Will Kaiser Foundation Health Plan lawsuit against its own investigator reveal more than Kaiser would like?

I'm guessing Quinn told Kaiser what they wanted to hear so they didn't ask questions. I wonder how many Kaiser members were denied health care on the basis of this man's information? How much money did he save Kaiser? I imagine that what Quinn charged Kaiser was a small fraction of the large amount of money he helped Kaiser avoid paying. Will Kaiser reopen those cases and give back to members all such amounts?

Kaiser Foundation Health Plan is not a subsidiary. It's the heart and soul of Kaiser Permanente. It makes about 8 billion tax-free dollars a year. Denying care is a major part of its business plan.

Report: Kaiser accuses California employee of embezzling $7M

By Associated Press | 11:02 a.m. July 11, 2016

OAKLAND, Calif. (AP) — A subsidiary of health care giant Kaiser Permanente has filed a lawsuit in California accusing an employee responsible for investigating insurance fraud claims of embezzling $7 million, a newspaper reported.

The suit by Kaiser Foundation Health Plan accuses Michael Albert Quinn of submitting invoices for investigative services that were not performed or were not justified over a 16-year span after he joined the company in 1998, the San Francisco Chronicle reported (http://bit.ly/29K2QoA) on Sunday.

Quinn, 45, was responsible for hiring investigators to conduct surveillance on people who were suspected of filing fraudulent claims, He was authorized to approve charges up to $50,000.
The newspaper said Quinn was fired in 2014. Kaiser filed the lawsuit last year...

See more HERE.

Kaiser Cost a Man His Penis, He Claims

Kaiser Cost a Man His Penis, He Claims By BARBARA WALLACE  Courthouse News Jan. 21, 2015      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.

Health Insurance Complaints Skyrocket in CA, says DMHC (Department of Managed Health Care)

Apparently, insurance companies don't want to let customers cancel policies.

"Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service."

Sadly, long before the new health care law went into effect, Kaiser was preventing patients from making complaints.

DMOC isn't likely to do much. There's a long history between DMHC and Kaiser.

Health Insurance Complaints Skyrocket in CA
Having trouble reaching your health insurance company? You're not alone. State regulators say in January alone, they've seen a 53% jump in complaints, in part because calls about Covered California. A little known state hotline can help
By Vicky Nguyen, Felipe Escamilla, Liza Meak, and Scott Pham
NBC News
Apr 22, 2014

The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies. Vicky Nguyen reports in a video that aired on April 21, 2014.

Even if you aren’t one of the 1.2 million people signing up for Covered California, chances are you’re feeling the pinch when calling your insurance company. The Investigative Unit has learned complaints to state regulators have skyrocketed as people find themselves unable to reach anyone at several major health insurance companies.

For some health insurance companies, the influx of calls is so bad, they’re hanging up on customers after a pre-recorded message, while others put callers on hold indefinitely.

“I’ve been put on hold anywhere from 15-40 minutes,” said Don Tran, a full-time grad student at San Jose State.

Tran said he wanted to cancel his individual health plan with Blue Shield of California because he was eligible for less expensive coverage through his employer. But getting in touch with Blue Shield turned out to be much more difficult than he anticipated. “It’s been over a month and a half and I still haven’t been able to reach anybody,” Tran said.

Tran's story is a familiar one to Marta Green, spokeswoman for the California Department of Managed Health Care. The agency regulates [or at least, it collects a lot of money from the taxpayers in exchange for promising to regulate] health care plans and protects consumers.

“We have seen our call volume go up quite a bit,” Green said. She attributes much of the increase to the sudden spike in health insurance enrollment due to Covered California.

The rise in complaint volume was so extreme, the department began tracking the number of complaints from people who said they couldn't even reach their insurance providers.

“It was never an issue before this year,” Green said. But the department is only tracking “can’t reach plan” complaints for customers enrolled in Covered California. Of the roughly 1,000 complaints received between January and March of 2014, 1 in 10 people said they were trying to cancel or couldn’t reach their plan.

Green said there’s little consequence at this point for health plans that aren’t responsive to consumers. “If a health care plan is found to have violated the law, they can face enforcement action…[but] there is no specific law in relation to wait times.” Green said consumers can call, email or even send postal mail to the department regarding any issues with their health insurance. She said the department is committed to helping consumers resolve their problems, a process that can take anywhere from a day to a month.

“Every complaint we receive is investigated,” Green said. She encouraged consumers to call the department’s hotline, 1-888-466-2219, where they are guaranteed to reach a human being during business hours.

Don Tran took his complaint online, joining dozens of others NBC Bay Area found on social media, who are posting pictures of their wait times and airing their complaints on Facebook and Twitter. A check of the Facebook pages for the two largest providers in California—Anthem and Blue Shield – revealed new complaints daily.

Kaiser, the state’s third largest provider, doesn’t allow users to post directly to its Facebook page. It’s also where some callers complained they were receiving a pre-recorded message that ended with a dial tone when they called customer service.

“It’s a real hassle,” Tran said, adding that Blue Shield only responded after he posted several comments on social media. Now, more than 2 months later, he finally has his cancellation notice, but didn't get a reimbursement check until a few days ago.

Blue Shield of California spokesman Sean Barry said via email the company has expanded its customer service staff, adding, “We’re committed to delivering a high-quality customer experience. We have put several measures in place to reduce the delays in resolving issues by phone, receiving new ID cards and making payments.”

He directed customers to this customer service home page with a list of contacts to help resolve issues.

Darrel Ng echoed a similar sentiment. In an emailed statement, the Anthem Blue Cross spokesman said, “At the beginning of the year, hundreds of thousands of Californians were added to the insurance rolls on Jan. 1 as our nation’s health care delivery system went through a complete transformation. Because of that, in the first two business days of January, our company received a million calls nationally. Since then, we hired and trained hundreds of additional customer service agents and reassigned hundreds of other internal assets to assist on our phone lines. Through those efforts, the average hold time for customer service was under 3 minutes in March and is down to less than 90 seconds thus far in April.”

Kaiser Permanente spokesperson Karl Sonkin emailed this statement. "Prior to the deadline for Affordable Care Act Kaiser Permanente experienced a higher volume of calls to our Member Services Call Center during peak hours than we typically receive in the first part of the year, and that had resulted in longer than normal hold times. However, now that the enrollment deadline has passed our call volumes have returned to more typical levels and we are no longer experiencing delays."

[Maura Larkins' comment: This seem to be Kaiser's way of saying that patients will be experiencing the same treatment that they received for years before the Affordable Care Act.]

