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.

Finally, a Kaiser doctor, oncologist Jennifer Lycette, speaks out about doctors forced to allow harm to patients to increase profits

"...Lycette’s suit states, however, that she became troubled by new Kaiser policies after [executive Jeffrey] Weisz was brought in.

"Among her other complaints, her suit alleges she expressed concerns about a ban on referring patients to non-Kaiser specialists or clinical trials outside of Kaiser -- even though doing so would be in the best interests of patients.

"She resigned in April 2013, because of her oath to do no harm and her belief that Kaiser policies were "making patients suffer," her suit states.

"According to the website for Oregon Health & Science University, Lycette relocated to Astoria and is now working at OHSU's Cancer Care Center at Columbia Memorial Hospital..."

Former oncologist claims Kaiser Permanente pushed profits over patient care, files $7 million lawsuit
Aimee Green
Oregon Live
April 23, 2014

A former oncologist at Kaiser Permanente is suing the health care company for $7 million, claiming she had no choice but to quit her job after complaining the organization was maximizing profits to the detriment of cancer patients.

Dr. Jennifer Lycette claims quality of care took a nosedive when Northwest Permanente Medical Group hired Jeffrey Weisz as its president and executive medical director in 2011. Weisz had previously worked for Kaiser in Southern California.

"During Dr. Weisz's tenure (in California), he established a reputation as a ruthless administrator who found ways to minimize payrolls by shrinking staff while patient loads skyrocketed, often leaving the remaining staff members trying to cope with impossible patient demands which ultimately harmed Kaiser's patients," reads Lycette's lawsuit, filed Tuesday in Multnomah County Circuit Court.

In an email statement, Kaiser spokesman Michael Foley said, "The care needs of our members, patients, and customers come first. Allegations that claim otherwise are not supported by fact.

"We're reviewing the lawsuit that was filed," he addied, "and will address its inaccurate allegations through the judicial process."

The suit was filed by Lake Oswego attorney Roderick Boutin.

Lycette's suits claims that during a November 2012 meeting, Weisz ordered Kaiser's Portland oncologists to cram an initial consultation and bone-marrow biopsy of patients -- something that should take two to 2.5 hours and be done over two visits -- into one, 60-minute visit. Lycette’s suit states pain medication that must be taken orally takes 30 to 60 minutes to kick in, so a 60-minute visit would leave patients rushed and in pain.

Lycette "openly and respectfully voiced her concerns," and Weisz responded by shouting at Lycette in "a very angry and threatening manner," her suit states.

Lycette's suit also claims she complained in April 2012 to the then-chief of medical oncology, Nagendra Tirumali, about understaffing. She says patients were struggling to schedule appointments and some chemotherapy patients were only seeing their regular oncologist every two or three months.

Tirumali responded that Lycette was being “emotional,” according to a copy of an email attached to the suit. Lycette’s suit characterizes Tirumali's response as a "veiled attack" on her gender. Her suit states she later asked Tirumali whether he would have accused a man of being "emotional" over the issue of understaffing.

Lycette, 40, worked for Kaiser for about seven years -- from 2006 until she resigned in spring 2013 -- at its Interstate medical offices in North Portland and Sunnyside Medical Center in Clackamas, according to her suit. Her suit states she had the highest patient satisfaction rating, 89 percent, in her department.

Lycette’s suit alleges that before taking the job in 2006, she asked several Kaiser doctors if they thought they could care for patients without feeling that financial overhead compromised care. They assured her they could, the suit states.

Lycette’s suit states, however, that she became troubled by new Kaiser policies after Weisz was brought in.

Among her other complaints, her suit alleges she expressed concerns about a ban on referring patients to non-Kaiser specialists or clinical trials outside of Kaiser -- even though doing so would be in the best interests of patients.

She resigned in April 2013, because of her oath to do no harm and her belief that Kaiser policies were "making patients suffer," her suit states.

According to the website for Oregon Health & Science University, Lycette relocated to Astoria and is now working at OHSU's Cancer Care Center at Columbia Memorial Hospital.

Lycette is seeking $2 million in economic damages and $5 million in non-economic damages.

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.

[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.

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

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.

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.

