6

Inside Mega Medical Insurance

If Congress ever stops obsessing about whether Vladimir Putin’s attire (or lack of) is an indicator of Russian foreign policy, maybe they can actually look into the running of the medical insurance companies. In the meantime, maybe this is what’s happening inside the boardroom:

Chairman: Gentlemen, we have invited you here for an explanation of why profit margins have plunged so dramatically.

Board Member A: The investors are very unhappy. Our largest shareholder had to use existing funds to make the payment on his ski lodge. Another had to postpone his trip to Fiji and Micronesia.

Chairman: Let’s start on the pharmaceutical side. What is going on, Mr. Hogg?

Lester Hogg (Pharm Guy): Well, you know that it’s hard to get companies to create new drugs because it’s so hard to get the government to approve anything. It’s all going generic.

Chairman: We’ve heard all that. Are there any new trends?

Hogg: A lot of people seems to be trying herbs and other supplements. We’ve even heard of psychiatrists prescribing them. That pulls people completely out of the pharm system.

Chairman: That makes no sense. Insurance doesn’t cover herbs. It has to be more expensive.

Hogg: Talk to the twits over there (points to the medical insurers). Copays for drugs keep going higher.

Julius Bones (Med Guy): You people can’t keep your costs down. We had to start charging them a percentage of the price instead of a flat fee. You said it was the only way to make a profit. The customers said the premiums were too high.

Hogg: And whose fault is that? You guys are letting patients get CT scans for a sprained ankle.

Chairman: We thought that forcing people into HMOs and such was supposed to keep costs down and profits up.

Bones: Well, it didn’t work out quite the way we expected. We thought that by forcing everyone to go through a primary doctor, a lot of the specialist fees would be eliminated.

Chairman: What happened?

Bones: Them. (Points to a team of attorneys)

Phineas Shark (Legal Guy): We have to make sure the doctors don’t get sued for malpractice.

Chairman: So you decide which tests are needed to protect the doctors?

Shark: In a manner of speaking. We make sure the doctors don’t make promises they can’t keep.

Hogg: So they try herbs instead of drugs.

Shark: There are fewer proven side effects. People don’t want to die from their treatment.

Bones (aside): That completely dries up the flow of money.

Shark: And we make sure enough tests are done to avoid missing a problem.

Chairman: So why aren’t we making money off all these extra tests?

Bones: Well, we made some reforms in the past that are cutting into those profits. We forced the providers to form groups for internal referrals and improved communication. And we made them switch to electronic communication.

Chairman: So??

Bones: So instead of taking the x-ray and sending the patient somewhere else for further diagnosis, the patient is referred internally and the x-ray is available for anyone in the system to see.

Chairman: What idiot thought that would be good for the insurance industry?

Shark: We never thought the medical world was organized enough to actually follow through. Our bad.

Chairman: This is totally unacceptable. It seems that every time we come up with something to protect our interests while still looking like the good guys, they figure out how to actually use it.

(He looks around the table.)

Chairman: I’m giving you insurance executives 90 days to come up with a way to exploit the holistic medicine industry or you’re gone.

 

2

Bedlam in New York – The Conclusion

(This is part 3 of a 3-part story investigating Stringham Hospital, a psychiatric facility, and the doctors associated with it. Previously we heard an account from a former patient about his stay there and the story of our undercover work. Patient names have been changed to protect their privacy.)

You may be aware that Stringham Hospital closed at the beginning of this month due to the investigative work done by this paper. Once we had finished putting the pieces together, they painted a very ugly picture of what had been happening.

Patients became aware of the medical offices of Drs. Igor, Boris, and Bela from flyers posted on lampposts and subway walls in middle- and lower-income neighborhoods. They were written to appeal to the employees of the uptown millionaires and disgruntled plant workers:

Tired of the Bosses Getting Better Medical Care?

We can help you get first class service without the first-class price!

Visit Doctors Igor, Boris and Bela today!

No waiting!

Cash and all Insurance Accepted!

Call 212-555-5522 for an immediate appointment!

Callers would be given same-day appointments to meet with one of the doctors. The receptionist would call the insurance company to determine the person’s coverage.

If the person was paying cash, they would be given a “complimentary” bottle of sugar pills and sent on their way. If they had complete coverage under a union policy, the receptionist called Stringham so orderlies could come to office to pick up the patient. If the receptionist couldn’t get the required information or the insurance was less comprehensive, the patient was given a follow-up appointment so Stringham could decide whether adequate payment could be made.

When the patient arrived at Stringham, he was taken directly to the Burmese cat panel and admitted to the hospital. An insurance claim was initiated with the notation that it was an involuntary admittance and there was no projected date of release. The Siamese doctors received payment for each patient admitted.

Once the animals were admitted, they were taken to one of six rooms. On a rotational basis eight animals were taken from each of the rooms for “exercise”. When they arrived at the lab, Michele told them that they would be testing a new anti-psychotic drug.

Michele spoke with each of her subjects to determine which four would be easiest to control. The others were to be given a lethal injection and taken to a disposal site. The drugs being tested had been created by Dr. Stein in hopes of creating a success that would make him a rock star of science.

The only heroes in this story are the cats responsible for the disposal of the unwanted test subjects. Somehow they managed to dilute the lethal dose so that the animal was unconscious but not dead. The cat responsible for disposing of the bodies would take them to a remote part of the city and leave them to wake up. There were six cats involved in this part of the operation.