Kaiser, which has long claimed to practice preventive medicine, to raise rates 9.2 per cent, on reinstated policies

Apparently, Kaiser Permanente wasn't so interested in preventive medicine as it claimed. When required to provide preventive care, it raises rates.

Kaiser to raise rates on reinstated policies
The proposed 9.2% boost would cover higher costs associated with Obamacare
By Kristen Consillio
Star Advertizer
Nov 30, 2013

Kaiser Permanente Hawaii plans to boost rates by an average 9.2 percent for 11,000 individuals who were earlier notified their health insurance policies would be canceled at year's end because they did not meet the minimum requirements of the federal Affordable Care Act.

The state's largest health maintenance organization said it filed the proposed rate hike this week with the Insurance Division to cover higher projected medical expenses next year, costs associated with an aging population and taxes and fees related to the federal Affordable Care Act...

Class Action lawsuit filed against Kaiser over mental health care wait times

Class Action lawsuit filed against Kaiser over mental health care wait times
By Rachel Raskin-Zrihen
Times-Herald
10/25/2013

A lawsuit served at Kaiser Permanente's Oakland headquarters Thursday alleges that Kaiser Foundation Health Plan facilities, including Vallejo's, routinely deny its members timely access to mental health services.

Kaiser officials call the suit a ploy in ongoing contract negotiations.

The Oakland-based law firm of Siegel LeWitter Malkani that works closely with the National Union of Healthcare Workers (NUHW) -- which represents Kaiser's mental health professionals and optical workers -- filed the suit earlier this month on behalf of "three named plaintiffs and thousands of other Kaiser members who have been harmed" by this alleged practice, attorney Jonathan Siegel said Thursday.

The union represents some 70 members at Kaiser Permanente Vallejo Medical Center. The firm has sued Kaiser before, Siegel said.

Kaiser officials called the suit the "NUHW's latest attempt to use inaccurate claims about our mental health care services to apply pressure in their protracted labor negotiations with Kaiser Permanente."

The union's actions do "nothing to further the negotiations that should be taking place at the table," they said.

The lawsuit alleges that Kaiser routinely violates state law by refusing to provide critical mental health services to its members within the time frame set by law.

"As a result, Kaiser members have been denied urgent services, forced to wait for long periods of time to receive needed services, discouraged from seeking services altogether, or compelled to incur out-of-pocket expenses for treatment outside of the Kaiser system," according to the suit.

The lead plaintiff, Point Richmond resident Susan Futterman, said her husband, Fred Paroutaud, killed himself after "desperate" requests for an urgent mental health appointment were delayed until his psychiatrist returned from vacation.

Los Angeles area plaintiff Megan Mortensen wound up seeking an urgent mental health appointment outside the system after Kaiser allegedly "refused" her request for a timely appointment after the loss of her brother. The third plaintiff, Acianita Lucero of Oakland, allegedly "made repeated requests for Kaiser to provide her with an urgent mental health appointment but Kaiser refused to see her within the 48 hours required by law," according to the suit.

The suit follows a report from earlier this year by the California Department of Managed Health Care which suggested Kaiser needed to reduce mental health appointment wait times. Kaiser was fined $ 4 million -- the second largest fine issued by the Department -- and issued a Cease and Desist Order to correct the problems, Siegel said.

Kaiser officials say the report did not fault Kaiser's mental health care quality or member's ability to obtain urgent or emergency mental health care.

"What was identified in the DMHC survey were some areas where our non-urgent appointment wait times and data tracking needed improvement," officials said. "We took the findings seriously, have submitted a corrective action plan to the DMHC, and have worked to correct the issues identified in the survey."

The class action lawsuit seeks compensatory and statutory damages for class members as well as an injunction requiring Kaiser to comply with the law, Siegel said.

"We're suing for Kaiser to clean up there act and provide mental health services to their clients that complies with the law," he said. "And we want damage compensation for the tens of thousands of Kaiser members who have been victimized by this."

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.

Patients who were harmed can join class action suit against Kaiser Permanente

Chance to participate:

On October 2, 2013 a class action suit was filed in Alameda County, California - alleging denial of timely and/or appropriate care.

Filed by Siegel, Lewitter, Malkani of Oakland, California
Contact Information: Latika Malkani
Phone Number: 510-452-5000
1939 Harrison Street, Suite 307
Oakland, California 94612

California Class Action Case RG13697775
Filing found here for your viewing: http://legalstuff.kaiserpapers.org/pdfs/Futterman-v-KFHP.pdf

[The complaint is interesting reading, discussing the investigation of the California Department of Managed Health Care (DMHC).]

This suit consists of all current and former Kaiser members who have either been denied access to mental health services, dissuaded from pursuing mental health services, provided with delayed access to mental health services and/or provided with inaccurate and confusing information from Kaiser regarding mental health services available to them from October 2, 2009 to the present.

(Violations of Business and Professions Code, Section 17200 et seq., Violations of the Unruh Civil Rights Act, Breach of the Covenant of Good Faith and Fair Dealing, Breach of Contract)

--Vickie Travis
http://kaiserpapers.org

Is Kaiser Permanente in cahoots with the Department of Managed Care? NUHW Files Complaint Over Hiring of DMHC Attorney

DMHC Director (and former Kaiser counsel) Brent Barnhart

I've known for a long time that the Department of Managed Health Care (DMHC or DOMHC) was in cahoots with Kaiser. DMHC responded to a complaint I filed by saying that Kaiser fulfilled its duty by taking X-rays, and was not obligated to look at them!

DOMC's actions shouldn't come a surprise, since Brent Barnhart,the Director of DMHC, is a former senior counsel at Kaiser Foundation Health Plan.

Having one of his attorneys move to Kaiser will make everything work smoothly. Marcy Gallagher will have access to Director Barnhart, and knowledge of the inner workings of DMHC. Although I can hardly imagine that things could actually get easier for Kaiser. After all, DMHC has to disapprove of SOMETHING every once in a while, just to pretend it's regulatory agency, right?

NUHW Files Complaint Against Kaiser Over Hiring of DMHC Attorney
California Healthline
September 19, 2013

The National Union of Healthcare Workers has filed a complaint against Kaiser Permanente alleging that the company hired an attorney who previously worked at a state regulatory agency to impede an investigation into its practices, Payers & Providers reports.

NUHW filed the complaint with the California Fair Political Practices Commission (Shinkman, Payers & Providers, 9/19).

The move comes only a few weeks after NUHW filed a lawsuit to keep Kaiser from participating in California's health insurance exchange. Exchange officials have selected Kaiser to offer individual and small business policies (California Healthline, 9/6).

