letter, the three insurers also point out that other state-run exchanges, such as those in Colorado, Maryland and Oregon, are displaying quality data prominently on their websites. Colorado’s website even sorts a consumer’s options by quality, rather than just price.
“The leadership of these three state exchanges faced a choice, as California’s does now – and they chose to put consumers first,” the insurers said.
I'm happy to help with this blog. Of course, I agree that Covered California should post ratings of insurers. I'd also like to suggest that the California exchange public Kaiser's treatment guidelines and those of other insurers.
The desire for openness is a big change in attitude for Kaiser, a company that usually wants to keep secrets.
Kaiser faults California’s exchange for lack of quality ratings
Chad Terhune
Los Angeles Times
Oct. 22, 2013
Healthcare giant Kaiser Permanente and two other insurers say California’s insurance exchange is withholding crucial information from consumers by not posting quality ratings alongside health plan rates.
The insurance companies said “there has never been a compelling reason to deny this information to consumers…. On this issue, Covered California has surrendered its ‘pace car’ status.”
Sharp Health Plan in San Diego and Western Health Advantage in Sacramento joined Kaiser in criticizing the state’s position in a letter sent Monday to Covered California, the state health exchange. Some consumer advocates have also urged the state to reconsider, saying any delay rewards lower-performing insurers.
Thousands of people have been shopping for coverage at the state’s website at www.coveredca.com since enrollment opened Oct. 1 under the Affordable Care Act, also known as Obamacare.
Covered California ignited this debate in August when it backed off earlier plans to include insurance company ratings in its online enrollment system.
This came as a surprise because state officials had touted the idea of consumers choosing coverage based on the overall value, combining price and quality measures.
At the time, the exchange said it reversed course because the latest state rankings examine performance from 2011, and they don’t reflect many of the new health plans and provider networks being offered for the first time under the federal healthcare law.
Major insurers such as Blue Shield of California and Health Net Inc. have offered narrower networks for some exchange policies to help lower premiums. In contrast, Kaiser and its full provider network are often more expensive.
State officials have discussed including ratings for some health plans, such as Kaiser, that are using their current network and labeling newer products as “not yet rated.” Covered California’s five-member board is expected to consider the matter at a regularly scheduled meeting Thursday.
In their letter, the three insurers also point out that other state-run exchanges, such as those in Colorado, Maryland and Oregon, are displaying quality data prominently on their websites. Colorado’s website even sorts a consumer’s options by quality, rather than just price.
“The leadership of these three state exchanges faced a choice, as California’s does now – and they chose to put consumers first,” the insurers said.
Friday, May 31, 2013
Suicidal Patient Escaped From Kaiser, Mom Says
Suicidal Patient Escaped From Kaiser, Mom Says
By BARBARA WALLACE
Courthouse News Service
May 31, 2013
ROSEVILLE, Calif. (CN) - A suicidal patient escaped through an unlocked door at a Kaiser hospital while awaiting transfer to a psychiatric facility, his parents claim in court.
Brian and Suzanne Amsbaugh sued Kaiser and Securitas Security Services for wrongful death and premises liability. Their son, Corey Amsbaugh, was diagnosed at Kaiser Roseville's emergency room with "psychosis, paranoia and suicidal ideation," the complaint says. "Health care providers and/or others at Kaiser Roseville determined that decedent was a 'high risk for suicide' and detained decedent," involuntarily, pending transfer to a psychiatric facility, according to the complaint.
"While waiting for the transfer to a psychiatric facility, decedent was placed, put, brought to, detained or otherwise kept in a designated room at Kaiser Roseville, chosen by defendants, to prevent his escape and the Kaiser Roseville's security personnel were summoned for 'bedside patient observation' to prevent decedent from escaping," the complaint continues. However, the next day "decedent walked out of the hospital room, through an unlocked door, escaped from Kaiser Roseville and committed suicide," according to the complaint.
The Amsbaughs allege Kaiser and Securitas "created, knew, or in the exercise of reasonable care and diligence, should have known, that unless reasonable inspections, repairs, modifications, supervision, control, monitoring and other appropriate measures were made and/or undertaken, such dangerous and defective conditions endangered the safety of patients."