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...

What does non-profit Kaiser do with its billions of dollars of profit each year?

Kaiser is a non-profit with billions of dollars of profits every year(!?) Much of that money is used to buy political clout--and it is very effective. Kaiser seems to control the Department of Managed Care in California.

Also, a lot of the money is funneled into Permanente Medical Group, which aggressively strives for big profits. Permanente uses it to pay generous pensions for doctors and administrators.

Patients are not Kaiser Permanente's shareholders, the doctors are. Perhaps consumers need a health care organization with the public as the owner.

Kaiser Permanente HOSPITAL GIVE $5 million to another hospital when customers continue to pay 10% average increases every year Oakland, California
Ripoff Report
Reported By: SteveW
Livermore California USA
January 05, 2013

Kaiser Permanente has donated/given away $5 MILLION DOLLARS to another hospital, how can this medical company give away $5 million when each and every year they increase customer cost by approximately 10%. 10% increase includes co-pays for doctor visist, monthly premiums and medicine co-pays as well as hospital stays. When customer cost continue to rise and I am now paying $1,237.00 per month plus co-pays on doctors, medicine and related cost. Something is wrong when my cost go up every year and this KAISER CAN donate money to some other hospital. Customer service and call backs are also problem and when you complain nobody ever calls you to explain why things are happening.

Lawsuit against Kaiser Permanente: doctors did not do pathology testing on growth

Lawsuit against Kaiser Permanente: doctors did not do pathology testing on growth
Courthouse News Service
October 17, 2012

SANTA ANA, Calif. (CN) - With classic signs of basal cell carcinoma, a woman was left with a growth on her eyelid for 2.5 years, her court complaint alleges, in Orange County Superior Court.

Kaiser has "policies and procedures that instructed and ordered defendant Wong and other physicians within defendant Kaiser's physician groups to refrain, for financial and/or cost cutting reasons, from sending the material removed from plaintiff's eye-lid for pathology or biopsy testing," until the third time the growth was excised, the patient alleges in her court complaint.

Five months before a correct diagnosis, along with growth removal and reconstructive surgery of the patient's eyelid, leaving her with a deformity, Kaiser's "specialist" (italics in complaint) noted that the growth showed "characteristics of being 'thick walled,' " but still did not send the matter removed from the site to a lab for testing, the woman says in her court complaint.

As Kaiser Workers Face Cuts, Execs Have Enjoyed Lavish Benefits

See Kaiser executives.

As Kaiser Workers Face Cuts, Execs Have Enjoyed Lavish Benefits
Dave Jamieson
Huffington Post
7/12/11

Despite strong profits and robust executive compensation at Kaiser Permanente, workers for the Calfornia-based health care giant say they're facing down cuts to their health and retirement benefits in pending contract negotiations.

Proposed cuts include freezing employees' defined-benefit pension plan and switching to a less desirable defined-contribution plan, according to a flier circulated by the National Union of Healthcare Workers. Workers are being asked to accept a more costly employee health insurance plan and cuts to their retirement health benefits, the union says.

While those cuts get debated, Kaiser executives have been living well. Pay and perks for high-ranking officials at the nonprofit have been generous in recent years, according to disclosure forms.

In 2009, the most recent year for which figures were available, George Halvorson, the CEO for Kaiser Foundation Health Plan & Kaiser Foundation Hospitals, received compensation of $6.7 million. Halvorson's package included a $1.2 million payment to his "supplemental non-qualified retirement plan." More than 40 other officers and employees received payments to such retirement stashes -- several of them in the hundreds of thousands of dollars.

Members of management have also received large "relocation" loans from the nonprofit. Philip Fasano, the chief information officer and vice president, was given such a loan for half a million dollars, according to Kaiser's IRS filings. Disclosure forms with the State of California indicate that two of those relocation loans -- including one for $500,000 -- are forgivable, meaning that the principal of the loan can eventually be forgiven, so long as conditions are met in the short-term. (The state filings do not name the officers who received the forgivable loans.)

John E. Nelson, a Kaiser spokesperson, told HuffPost that the nonprofit's executive compensation is fair and reasonable, given that between its hospital network and health plans Kaiser is "by far the largest and most complex health care organization in the nation."