The union -- which represents about 5,000 Kaiser workers -- has been pressuring the organization since it lost an election earlier this year to represent about 45,000 employees, according to Payers & Providers.

However, John Borsos -- a spokesperson for NUHW -- said the complaint filed this week is unrelated.

The complaint highlights Kaiser's hiring of Marcy Gallagher, a former attorney with the California Department of Managed Health Care's enforcement division.

Kaiser hired Gallagher in 2012 while she was investigating the organization's health plan for issues related to mental health services access. She now serves as a practice leader in Kaiser's regulatory response business unit.

In a statement, NUHW said that Gallagher "reportedly trained Kaiser officials on how to answer questions posed by DMHC's investigators."

The union argues that the move violates the state's Political Reform Act, which regulates "switching sides by state officials" and "influencing prospective employment."

Gallagher, DMHC and Kaiser declined to comment on the complaint (Payers & Providers, 9/19).

Infection Ate Shoulder, Kaiser Patient Claims

Infection Ate Shoulder, Kaiser Patient Claims
By TISH KRAFT
Courthouse News Service
July 25, 2013

ANNAPOLIS, Md. (CN) - Kaiser's failure to diagnose and treat a woman's oozing bone infection resulted in part of her shoulder being eaten away, she claims in Anne Arundel County Circuit Court. Billie Jo and Ron Bonolis have sued Kaiser Foundation Health Plan of the Mid-Atlantic States Inc. and Mid-Atlantic Permanente Medical Group for malpractice and loss of consortium.

After Mrs. Bonolis had shoulder surgery, her Kaiser doctor thought she had an infection of the shoulder tissue for five months, when it actually was osteomyelitis, a bone infection, her complaint says. Within a month of the surgery, an MRI report suggested that the problem may be osteomyelitis, but no further testing was done, according to the complaint.

Three months after the surgery, and after several courses of antibiotics and attempts to clean out the surgical area, an infection consultant reported that a piece of bone used as an "anchor" during the surgery, was positive for MRSA, a "superbug" resistant to antibiotics, according to the complaint.

The infection had gone so long unchecked that it had eaten away the humoral head (the ball in the socket), and her new doctor was unable to estimate how many surgeries it would take to get rid of the painful infection, according to the complaint.

Once more of the bone had been removed to get rid of the infection, and Mrs. Bonolis was able to have her shoulder replaced, she went through a painful recovery and has suffered great mental anguish, in part due to knowing that she could have died from a superbug infection.

Mrs. Bonolis has a limited range of motion in her dominant arm and is no longer able to write normally, crochet, swim or take care of her grandchildren, among other things. Also, she needs help with personal hygiene, such as washing and combing her hair.

The new doctor told her it is unlikely that she will ever have full use of the right shoulder, the complaint says.

Roy L. Mason represents the plaintiffs, who are seeking $75,000.

Kaiser's Obamacare rates surprise analysts

Kaiser's Obamacare rates surprise analysts
Kaiser Permanente has offered some of the highest rates in the California health exchanges next year. It denies that it is doing so to avoid treating many of the sickest newly insured patients.
By Chad Terhune
Los Angeles Times
June 12, 2013

Despite its higher rates, Kaiser Permanente said it wants to enroll a large number of people in the state exchange.

In California's new state-run health insurance market, Kaiser Permanente will cost you.

The healthcare giant has the highest rates in Southern California and some other areas of the state, surpassing rivals such as Anthem Blue Cross and other smaller competitors. The relatively high premiums from such a strong supporter of the federal healthcare law surprised industry analysts, and it has sparked considerable debate about the company's motives.

Some experts say Kaiser intentionally bid high to avoid drawing too many customers next year who are sick or who have been uninsured for years and may be costlier to treat. Others suspect Kaiser was worried that lower premiums would bring an influx of newly insured patients that could overwhelm its in-house roster of doctors and hospitals.

Making health insurance affordable is a crucial factor in the expansion of coverage to an estimated 5 million Californians — many of them lower-income and the uninsured — who will be eligible for a state-run exchange next year. Price will be paramount to many consumers, even for those who receive federal subsidies to help lower their costs.

In one key barometer of rates, Kaiser has the most expensive premiums for a 40-year-old in Los Angeles, Orange, San Bernardino and Riverside counties for a mid-level Silver plan. Statewide, the nonprofit company has the highest or second-highest premiums for a Silver plan in 12 of the 18 regions where it's selling HMO policies in Covered California, the state market that opens for enrollment Oct. 1.

Kaiser's Silver plan premium for a 40-year-old in southern Los Angeles County is $325 per month, 34% higher than the cheapest policy in the area, from Health Net Inc., at $242.

"Kaiser is not as low cost as many people think," said Glenn Melnick, a USC health policy professor. "They appear to be protecting themselves because the people signing up in the first year are likely to be the sickest ones."

For its part, Kaiser says it was as surprised as others were when the state announced the 13 winning health insurers and their proposed rates for 19 regions last month. These rates are scheduled to be finalized this month after a regulatory review. Individual premiums will vary based on people's age, location and family size.

Despite its higher rates, Kaiser said it wants to enroll a large number of people in the state exchange. It blamed its lackluster showing, in part, on rivals offering cheaper plans that give consumers far less choice of doctors and hospitals.

Blue Shield of California, for instance, is offering 36% of its physician network in Covered California plans.

"We were surprised to see some of the rates," said Bill Wehrle, Kaiser's vice president of health insurance exchanges. "We were surprised at what looked like very narrow networks from our competitors. We don't cut off any slice of our network."

Of course, for years Kaiser has served as a model for the limited networks other insurers are now rushing to adopt. Kaiser is a unique healthcare system because it operates its own hospitals, physician offices and insurance company for its 9 million members nationwide.

"Blue Shield or Anthem could be a little more selective in putting together a network for this new market. Kaiser is one size fits all," said Marian Mulkey, director of the health reform and public programs initiative at the California HealthCare Foundation. "The question now is will people find Kaiser attractive enough compared to their other options. This could put pressure on Kaiser to be less expensive."

Overall, Kaiser is the state's biggest health insurer with a 40% share of the market, according to 2011 data from Citigroup. Anthem Blue Cross, a unit of industry giant WellPoint Inc., was second with a 23% share of employer and individual customers.

More than 5 million Californians who don't get insurance through work are expected to participate in the state's new market. About half of those people will qualify for federal premium subsidies because they are low or moderate income.