Plaintiffs are represented by Werner Meissner of San Pedro.
By BARBARA WALLACE
Courthouse News Service
May 31, 2013
ROSEVILLE, Calif. (CN) - A suicidal patient escaped through an unlocked door at a Kaiser hospital while awaiting transfer to a psychiatric facility, his parents claim in court.
Brian and Suzanne Amsbaugh sued Kaiser and Securitas Security Services for wrongful death and premises liability. Their son, Corey Amsbaugh, was diagnosed at Kaiser Roseville's emergency room with "psychosis, paranoia and suicidal ideation," the complaint says. "Health care providers and/or others at Kaiser Roseville determined that decedent was a 'high risk for suicide' and detained decedent," involuntarily, pending transfer to a psychiatric facility, according to the complaint.
"While waiting for the transfer to a psychiatric facility, decedent was placed, put, brought to, detained or otherwise kept in a designated room at Kaiser Roseville, chosen by defendants, to prevent his escape and the Kaiser Roseville's security personnel were summoned for 'bedside patient observation' to prevent decedent from escaping," the complaint continues. However, the next day "decedent walked out of the hospital room, through an unlocked door, escaped from Kaiser Roseville and committed suicide," according to the complaint.
The Amsbaughs allege Kaiser and Securitas "created, knew, or in the exercise of reasonable care and diligence, should have known, that unless reasonable inspections, repairs, modifications, supervision, control, monitoring and other appropriate measures were made and/or undertaken, such dangerous and defective conditions endangered the safety of patients."
Plaintiffs are represented by Werner Meissner of San Pedro.
Tuesday, May 14, 2013
Is $2 million paid to a doctor in Arkansas really making any difference in the length of Jalal Afshar's life? I suspect not.
Two months ago I wrote about this case here. I am not at all a fan of Kaiser Permanente, and I know that Kaiser turns a profit by failing to provide life-saving treatments. It achieves its billions of yearly profit through "treatment guidelines" that cause practitioners to fail to appropriately diagnose and treat illnesses.
But I am suspicious of this particular case. I suspect that some charlatan in Arkansas offered hope to Mr. Afshar in exchange for $2 million dollars.
I did a little research and found this information on the American Cancer Society website:
"Infection with HIV is the only clear-cut risk factor for CD. Castleman disease is much more common in people with this infection, particularly in those who have developed the acquired immunodeficiency syndrome (AIDS)...The cause of Castleman disease (CD) is not known for sure, but doctors suspect it is related to problems with the way a person's immune system is working...A virus seems to be involved in at least some cases of CD. Human herpes virus type 8(HHV-8) is found in the lymph node B cells of many people who are HIV-positive and have multicentric CD. This virus is also known as Kaposi sarcoma-related herpes virus(KSHV) because it has also been found in people with Kaposi sarcoma (a rare type of cancer). In fact, some people with CD also have Kaposi sarcoma."
I suspect that Mr. Afshar will live exactly as long with his $2 million Arkansas treatment as he would have lived without it.
Man Files $2M Lawsuit, Says Kaiser Refused To Cover Life-Saving Treatment
May 13, 2013
CBSLA.com
A Pasadena man is suing Kaiser Permanente for $2 million alleging breach of contract and unfair business practices after he says they gave up on him and refused to provide or cover the cost of life-saving care.
Kaiser doctors diagnosed 58-year-old Jalal Afshar with Castleman disease, a rare and often deadly disease that targets the lymph nodes.
...A former Kaiser employee, Afshar said the non-profit medical group initially granted his request to see an out-of-network specialist in Arkansas.
“It was like, you know, finding your life again,” he said.
The lawsuit alleges that Kaiser ultimately declined to pay for his care, claiming that services were available within his existing plan to treat the disease.
“Kaiser, in bad faith, unreasonably denied medical care that Jalal needed to save his life,” said his attorney, Scott Glovsky.
Afshar continued his treatment out-of-network. Six months later, he is on the way to recovery, but owes $2 million in health care costs.
