1. Those present: President Lee Beecher, Don Gehrig, Dave Feinwachs, Bob Geist, Mike Ainslie, Doug Smith, Wayne Zuehlke, Rick Morris, Dave Racer, Hannelore Brucker, Greg Plotnikoff, and Scott Jensen.
1. Feinwachs discussed at length the operations of public and private sector HMO business as it pertains to the Hilex v, MI Blue Cross wherein the federal court found 20 years of fraudulent reports and stealing money from Hilex. The Court said that the Blues shall pay all claims presented by plaintiffs thereafter. Subsequently many MI companies have been paid.
• He discussed the problem of getting a MN ERISA (self-insured) company or labor union (insurance payments are paid by workers) to do an audit in MN. One problem is that the HMOs went back to the federal Court and asked that their defense testimony be sequestered. The defense testified that all HMOs in the nation similarly pocketed public and private money or they would not make money! They appealed to the Court, that if this testimony was allowed to stand, that it would destroy the nation’s insurance industry—and won hiding the testimony about all HMOs were stealing money.
• He recently spoke to the FL Hospital Assoc., which is opposing HMO take-over of the state’s Medicaid program as is the IA Hospital Assoc.
• He said that there is a solid political wall in MN built to stop an audit of our MN public medical programs; essentially Medicaid and Medicare Advantage are similar to an ERISA plan.
• There is no way to delve into the proprietary insurance industry Claims Exchange. In other words a business or union or other group would need to match what an HMO said it paid to a provider and what was actually paid—something legal to ask under ERISA law.
• To date, no large legal firm or company has found it expedient to take on the HMOs, albeit, employers have a fiduciary duty to their stockholders if their ERISA plans are being systematically raided.
• [We have previously discussed the fact that MN citizens and clinics are being short-changed, and patients endangered by HMO Medicaid profiteering in collusion with the State. ObamaCare waivers allowing massive mergers and legalizing collusive profiteering through ACO bedside rationing of care brings similar possible fraud to the national scene.] • Feinwachs also discussed the ramifications of the Somali community suit regarding patients not being offered fee-for-service as an alternative to mandatory HMO enrollment.
• Under federal law, people are able to choose their own providers including fee-for-service clinics. Further, the MN Medicaid HMO program was started as an experiment and still is so designated in which case the Somali community has a right to choose providers. The NAACP has joined the suit.
• It is rumored that Health Partners is a likely buyer of UCare.
2. Beecher will be discussing “Behavioral Health Integration at the MN physician round table on Nov. 12—the problem with EHRs will be an issue (pertinent to last summer’s Ranked item #3—see addendum below).
3. Racer—will be discussing the MPPA website publication section later.
4. Racer, Beecher. Gave a handout of their recent MetroDoc article, “The patient—honoring choices”.
5. Greg Plotnikoff was elected to the Board
6. Ainslie. Opened discussion of Ranked item #2 Mission Statement and Values Report (see addendum). After much discussion and word-smithing suggestions, including those by Wayne Zuehlke, the Committee was asked to rewrite the Report including additional comments for the next meeting.
7. RWG—Said that ranked item #1, ObamaCare was being addressed and that no action was required.
8. RWG—noted that ranked item #5, a MN Family Medical Account proposal, can be discussed, when the political climate changes. Racer noted that insurance agents strongly support expansion of HSAs, including making some form of HSAs available to low-income individuals, even those on Medicaid.”.
9, Morris—will discuss ranked item #4 at a later meeting.
Next meeting is scheduled for 6 PM January 21, 2016. In-house Pizza before meetings was approved!
Respectfully submitted, Robert W. Geist MD, Secretary pro-tem
Ranked Items for MPPA Season Agenda 2015-2016