Individuals earning up to about $46,000 a year and families making $94,000 or less will qualify for government help with their premiums. Even with that financial boost, however, most consumers are expected to look for the cheapest plans available.

"I think the lowest and second-lowest plans will really be attractive," said Lucien Wulsin, executive director of the Insure the Uninsured Project, a nonprofit research group in Santa Monica. "I'm sure being at the low end of the spectrum puts you more on the receiving end of everybody."

One of the bigger unknowns in the federal healthcare expansion is how many people will sign up initially and who will they be. Patients with preexisting medical conditions or chronic illnesses who have been denied insurance for years should be eager to enroll. Younger, healthier people may not see much reason to buy, content instead to pay a modest penalty.

Starting in January, most Americans must have health insurance or pay a fine. The penalty starts at $95 per adult or 1% of income, whichever is greater. The penalties increase over time.

"Kaiser has structured this so they don't get a lot of the poorer and potentially sicker people," said Steve Valentine, president of the Camden Group, an El Segundo healthcare consulting firm.

"Some people have been unemployed and underemployed for years, and they may have a lot of healthcare needs. There could be a lot of pent-up demand, and Kaiser may be trying to dodge that bullet," Valentine said.

For years, some consumer advocates have faulted Kaiser for not doing more for the state's poorest residents on Medi-Cal, the state Medicaid program, and for building many of its hospitals and medical offices in more affluent areas.

Kaiser defends its record of charity care and denies any effort to duck certain customers. Last year, the Oakland company said it provided care to more than 560,000 Californians enrolled in Medi-Cal and other safety-net programs.

"There is a lot of uncertainty about whether the healthy show up as well as the sick," Wehrle said. "We are very competitive on rates in some regions, which is a pretty strong indication we are not trying to avoid anything. There is no question we want to grow in the exchange, and I think we will."

Mulkey of the California HealthCare Foundation said Kaiser has regretted being the low-cost option at times in the past and being overrun by too many members at one time. Other insurers may have more flexibility to add doctors and hospitals to their network as enrollment builds.

Kaiser, on the other hand, could face the costly decision to contract with outside hospitals to absorb some of its overflow.

"We are focused on sustainable prices for the long haul," Wehrle said. "If you make a large mistake in this environment, it can be hard to recover."

Transgender teen settles with Kaiser Permanente in landmark health case

Kaiser Permanente's motive was simple: any excuse to save money. Kaiser has narrow treatment guidelines that harm patients, not infrequently causing death, but save a fortune. This is the reason Kaiser, a non-profit company, makes billions in profits each year. Kaiser then channels these untaxed profits into its for-profit Permanente companies.

Transgender teen settles landmark health case
Posted on 17 July 2013
By Katie Kerwin McCrimmon
Healthypolicysolutions.org

FORT COLLINS — An 18-year-old college student who grew up as a girl and now identifies as a young man has settled a landmark civil rights case against Kaiser Permanente of Colorado.

In the rare case, the Colorado Civil Rights Commission found in March that there was probable cause that Miki Alexander Manigault suffered discrimination and unequal access to health care specifically because he is transgender. (Click here to read the determination of probable cause.)

On the same day, after pressure from advocates at One Colorado, Colorado’s Division of Insurance issued a bulletin and became the third state in the country to specifically bar health insurance companies from discriminating against people who are gay, lesbian, bisexual or transgender. (California and Oregon preceded Colorado. The District of Columbia also bans discrimination against LGBT patients and Vermont has since followed suit.)

Faced with charges of unequal treatment, Kaiser Permanente quietly settled Manigault’s case before it was slated to go to a hearing in June. Amy Whited, a spokeswoman for Kaiser Permanente, declined to discuss Manigault’s case. As a result of a settlement with the Civil Rights Commission, however, Kaiser, one of Colorado’s largest health insurance companies, has agreed to work with the commission to convene discussions among insurers regarding health care for transgender people.

Manigault’s case has already prompted at least one other complaint to the Civil Rights Commission and may open the doors for equal health care for LGBT patients in Colorado and elsewhere in the U.S. (Coming next week: read about Kelly Costello, another transgender person who has also filed a civil rights complaint.)

Manigault grew up as Michaela, a girl with irresistible Shirley Temple dimples who nonetheless loathed girly dresses. She has now evolved into Alex, a young man embracing the gender that he believes he was born with. It just never matched his body. Until now.

Alex finally had the chest reconstruction surgery that doctors deemed medically necessary but Kaiser previously failed to cover, according to the determination and complaint.

Alex and his family cannot discuss any details of his settlement with Kaiser. But the Colorado State University art major agreed to share his story of struggle and transformation.

Alex recently traveled to San Francisco to have an experienced surgeon remove his female breast tissue and sculpt a male chest.

They felt like tumors on my chest or phantom limbs,” Alex said of the female breasts, which he used to bind to try to flatten them.

He and his mom decided to bring the civil rights complaint and filed it in January of 2012, when Alex was just 17, because insurance companies provide all sorts of breast surgeries for other patients, including reconstruction for psychological well-being for cancer patients. It seemed fair to them that health insurance should also provide coverage that makes transgender people healthier.v “A lot of transgender people go through so much drama and so much heartache and waiting for years and sometimes decades to even talk about what it is they want and need,” said Alex. “When you can finally admit what you want and feel safe, then the insurance company tells you ‘No,’ and puts another obstacle in front of you, that’s wrong.

“I’m just as surprised as you that I’m transgender,” Alex says.

Alex credits his mom for being in his corner and pressing the case. Deborah Manigault is a civil rights law enforcement officer for the U.S. Department of Housing and Urban Development. So she knew how to file a civil rights complaint and felt it was clear that Alex deserved to win.

“These are not elective surgeries. They are medically necessary for their health, for their mental health and their medical well-being,” she said. “There are many insurance companies who are claiming to be LGBT-friendly, but they are denying coverage based on transgender status.” Alex has not decided how to proceed with what transgender people call bottom surgery. Many transgender people evolving from female to male don’t bother seeking a surgically created penis since the options are poor. Results are much better for males becoming female because an experienced surgeon can essentially tuck the penis into the body and retain sensation. Alex has been taking testosterone injections since his junior year of high school, so his voice is now deep and body hair has sprouted on his stomach and will fill his chest once it fully heals. Now a sophomore in college, he still thinks he looks somewhat feminine because of a long, graceful neck and fine cheekbones that any model would envy. But the testosterone he must inject every two weeks literally empowers him as it bulks up his muscles. In contrast to the famous “It Gets Better” campaign, http://www.itgetsbetter.org/ Alex says it doesn’t get better overnight. Still, he is no longer hiding from friends and the world, afraid to hear his own voice. At last, he is embracing his manhood. He is becoming Alex. ‘I didn’t want to be transgender’ Alex doesn’t remember a light bulb moment when he suddenly knew that he should have been a boy. Instead, growing up in Maryland and the conservative South, he remembers being a weird kid who could beat all the boys in running races, but never fit in. “I went through a long process of feeling I was different in some way and not knowing what that difference was,” Alex says. Way back, at age 2, Michaela was a flower girl in a relative’s wedding. An outgoing toddler, Michaela pitched a fit over wearing the poufy floral dress for the ceremony. At the time, Deborah Manigault attributed the tantrum to a 2-year-old’s fickle independence. Now Deborah wonders if it was an early sign that Michaela didn’t feel right in her body. As a fifth-grader, Michaela remembers once being teased by a group of classmates for not fitting in. She sought solace in a large cubby where she curled up and hid.