“He would be dead for sure because they had given up on him,” said his wife, Maryam.
[Maura Larkins comment: I have not seen any evidence that Mr. Afshar was given a prognosis of six months to live. Kaiser simply said it didn't have a treatment to offer him. This doesn't mean he was expected to die right away. It only means that Kaiser was not planning to interfere with the course of nature.]
“We should care about people more about their lives than making money,” said Afshar.
“When I was there, they were clearing a couple of billion dollars of pure profit every quarter,” he said.
Kaiser declined an interview, but released a statement Monday.
The statement reads in part:
“We dispute the allegations included in the lawsuit…We did not give up on our member. Respecting patient privacy, we cannot provide details about the treatment options which were made available and being pursued…We will fully address the lawsuit in the proper judicial forum.”
But I am suspicious of this particular case. I suspect that some charlatan in Arkansas offered hope to Mr. Afshar in exchange for $2 million dollars.
I did a little research and found this information on the American Cancer Society website:
"Infection with HIV is the only clear-cut risk factor for CD. Castleman disease is much more common in people with this infection, particularly in those who have developed the acquired immunodeficiency syndrome (AIDS)...The cause of Castleman disease (CD) is not known for sure, but doctors suspect it is related to problems with the way a person's immune system is working...A virus seems to be involved in at least some cases of CD. Human herpes virus type 8(HHV-8) is found in the lymph node B cells of many people who are HIV-positive and have multicentric CD. This virus is also known as Kaposi sarcoma-related herpes virus(KSHV) because it has also been found in people with Kaposi sarcoma (a rare type of cancer). In fact, some people with CD also have Kaposi sarcoma."
I suspect that Mr. Afshar will live exactly as long with his $2 million Arkansas treatment as he would have lived without it.
Man Files $2M Lawsuit, Says Kaiser Refused To Cover Life-Saving Treatment
May 13, 2013
CBSLA.com
A Pasadena man is suing Kaiser Permanente for $2 million alleging breach of contract and unfair business practices after he says they gave up on him and refused to provide or cover the cost of life-saving care.
Kaiser doctors diagnosed 58-year-old Jalal Afshar with Castleman disease, a rare and often deadly disease that targets the lymph nodes.
...A former Kaiser employee, Afshar said the non-profit medical group initially granted his request to see an out-of-network specialist in Arkansas.
“It was like, you know, finding your life again,” he said.
The lawsuit alleges that Kaiser ultimately declined to pay for his care, claiming that services were available within his existing plan to treat the disease.
“Kaiser, in bad faith, unreasonably denied medical care that Jalal needed to save his life,” said his attorney, Scott Glovsky.
Afshar continued his treatment out-of-network. Six months later, he is on the way to recovery, but owes $2 million in health care costs.
“He would be dead for sure because they had given up on him,” said his wife, Maryam.
[Maura Larkins comment: I have not seen any evidence that Mr. Afshar was given a prognosis of six months to live. Kaiser simply said it didn't have a treatment to offer him. This doesn't mean he was expected to die right away. It only means that Kaiser was not planning to interfere with the course of nature.]
“We should care about people more about their lives than making money,” said Afshar.
“When I was there, they were clearing a couple of billion dollars of pure profit every quarter,” he said.
Kaiser declined an interview, but released a statement Monday.
The statement reads in part:
“We dispute the allegations included in the lawsuit…We did not give up on our member. Respecting patient privacy, we cannot provide details about the treatment options which were made available and being pursued…We will fully address the lawsuit in the proper judicial forum.”
Tuesday, October 18, 2011
Why Are Customers of This Health Insurer So Happy?
Here's a puff piece about Kaiser Permanente. This is clearly not investigative journalism. The article doesn't mention the downside of Kaiser's "guidelines for treatment." The biggest downside is that Kaiser Permanente makes its profits by offering assembly-line care. It has lists of symptoms that it checks for and treats. But if you have symptoms that differ from the guidelines, you may well end up dead. Kaiser is playing the percentages. It sacrifices patients with problems that don't fit the pre-determined process.