"Compensation paid to senior management is substantially less than that of many for-profit health plans, and less than would be expected when compared to nonprofit health care companies, once the size and complexity of Kaiser Permanente is taken into account," Nelson wrote in an email. "Kaiser Permanente's senior management have unique leadership positions, in that they have the equivalent of two roles: overseeing a major health plan with 8.8 million members, as well as a total care delivery system in multiple states with 36 hospitals, 450 medical office buildings, and 500 pharmacies."

Kaiser reported a net income of $921 million for the first quarter of 2011. Last month the non-profit announced it would be raising premium rates by about 11 percent on 300,000 Californians enrolled in plans through small businesses -- a hike much smaller than some other insurers have recently implemented, but a hike nonetheless.

Turusew Gedebu-Wilson, a Kaiser dietician who's been involved in the bargaining talks between workers and management, says she finds the prospect of cuts to employee retirement and health benefits "shocking."

"If the organization is making a lot of money, if the executives are making a lot of money, then why do they want to take away so much?" Gedebu-Wilson said. "To tell us that we have to be paying more is really mind-boggling to me."

Nelson would not say whether Kaiser management indeed seeks concessions from workers, noting that the negotiation process is not complete. The nonprofit intends to bargain with workers "in good faith," Nelson said, and it plans on providing "market-competitive" employee benefits to attract the best talent possible. Nelson declined to say whether executives would take cuts to their benefits if employees were asked to do so.

"Kaiser Permanente sets senior management compensation levels so that the organization can successfully attract and retain the leadership it needs to deliver affordable, high quality health care," Nelson said.

Absolute greed: Michael Moore supports Kaiser workers in Los Angeles

Kaiser Permanente: Absolute Greed
By Patricia Tamayo
Michael Moore.com
October 4th, 2011
(included video)

If I told you that thousands of healthcare workers who provide care to patients at Kaiser Permanente hospitals and clinics every day are routinely forced to work short staffed, to defer patient appointments, to float to unfamiliar departments we're not adequately trained for and to work long hours of overtime while fatigued, you might say, “Well, that’s not Kaiser’s public image.”

Those of us who have seen Michael Moore’s outstanding film ‘Sicko’ know the real Kaiser that hides behind its feel-good ad campaign. While the work conditions above may not fit Kaiser’s promotional self-image, Kaiser RNs and psychologists have repeatedly made all of the above complaints to Kaiser management. The problem is that Kaiser isn’t listening.

That’s why, together with more than 1,100 of my brother and sister RNs, we took the streets outside Kaiser Los Angeles Medical Center for three days last month. For two of those days we were joined by Kaiser psychologists and health professionals from across Southern California. And for one of those days, we were joined by more than 20,000 other RNs, psychologists and optical workers from all over California in the largest strike in Kaiser history.

We had good reason to strike against Kaiser.

Kaiser has made $5.7 billion dollars in profits in the last 30 months. Yet Kaiser refuses to agree to reasonable safe staffing language that would protect patients and workers. Just a small part of those billions of dollars in profit could go a long way to ensuring safe staffing at Kaiser Permanente. But when we propose using profits to protect patients and workers, Kaiser just says, “No.”

Kaiser also wants cutbacks. Even though Kaiser is rolling in money, Kaiser wants to eliminate our secure retirement plan and make deep cuts to our health benefits! There’s a simple explanation for this. And it’s not pretty.

Greed.

Kaiser’s CEO, George Halvorson makes $8 million a year and Kaiser executives have no fewer than 8 separate pension accounts. George Halvorson will never have to worry about making a co-pay or the elimination of his retirement plan. Worse, when George Halvorson refuses to listen to our patient care complaints and our reasonable safe staffing proposals, he’s turning his back on healthcare workers and the patients we care for.

That’s not thriving, that’s absolute greed.

That’s why 21,000 Kaiser workers took to the streets last week. We want to tell the world about Kaiser Permanente, and let folks know how they can help us make things better.

We were thrilled when Michael Moore showed his incredible commitment to workers and to safe patient care by joining us on the picket line. In fact, we made a short video to share with you that we think you’ll like.