State fines Kaiser $4 million for mental health violations

The California Department of Managed Health Care ignores almost all complaints from Kaiser patients, but this complaint came from Kaiser providers, so the DOMHC couldn't look the other way.California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services.

State fines Kaiser $4 million for mental health violations
The California Department of Managed Health Care fined Kaiser Permanente $4 million Tuesday related to problems it found with patient access to mental health care.
Los Angeles Times
By Chad Terhune
June 25, 2013

California officials have fined healthcare giant Kaiser Permanente $4 million for problems related to patient access to mental health services.

The fine announced Tuesday stems from deficiencies the California Department of Managed Health Care identified in March that were found during a routine medical survey. This marks the agency's second-largest enforcement action after a $10 million fine against Anthem Blue Cross in 2008 related to improper policyholder cancellations.

"The Department's actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them," said Brent Barnhart, director of the Department of Managed Health Care.

"The Department is taking this action to ensure that Kaiser promptly corrects these deficiencies and provides its patients with the mental healthcare promised to them by their health plan," Barnhart added.

State officials said Kaiser's problems covered a variety of issues affecting patients. It found that Kaiser needed to better track and monitor the availability of providers.

The health plan needs to ensure that appointments are offered in a timely manner and improvements to care are made when deficiencies are identified, according to the state investigation.

Regulators also said that Kaiser's educational materials and its "frequently asked questions" included inaccurate information that could dissuade a patient from seeking care.

John Nelson, a spokesman for Kaiser, said each of the state's findings "has already been corrected or is very far along toward resolution."

In light of that, the company said the "amount of the proposed penalty is unwarranted and excessive."

Agency officials said they would conduct a follow-up survey in October to ensure Kaiser has corrected the deficiencies and is complying with the law.

"Horrific" consequences of Kaiser Permanente's failure to properly monitor bladder patient during and after surgery

See comparison of Kaiser urology department with other medical centers.

Patient Blames Kaiser for 'Horrific Events'
By BARBARA WALLACE
Courthouse News Service
May 08, 2013

DENVER (CN) - Two Kaiser doctors and a nurse practitioner overlooked an important lab test for a patient about to undergo bladder surgery, and both doctors made mistakes during the surgery, resulting in a "cascade of horrifying complications," the patient says in a complaint filed in Denver District Court.

Urologist Mina Shabnam Lee diagnosed 71-year-old Josephine Jansen with a mass in her bladder in April of 2011 and recommended a surgical procedure called a "bladder transurethral resection neoplasm," according to Jansen's complaint.

A nurse practitioner, Andrea Anderson, performed a pre-operative examination and Dr. Lee ordered lab work, the complaint states. Nonetheless, neither they nor the anesthesiologist, Thomas Arthur Gettelman, ordered a test of Jansen's sodium level, according to the complaint. "Either defendant Anderson or defendant Lee or defendant Gettelman could have easily ordered a simple blood test which would have included a panel of electrolytes such as sodium. The ordering of a sodium lab value is extremely easy, and non harmful to the patient, and would only take a matter of minutes to obtain. However, the priorities of each defendant were such as not to obtain this test. Moreover at least one of the drugs that the plaintiff was taking, Hydrochlorothiazide, (HCTZ) is a diuretic and has the effect of lowering some electrolyte lab values," Jansen says in her complaint.

"During the surgical procedure performed by defendant Lee, various and serious complications occurred," the complaint continues, including a ruptured bladder, and aspiration of stomach contents into Jansen's airway because Dr. Gettelman was "negligent in the performance of his duties as an anesthesiologist during the operative period," according to the complaint.

The complaint states that Dr. Lee, failed "to adequately consider the effects of fluid absorption as a result of the surgical misadventure."

"Defendant's superficial approach to this patient - particularly in having no understanding of her sodium prior to surgery - set into motion the cascade of horrifying complications which followed the surgery. And her operative and post operative mismanagement (especially in not ordering serum sodium immediately post surgery) caused further and increased harm to plaintiff," the complaint states.

"Following the surgery the plaintiff sustained severe and irreparable injury. She went into shock caused by abnormal and an almost deadly level of sodium, plaintiff's bladder was ruptured during the surgery and shortly following the surgery it was determined that plaintiff had developed severe hyponatremia which was complicated by acute cardiac decompression due to the stress induced cardiomyopathy, respiratory failure, renal failure requiring dialysis, prolonged ventilation, and significant neurological injuries. This cascade of horrific events including multi organ failure, were caused by the negligence of the defendants," Jansen's complaint says.

"Much of her damages are permanent in nature and her life has been forever changed," the complaint states. "The plaintiff has incurred substantial economic losses including the loss of her career."

Plaintiff is represented by John Astuno, Jr. of Denver.

Has Kaiser achieved its position through illegal tactics such as mislabeling employees to cut costs?

Kaiser avoided paying overtime wages and giving breaks by falsely labeling employees as managers, violating the California Labor Code.

Kaiser Uses Title Alone for Tax Status, Class Says
By PHILIP A. JANQUART
Courthouse News Service
May 07, 2013

SAN DIEGO, Calif. (CN) - Certain Kaiser Foundation Hospital Inc. employees were paid an exempt-status salary, but performed non-exempt tasks, according to a San Diego Superior Court class action lawsuit.

Lead plaintiff Adam Hardesty was employed at a San Diego County Kaiser hospital as a "project manager" from August 2012 to February 2013.

Hardesty states in his complaint that despite the title, employees had little to no authority, never served in a supervisory role and were otherwise "engaged in a type of work that required no exercise of independent judgment or discretion as to any matter of significance."