Electronic records are interesting. They can be easily altered, and Kaiser takes full advantage of this when a patient presents with a problem that Kaiser doesn't want to deal with.
If Kaiser is at the top in customer ratings, there must be a lot of really bad plans out there.
Why Are Customers of This Health Insurer So Happy?
By Maggie Mahar
Time Magazine
October 18, 2011
Kaiser Permanente’s stand-out performance in Consumer Reports’ national rankings of some 830 insurance plans raises an obvious question: What makes Kaiser so different? In a word: collaboration.
Kaiser is distinctive among the major health insurers in that it’s not just a health insurer. While the non-profit Kaiser Foundation Health Plans provides coverage for its 8.8 million patients, Kaiser also offers an integrated network of doctors and hospitals. The insurer and the providers share one goal: keeping patients healthy over the long term.
(MORE: We’ve Been Wasting a Ton on Vitamins and Dietary Supplements)
Because Kaiser is both the insurer and the provider, it has a larger incentive to invest in preventive care, wellness classes and free smoking clinics. Many other insurers and health systems avoid sinking money into such programs because patients switch insurers so frequently that such spending winds up benefiting another company. But as the Consumer Reports’ ratings show, Kaiser patient satisfaction is high and patient turnover low, so it makes more sense for the insurer to invest for the long haul.
Founded in 1945, the California-based plan was one of the earliest “health co-operatives” that, instead of charging fee-for-service, accepted a lump-sum payment of, say, 85 cents per patient per month. The American Medical Association objected; it insisted that doctors should be free to set prices for each procedure, thus leaving total health care costs open-ended. The AMA had great clout: By 1950, most states had passed laws that barred the co-ops. Kaiser was one of the few that survived.
Today, Kaiser’s physicians are still on salary, treating patients in nine states, plus D.C. Each year Kaiser Health Plan (the insurer) and the Kaiser Permanente Medical Group (the doctors) in each region negotiate and agree on a lump sum that the Health Plan will pay the Medical Group on a monthly basis for each patient. Rather than compensating doctors for volume (fee-for-service) the goal is to hold physicians “accountable” for keeping patients well. If they succeed, fewer patients will need to be hospitalized or undergo expensive procedures, and the payment will turn out to be greater than the actual cost of necessary medical care. When that happens, the Medical Group, as a whole, shares in some of the surplus. Thus, rather than having an incentive to “do more” tests and procedures, Kaiser’s doctors have an incentive to “do less, and do it right.”
(MORE: Patients Prefer HMOs (And Other Healthcare Surprises))
Nationwide, many doctors prefer working fee for service, running their own business and competing for market share with an eye to increasing their income. But others compete for jobs at Kaiser: In California, Kaiser hires just 11 percent of the doctors who apply for positions. These tend to be physicians who don’t want the hassle of running a business.
Kaiser also makes very effective use of information technology in coordinating patient care. It maintains a single computerized record for each patient, so all physicians are looking at the same chart, where they can read their colleagues’ notes and know what they are thinking. In other healthcare “systems,” patients can often be seeing five doctors, none of whom have no idea what the others are planning or prescribing.
Perhaps just as important, Kaiser uses that electronic database of patients’ records to determine which treatments work best for which patients. By mining that medical evidence, it is able to create “guidelines” — they’re careful not to call them rules — for consistent standards of care. Without such guidelines, many experts agree, U.S. healthcare can be frighteningly idiosyncratic, particularly when doctors are working alone. It is impossible for any single physician to keep up on all of the newest research. But when doctors are working elbow to elbow in large multispecialty groups, they share their knowledge.
Over time, a combination of teamwork, guidelines and computerized records has helped Kaiser achieve remarkable results that go well beyond the Consumer Reports findings. For example, in Northern California, Kaiser has reduced death from heart disease among its 3 million members so significantly that it is no longer the leading cause of death. In fact, after adjusting for age and gender, death from heart disease is more than 30 percent lower among the Kaiser population than among Northern Californians who receive care through another insurer.
Maggie Mahar writes the HealthBeat blog for The Century Foundation, where she is a fellow.