Aftermath:

The Siamese “doctors” turned out to not have medical licenses. They have been convicted of practicing medicine without a license, insurance fraud and illegally receiving kickbcks. They are currently serving a sentence of six months as “ratters” at the federal penitentiary. They will then be under house arrest for another six months at a public housing project and probation for the rest of their lives. They are required to return all money they received illegally.

Dr. Stein was convicted of malpractice, insurance fraud and unlawful imprisonment. His medical license was revoked. He will spend a year as “class pet” for a first grade class in an undisclosed Staten Island school. He will then spend a year under house arrest and probation for the rest of his life. He is required to return all money he received illegally.

Michele was convicted of attempted murder, assault, and unlawful imprisonment. She will spend the rest of her life as a “bad example” during police presentations to school children. She is living in an undisclosed precinct, ratting for them at night.

The other four Burmese were convicted of unlawful imprisonment and insurance fraud. They have each been sent to a shelter specializing in dog adoptions to act as “ratters” for six months. They will then spend a year under house arrest and probation for the rest of their lives.

Orderlies who had been with the hospital for more than six months were convicted of cruelty to animals and sentenced to a year’s probation. They are prohibited from working at any medical facility for the rest of their lives. Orderlies who had been with the hospital for less than six months were not charged.

The six cats who assisted the patients in escaping have received honors from the city and placement in fast-track positions at Gibbons Medical Research.

The patients are receiving whatever psychological and/or mental health treatment they require and will receive job placement training when they are finished if their prior positions are no longer available.

Ed and Pavlov have formed a private investigation partnership specializing in medical fraud.

 

7

Bedlam in New York – Part 2

(This is part 2 of a 3-part story investigating Stringham Hospital, a psychiatric facility, and the doctors associated with it. Previously we heard an account from a former patient about his stay there. Patient names have been changed to protect their privacy.)

As reported by archy and mehitabel

At the end of Ed’s story, we were perplexed. Was there a story there or not? Maybe what Ed needed was a competent doctor. But stories of cats tormenting rodents sounded too close to the bad old days of New York City to ignore. We decided to split up to do some investigating.

From archy:

As a cockroach, it seemed natural that I would go to the offices of Dr. Igor, Dr. Boris, and Dr. Bela. I would be able to hide in a nook and listen. Even if I was discovered, it would just look like an addition to the neighborhood.

The office is in a well-kept part of a working neighborhood. They shared the building with several other medical practices. The sign said “Medical Office” under their names. I thought it was a little strange. Usually doctors specialize: “Small Animal Skin Disorders”, “Rodent Eating Disorders,” or the like.

I went one night and settled in a nice spot in the wall where I could get to any part of the office easily. I spent the first day with Dr. Igor. He only works in the mornings. In four hours, he saw twenty-five patients. Needless to say, he only spent a few minutes with each one. But that wasn’t a red flag. Lots of doctors barely see their patients anymore before diagnosing and writing a prescription.

He had a tablet that gave him the patient’s name, address, occupation, and insurance information. It also had the reason the patient was there. A typical visit went something like this:

Doctor: Hello Jack. Nice to meet you. I see you have a cold.

Jack: Well, I’ve been feeling….

Doctor: No need to get into that, I’ve been seeing a lot of patients like you.

(Looks at the tablet)

Doctor: You can pick up a prescription on your way out. Please come back in a week so I can make sure you’re better.

Dr. Igor’s patients got one of three instructions: I’m sorry I can’t help you, I need to refer you to Dr. F.N. Stein, or come back in a week.

Listening to Dr. Boris and Dr. Bela, I heard similar responses. What triggered which response?

The receptionist was Siamese, like the doctors, and talked a lot. I’m surprised the patients could get a word in. Every call was the same: patient species, patient name, patient address, patient phone, patient federal ID number, type of insurance, insurance numbers, and date of appointment. Interestingly, they did not accept cats as patients.

When she got off the call, she immediately called the insurance company to find out when coverage began, whether medical services were covered, if psychiatric services were covered, how long benefits would continue and whether there was monetary limit to the benefits.

From mehitabel:

I applied for a job at Stringham. At the interview, they said I looked like I would be good at managing patients and hired me as an orderly. Later I discovered that only pure-blood cats would be hired into administrative/executive positions. The rest of us would be orderlies, maintenance or cooks.

We “mutt cats” were treated as if we were invisible. It was degrading, but worked to my advantage. (Ed. Note –The term “mutt cat” was applied by the hospital. This paper does not discriminate based on species or parentage.)

When a patient arrived, the first thing we did was accompany them to their medical assessment. There were five cats (Norwegian Woods) on the panel, with a Dr. Stein as the leader. Everyone who came here was admitted. There was no appeal. If they made too much trouble, an orderly gave them a shot and dragged them to their room.

There were 15-20 animals in each room. We fed them once a day, kitty kibble. Once a week, we put down new litter. The place was beyond disgusting. The patients were mainly small animals with a few dogs thrown in. There were no feline patients.

Every morning, a Burmese named Michele would tell us which animals were to be taken to the lab. She was the head researcher. We took the animals to the lab. She decided which ones she needed that day and told her maintenance staff to get rid of the rest. The maintenance staff was three “mutt cats.” They took the unneeded animals out, and we never saw them again.

We orderlies waited outside until the experiments were over. We took the test subjects back to their room. Usually they were sedated to the point of insensibility.

They fired me after two weeks. They had decided I wasn’t the right “type” for the position.

 

Coming soon: Part 3: Putting the pieces together.