Instead, Kaiser project managers performed a "finite" set of non-exempt tasks that included transcribing written and electronic prescriptions, completing patient profile entries and notes, sending requests to doctors for medication refills and were even expected to troubleshoot the pharmacy computer system, all on top of "daily debriefing" conference calls.

"As a matter of company policy, practice and procedure, Kaiser unlawfully, unfairly and/or deceptively classified every project manager as exempt based on job title alone, failed to pay the required overtime compensation and otherwise failed to comply with all labor laws with respect to these project managers," the complaint states.

Hardesty alleges Kaiser operates the scheme to save money and be more competitive in the health care industry. "To successfully compete against the other health care service providers, Kaiser substantially reduced its labor costs by placing the burden of overtime work on a smaller number of salaried employees that Kaiser classified as exempt from overtime wages and other related benefits . . . the requirement to pay overtime wages extends beyond the benefits individual workers receive because overtime wages discourage employers from concentrating work in a few overburdened hands and encourages employers to instead hire additional employees," the complaint states.

In addition, the complaint alleges Kaiser did not provide the class compensation for missed meal and rest breaks, and did not provide accurate and itemized wage statements showing gross and net wages, hourly rates for regular and overtime hours or the corresponding hours worked at each hourly rate.

Hardesty is suing for violations of California's Unfair Competition Laws under California's Business and Professions code. He wants the court to enjoin Kaiser from continuing its practice of labeling employees as exempt by title only, to order Kaiser to correctly calculate and pay all wages due, and to disgorge "ill-gotten gains into a fluid fund for restitution" according to proof.

Norman B. Blumenthal, Kyle R. Nordrehaug and Aparajit Bhowmik, of La Jolla, Calif., represent the plaintiff.

Kaiser: Guts Pulled Out through Cervix, Woman Claims

Kaiser: Guts Pulled Out Cervix, Woman Claims
By BARBARA WALLACE
Courthouse News
April 04, 2013

LOS ANGELES (CN) - During uterine surgery, a Kaiser surgeon perforated a woman's uterus and pulled part of her small intestine out through her cervix before realizing what it was, the woman claims in court.

According to the complaint, Dorothy Ho had uterine surgery performed by a Dr. Murray because of postmenopausal bleeding. "During the operation, as was later discovered, defendant Murray apparently, in attempts to remove a polyp during the course of the medical surgery, noted a protrusion of tan colored tissue, which defendant Murray then attempted to remove from plaintiff's cervix. As defendant Murray continued to pull on the tissue, it continued to elongate and when the tissue was sufficiently removed from the vaginal area, it was discovered that the tissue was not of gynecologic origin. Upon further consultation and confirmation with other medical staff, it was determined that defendant had perforated plaintiff's uterus and instead caused a small bowel injury to plaintiff's bowel due to a tear in her bowels caused by said surgery," according to the complaint.

"In this, defendant Murray failed in defendant's position as a trusted surgeon to perform the surgery with the level of skill, knowledge, and care that other reasonably careful surgeons would use in similar circumstances when confronted with a tissue of unknown origin attached to and protruding from an abnormal growth," the complaint states.

Next, defendant Murray, "immediately performed" a procedure, "during which a large portion, i.e. approximately 40 cm, of plaintiff's small bowel had to be removed," according to the complaint.

"After the operation, defendant Murray informed plaintiff Ho that despite the complication during the procedure, i.e. perforation and small bowel tear, that plaintiff would make a full recovery and would suffer no further, significant effects from the medical complications from the procedure," the complaint says. However, Dorothy Ho remained hospitalized for nine days, during which she "suffered from vomiting, abdominal cramping, bloating, and pain, which she was advised were normal complaints arising from such surgery," according to the complaint.

Dorothy Ho did not learn the full extent of her injuries for four months, during which time she continued to have abdominal pain and needed to take a leave of absence from her job as a Kaiser pharmacist, the complaint says.

Having lost 40 centimeters (about 15.6 inches) of her small bowel, Dorothy Ho's medical problems continue, including "inability to eat much, inability to eat greasy foods, inability to undertake hikes, [and] travel abroad," and "major depressive and anxiety disorders," requiring prescriptions for Xanax, Cymbalta and Ativan, according to the complaint.

Plaintiff is represented by David Lin of Pasadena.

Was Kaiser Permanente correct, or simply trying to save money, when it said Castleman's patient was "hopeless"?

One of Kaiser Permanente's tricks is to avoid testing patients, or to avoid releasing test results, so Kaiser won't have to pay for treatment.

I agree with Plaintiff's claim in the story below that "...a deliberate strategy and business practice on the part of defendants to systematically deny medically necessary care that Kaiser is unable to provide itself...Based on a consistent pattern and practice, defendants routinely deny medically necessary treatment requested by members' medical professionals on invalid and unjustified and unjustifiable grounds for the sole purpose of saving money and, ultimately, cause the premature death of members, thus relieving defendants of the continuing financial obligation to provide care and treatment to desperately ill people."

It will be interesting to find out exactly how Kaiser handled the following case. It is true that some cases are hopeless. But Kaiser's strategies intentionally make it difficult, if not impossible, to know the truth about a patient's condition.

Here's an update on this case.

Man Says Kaiser Business Model Includes Death
By PHILIP A. JANQUART
Courthouse News Service
March 14, 2013

LOS ANGELES (CN) - Kaiser Foundation Health Plan refuses to pay for care necessary to save a man's life, he claims in court.

Jalal Afshar, 58, suffers from Castleman's disease, a rare condition known as lymphoproliferative disorder. The disease is not cancer, according to the American Cancer Society, but often leads to lymphoma and is treated with chemotherapy or radiation. He also suffers from a rare blood disorder that appears along with Castleman's disease, called POEMS syndrome.

Diagnosed in 2005, Afshar says he developed a growth in his abdomen in January 2012 and sought advice from his Kaiser oncologist, Dr. Iman Abdalla, who told him, "I don't know what to do with you," and that she had "run out of ideas and options" for his treatment, the complaint says.

She attributed his difficulty in breathing, edema in his limbs and stomach, and the growth in his abdomen to "middle-age fat" and a "sedentary lifestyle."

He then sought out a second opinion, ultimately traveling to Arkansas where he was seen by Dr. Frits van Rhee at the University of Arkansas in Little Rock. Afshar began receiving chemotherapy on the advice of Dr. van Rhee who also planned to have stem cells collected for a future stem cell transplant. Kaiser, however, denied any coverage of the treatments, claiming Afshar could get the same treatments under the Kaiser plan.