Read other related stories about this:
Health-Insurance Plan Rankings from the NCQA Consumer Reports
Electronic records are interesting. They can be easily altered, and Kaiser takes full advantage of this when a patient presents with a problem that Kaiser doesn't want to deal with.
If Kaiser is at the top in customer ratings, there must be a lot of really bad plans out there.
Why Are Customers of This Health Insurer So Happy?
By Maggie Mahar
Time Magazine
October 18, 2011
Kaiser Permanente’s stand-out performance in Consumer Reports’ national rankings of some 830 insurance plans raises an obvious question: What makes Kaiser so different? In a word: collaboration.
Kaiser is distinctive among the major health insurers in that it’s not just a health insurer. While the non-profit Kaiser Foundation Health Plans provides coverage for its 8.8 million patients, Kaiser also offers an integrated network of doctors and hospitals. The insurer and the providers share one goal: keeping patients healthy over the long term.
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Because Kaiser is both the insurer and the provider, it has a larger incentive to invest in preventive care, wellness classes and free smoking clinics. Many other insurers and health systems avoid sinking money into such programs because patients switch insurers so frequently that such spending winds up benefiting another company. But as the Consumer Reports’ ratings show, Kaiser patient satisfaction is high and patient turnover low, so it makes more sense for the insurer to invest for the long haul.
Founded in 1945, the California-based plan was one of the earliest “health co-operatives” that, instead of charging fee-for-service, accepted a lump-sum payment of, say, 85 cents per patient per month. The American Medical Association objected; it insisted that doctors should be free to set prices for each procedure, thus leaving total health care costs open-ended. The AMA had great clout: By 1950, most states had passed laws that barred the co-ops. Kaiser was one of the few that survived.
Today, Kaiser’s physicians are still on salary, treating patients in nine states, plus D.C. Each year Kaiser Health Plan (the insurer) and the Kaiser Permanente Medical Group (the doctors) in each region negotiate and agree on a lump sum that the Health Plan will pay the Medical Group on a monthly basis for each patient. Rather than compensating doctors for volume (fee-for-service) the goal is to hold physicians “accountable” for keeping patients well. If they succeed, fewer patients will need to be hospitalized or undergo expensive procedures, and the payment will turn out to be greater than the actual cost of necessary medical care. When that happens, the Medical Group, as a whole, shares in some of the surplus. Thus, rather than having an incentive to “do more” tests and procedures, Kaiser’s doctors have an incentive to “do less, and do it right.”
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Nationwide, many doctors prefer working fee for service, running their own business and competing for market share with an eye to increasing their income. But others compete for jobs at Kaiser: In California, Kaiser hires just 11 percent of the doctors who apply for positions. These tend to be physicians who don’t want the hassle of running a business.
Kaiser also makes very effective use of information technology in coordinating patient care. It maintains a single computerized record for each patient, so all physicians are looking at the same chart, where they can read their colleagues’ notes and know what they are thinking. In other healthcare “systems,” patients can often be seeing five doctors, none of whom have no idea what the others are planning or prescribing.
Perhaps just as important, Kaiser uses that electronic database of patients’ records to determine which treatments work best for which patients. By mining that medical evidence, it is able to create “guidelines” — they’re careful not to call them rules — for consistent standards of care. Without such guidelines, many experts agree, U.S. healthcare can be frighteningly idiosyncratic, particularly when doctors are working alone. It is impossible for any single physician to keep up on all of the newest research. But when doctors are working elbow to elbow in large multispecialty groups, they share their knowledge.
Over time, a combination of teamwork, guidelines and computerized records has helped Kaiser achieve remarkable results that go well beyond the Consumer Reports findings. For example, in Northern California, Kaiser has reduced death from heart disease among its 3 million members so significantly that it is no longer the leading cause of death. In fact, after adjusting for age and gender, death from heart disease is more than 30 percent lower among the Kaiser population than among Northern Californians who receive care through another insurer.
Maggie Mahar writes the HealthBeat blog for The Century Foundation, where she is a fellow.
Read other related stories about this:
Health-Insurance Plan Rankings from the NCQA Consumer Reports
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