Afshar twice appealed the decision over the phone because Dr. Abdalla had "already admitted that she did not know how to treat him, and given that all of the past treatment Kaiser had offered had been ineffective." Kaiser refused, causing Afshar to return to Los Angeles where doctors administered a 12-hour course of chemotherapy using a combination of drugs that were not the same as the ones used by Dr. van Rhee, according to the complaint.

By June 8, 2012 Afshar's legs were significantly swollen and his breathing had become more labored and difficult, according to the complaint. He developed a fever and his blood pressure dropped, leading to his admittance to the intensive care unit.

On June 13, Afshar's wife Maryam was told by doctors that his condition was "without hope" and that "there was nothing else they could do," according to the complaint.

A chaplain and a palliative care representative then visited Afshar in his room and told him they believed his case was hopeless, according to the complaint.

Afshar, however, refused to accept defeat, returning to Arkansas where he once again began receiving care from Dr. van Rhee. He has since amassed over $1.8 million in medical bills, which Kaiser refuses to pay.

Afshar has been under Dr. van Rhee's care since June 17, 2012.

"This action arises out of a deliberate strategy and business practice on the part of defendants to systematically deny medically necessary care that Kaiser is unable to provide itself," the complaint states. "Based on a consistent pattern and practice, defendants routinely deny medically necessary treatment requested by members' medical professionals on invalid and unjustified and unjustifiable grounds for the sole purpose of saving money and, ultimately, cause the premature death of members, thus relieving defendants of the continuing financial obligation to provide care and treatment to desperately ill people."

Afshar is suing for breach of contract, violations of California's Business and Professions Code and intentional and negligent infliction of emotional distress.

Scott C. Glovsky and Danae A. McElroy, of Pasadena, represent the plaintiff.

Kaiser Foundation Health Plan fails to pay medical bills, yet Kaiser's Rawlings Group goes after patient's settlement with restaurant where he was shot

The Rawlings Group corporate headquarters. The Rawlings Group does collections for Kaiser Foundation Health Plan.

"Defendants' conduct is particularly reprehensible because it was part of a repeated corporate practice and not an isolated occurrence."

See also, "The Rawlings Group plunders its own employees as it plunders Kaiser Permanente Patients"

Click on title of article to see Courthouse News story with link to case documents.

Kaiser Stiffs Hospital, Milks Man for $, He Says
By PHILIP A. JANQUART
Courthouse News
March 5, 2013

LOS ANGELES (CN) - Kaiser Permanente Health Plan failed to pay a man's medical expenses, and then attempted to get its hands on his settlement money, he claims in California Superior Court.

Jesse Cox was shot by a stray bullet while waiting in line at a restaurant drive-thru, leading to a five-day stay at Providence Holy Cross Medical Center in Mission Hills and a $300,000 medical bill that should have been paid by Kaiser, Cox says in his complaint.

Cox subsequently won a $300,000 settlement with the restaurant for failure to provide adequate safety measures for patrons, but alleges that Kaiser is illegally trying to get a big chunk of the dough.

"Not until the end of underlying litigation did defendant Kaiser, by and through its agent and joint venturer, defendant Rawlings, deceptively and unfairly claim a lien and subrogation rights to the proceeds of any settlement in the underlying personal injury action," the complaint states.

The Rawlings Group specializes in healthcare subrogation, or "recovery," services. Cox says Kaiser is using the company to obtain a portion of his settlement.

"Defendant Kaiser, by and through defendant Rawlings, has repeatedly asserted that they are entitled to $100,000 from the settlement proceeds, wholly ignoring the required reduction for costs and attorney fees, despite this being brought to their attention on multiple occasions," the complaint states.

Cox adds that Rawlings "has several times intentionally misled plaintiff's counsel into believing that they were in contact with defendant Kaiser on a regular basis and that their counsel was licensed in California," and that both Kaiser and Rawlings "knew that there was no basis for the claims they were asserting and have utterly failed to provide evidence pursuant to California Civil Code, that defendant Kaiser's lien claim is based upon the reasonable costs of medical services which were [not?] actually paid by any of the defendants herein."

Cox says he has received no proof that Kaiser has paid any of the bill. Under California law, "no lien asserted by a medical group, such as defendant Kaiser, may exceed the sum of the reasonable costs actually paid by the medical group," the complaint says.

Cox says "defendants refused to provide proof of payment actually made because in fact no payment for services was made by any of the defendants herein to any of plaintiff's underlying healthcare providers."

Cox is suing for breach of contract, breach of duty of good faith and fair dealings, fraud and for violation of California's Business & Professions Code. He seeks consequential, general, special, punitive and exemplary damages.

Philip J. Layfield and Jamie L. Keeton of El Segundo represent the plaintiff.

Kaiser Permanente Senior Advantage forcibly enrolled retired federal employee who had enrolled in Nationwide

Yikes! I guess I should count my blessings that I was able to escape from Kaiser.

Kaiser Permanente Senior Advantage Ripoff Report
Reported By: Barbara
Monrovia, California
February 24, 2013

Kaiser Permanente
PO Box 232400 San Diego, California 92193
Phone: 1-800-443-0815

After canceling service 12/31/2012 and arranging replacement coverage through the Office of Personnel Management as a Retired Federal Employee, Kaiser without my knowledge, request or consent enrolled me in San Diego, California.

Due to change in living situations, I was forced to cancel my Kaiser Permanente coverage aften 46+ years. I am a Federal Retiree and during the Open Season with the help of my Congresswoman's office I chose a Nationwide company and did everything necessary including closing visits with my doctors. I used the new coverage in January while I was in New York without a problem. When I came home to Southern CA late in January I found mail from Kaiser telling me that I had been approved by Medicare to have their coverage as of 2/1/2013. I checked with OPM in DC and they said to ignore it that my proper coverage was in place. I destroyed the new Kaiser Cards (3 in separate mailings) and went on with my plans to establish myself with the Doctor of my choice.

Now, I have seen the new doctor and she prepared new prescriptions (as mine were running out) and ordered lab work. I am almost 70 years old and have several serious chronic conditions which require ongoing consistent medications.

When I heard from a provider that I could not get services because Medicare is not my primary coverage I inquired further and found that Kaiser had enrolled me without any request or permission and that I could not get anything without going through them.

Here's the catch, when I had called Kaiser to have them remove their name from my record I was told that I had to request it in writing with a signature and that since it is not open season they might not recognize or honor my cancellation. I told them that I had not authorized the coverage and I was not going to sign anything that could imply that I had.

After several long calls to Medicare and Kaiser (threatening them with an official Complaint) they acknowledged that they had enrolled me in their Individual Senior Advantage Program as of 1/18/2013 because they had checked and saw that I was eligible for Medicare (so what!). After putting me on hold for a long time for them to speak to a supervisor the lady came back and told me that they were attempting to assure that I would not have a break in coverage (bull ...).

I did as Medicare Operator instructor and called them back with the information and an Escallated Complaint has been sent "up the chain". Problem is that I am getting more ill and cannot get assistance unless I go to Kaiser and if I do, that will acknowledge that I accept what they have done and I will legally becomme financially obligated to them for the rest of the year. I live on two coasts and they are not available in NY and have limited Out of Area allowances.

So, here I sit having my drug coverage (for which I have paid) not being honored and scared to death that I cannot get this straightened out before I become critically ill. Do they think because I am old, I am stupid? God only knows how many retired federal (and others) employees find themselves in this same mess. After supposedly taking care of me for over 46 years they are ready to cause me illness and possible death if I do not come back to them...

Kaiser Bungles X-Ray, Girl Suffers, Dad Says

The handling of this X-ray was accidentally bungled; Kaiser also intentionally mishandles X-rays to save money.

January 22, 2013
Kaiser Bungles X-Ray, Girl Suffers, Dad Says
By PHILIP A. JANQUART
Courthouse News

IRVINE, Calif. (CN) - Kaiser's delivery of an X-ray to the wrong doctor resulted in major surgery and a permanent scar for a 14-year-old girl, her father claims in Orange County Court.

Nicole Ley, now 16, had taken two bites of a barbecued hamburger during a family dinner on Jan. 10, 2010, when she felt something lodge in her throat. Attempts were made to clear the unknown object out, but parents Marc and Tina could not see anything. Nicole then began having a hard time breathing and complained of persistent pain. Marc and Tina are insured by Anthem Blue Cross, but rushed their daughter to a Kaiser Permanente hospital because it was the closest to their home.

An x-ray was taken of her throat, but Dr. Nak B. Chhiv said he did not see any foreign objects and that Nicole probably scratched her esophagus while eating the hamburger. He added she would need to "tough it out."

Nicole was cleared to go home and Chhiv told the family the radiologist would look at the x-ray to confirm his findings. They were told the radiologist would call the next day if there were any unforeseen problems.

Four days later, Nicole was still experiencing significant pain. On Jan. 15, 2010, she woke up with a 101.6 degree fever, prompting her mother to take her to the pediatrician. Dr. Michael B. Nestor, a Kaiser emergency room doctor on duty the night Nicole showed up, called while they were en route, explaining that the x-ray was mistakenly put in his in-box. He said he had passed Nicole off to Dr. Chhiv during a shift change and that the x-ray should not have been put in his in-box since he was leaving for vacation. He did not see it until four days later, when he returned.

He then informed Tina he had discovered a foreign object in her daughter's throat and she needed to get her to a hospital. Tina and Nicole raced to Hoag Hospital in Newport Beach, where a CT scan revealed the foreign body was lodged dangerously close to her carotid artery. Nicole was transported to Childrens Hospital of Orange County where she stayed for seven days. On Jan. 19, 2010, cardiothoracic surgeon, Dr. Brian Palafox, performed surgery to remove a metallic bristle that had migrated, penetrated through the esophagus and abutted against the carotid artery.

"If proper interpretation of abnormal x-ray findings had been communicated at an earlier date, the metallic foreign body would not have moved/migrated approximately 1 cm abutting carotid artery," the complaint states. "Nicole Ley has suffered very significant physical and emotional injuries. She has suffered with significant depression, nightmares, difficulty concentrating and became withdrawn and introverted."

She was consequently diagnosed with Post Traumatic Stress Disorder and has been receiving treatment from a psychotherapist, according to the complaint.

"Her school work suffered and she later switched schools," the complaint states. "She has felt very self-conscious about the scar on her neck and consulted with a plastic surgeon about scar revision."

Plaintiff is suing for negligence and is seeking general, incidental and consequential damages, in addition to medical and related expenses, and loss of earnings and earning capacity.

Ronald E. Harrington of Irvine represents Ley.

Kaiser Mistakes Blamed for Woman's Death from Cancer

Most Kaiser doctors are very careful not to spend too much money on finding and treating cancer patients. They are rewarded financially for keeping costs down. My childhood friend had bleeding for a year-and-a-half before Kaiser did a biopsy, then got very poor care after her cancer was diagnosed. Her first appointment with an oncologist was scheduled two weeks later than her death.



Kaiser Mistakes Blamed for Woman's Death
By PHILIP A. JANQUART
Courthouse News
January 24, 2013

CLEVELAND, Ohio (CN) - A woman who died of lung cancer may have had a shot at life had Kaiser Permanente radiologists not misinterpreted her CT scans, the woman's husband claims in Cuyahoga County Court.

In 2006, Deborah Lee Jones was under "radiological surveillance" for development of tumors in her lungs, according to the complaint. A chest X-ray taken Nov. 23, 2009 at Cleveland Heights Medical Center revealed a "questionable" new nodule in her left lung, the complaint said. A CT scan was consequently performed, revealing the new mass, which went unnoticed by Kaiser Permanente Radiologist and co-defendant David Acquah, the complaint said.

Another CT scan was performed March 9, 2010, but Kaiser radiologist David Radebaugh interpreted it as showing no change from the Nov. 23, 2009 scan, the complaint said.

Jones underwent yet another CT scan Oct. 25, 2010, which revealed a 3.3 x 2.1cm mass, and was diagnosed Nov. 11, 2010 with non-small cell lung adenocarcinoma, or lung cancer. Jones passed away Jan. 22, 2011 from bacterial sepsis due to metastatic lung cancer, according to the complaint.

Jones had been a Kaiser Permanente member since 1987.

Husband Gerald filed a wrongful death complaint in the Cuyahoga County Court of Common Pleas, naming Acquah, Radebaugh, Kaiser Foundation Health Plan of Ohio and Ohio Permanente Medical Group as defendants.v The defendants, he said, "rendered substandard care and were otherwise negligent and departed from the applicable standard of care by failing to properly interpret radiographic studies and treat Deborah Lee Jones for signs and symptoms of lung cancer."

Jones said his wife could have been saved if the tumor had been properly detected early on in its development.

"As a direct and proximate result of the aforementioned negligence, plaintiff's decedent condition was allowed to change from being curative to non-curative and untreatable," the complaint states.

Jones is seeking in excess of $25,000 including funeral costs.

Thomas H. Terry of Madison, Ohio represents the plaintiff.