Geneology International

Tag: Courts

  • KAISER HEALTH NEWS: Centene showers politicians with millions as it courts contracts and settles overbilling allegations | News

    KAISER HEALTH NEWS: Centene showers politicians with millions as it courts contracts and settles overbilling allegations | News

    On Nov. 2, 2021, Nevada Gov. Steve Sisolak’s reelection campaign received 10 separate $10,000 contributions from what appeared to be unrelated health insurance plans from across the country.

    The Buckeye Community Health Plan of Ohio, Louisiana Healthcare Connections, and Peach State Health Plan of Georgia were among the companies that sent money to the Democrat, according to state campaign finance records, even though only one, SilverSummit Healthplan, provided insurance in the Silver State.

    But a thread connects the companies: Each is a subsidiary of Centene Corp., ranked 26th on the Fortune 500 list, and the nation’s largest private managed-care provider for Medicaid, the government insurance program for people with low incomes or disabilities.

    Centene had already sealed Medicaid deals in Nevada through its SilverSummit subsidiary — yet a potential new line of business was on the horizon. Sisolak, who is up for reelection Nov. 8, had just approved a new public health plan option that would later open up to bidding from contractors such as SilverSummit.

    And then, less than two months after Centene’s subsidiary contributions were made, Nevada settled with the company over allegations the insurer overbilled the state’s Medicaid pharmacy program. The state attorney general’s office did not publicly announce the $11.3 million settlement but disclosed it in response to a public records request from KHN.

    Sisolak — who has accepted at least $197,000 from Centene, its subsidiaries, top executives, and their spouses since August 2018 — issued a statement through his campaign spokesperson Molly Forgey that said Medicaid contracts are awarded by an independent group. “There is zero correlation between Centene’s donations and how the governor legislates,” Forgey said. “The governor in no way acts unilaterally in decisions to award state contracts.”

    The contract went before the Nevada Board of Examiners for final approval. Sisolak is one of three voting members.

    Centene has similarly amplified campaign contributions to governors in New York and South Carolina, two states where it has profitable contracts and such giving by multiple subsidiaries is allowed. And despite having pledged to investors to disclose its political giving, Centene has revealed to shareholders only a portion of its contributions — omitting much of its subsidiary giving from reports on its website.

    Under corporate law, each subsidiary is its own business, which allows companies to increase their political footprints in some states by giving the maximum allowed donations from more than one entity, said Ciara Torres-Spelliscy, a law professor at Stetson University in Florida.

    “In some cases, they can increase it tenfold depending on how many subsidiaries and how much money they want to aim at a particular politician,” Torres-Spelliscy said. “They will exploit any loophole.”

    Since 2015, the St. Louis-based insurance behemoth, its subsidiaries, its top executives, and their spouses have given more than $26.9 million to state politicians in 33 states, to their political parties, and to nonprofit fundraising groups, according to a KHN analysis of IRS tax filings and data from the nonpartisan, nonprofit group OpenSecrets. That total doesn’t include the millions of dollars Centene and its subsidiaries have given to state politicians’ political action committees because OpenSecrets doesn’t track those donations. The KHN analysis also does not include giving to congressional and presidential candidates.

    It’s a purposeful political investment: Centene earns billions of dollars from governments and then uses its profits to back the campaigns of the officials who oversee those government contracts. The company has developed this sophisticated, multipronged strategy as it pursues even more state government-funded contracts and defends against sweeping accusations that it overbilled many of those very governments.

    Centene declined to make a representative available for an interview and didn’t respond to specific questions about its political giving. But company spokesperson Suzy DePrizio said in a statement that the company follows all local, state, and federal laws and records all contributions from its political action committee. She said Centene’s contributions “are intended to serve as support to those who advocate for sound public policy healthcare decisions, which is evident by our nearly equal support of candidates from both parties.”

    This year, according to IRS filings that go through Sept. 30, Centene has given $2.2 million, combined, to the Republican and Democratic governors’ associations, which help elect candidates from their respective parties. And Centene gave $250,000, combined, to the Republican Attorneys General Association and its Democratic counterpart.

    Since last year, state attorneys general, whose campaigns are benefiting from the associations’ money, have negotiated massive settlements with Centene over accusations the company’s prescription drug programs overbilled Medicaid.

    More than 20 states are investigating or have investigated Centene’s Medicaid pharmacy billing. The company has agreed to pay settlements to 13 of those states, with the total reaching about $596 million. And Centene told KHN in October that it is working to settle with Georgia and eight more states that it didn’t identify. It has denied wrongdoing in all the investigations.

    KHN found that Centene, like many corporations, also pays dozens of lobbyists in state capitals across the country and in Washington, D.C. It courts officials with fundraising parties and perks such as tickets to sporting events like Sacramento Kings games. And it helps fund committees set up to pay for governors’ inaugural events — as it did for Sisolak, with a $50,000 donation, separate from its campaign contributions, according to the Nevada secretary of state’s office.

    Executives and their family members make political contributions in their own names. For example, from 2015 through 2021, Centene’s then-CEO Michael Neidorff and his wife, Noémi, wrote at least $380,000 in personal checks to state candidates, with more than 60{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} going to California Gov. Gavin Newsom, a Democrat who governs a state where the insurer generated 11{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of its revenue in 2019. The Neidorffs lived in St. Louis.

    There’s no proof Centene’s contributions swayed politicians’ decisions, but campaign finance experts say money can translate into access and that can lead to influence.

    “They’re trying to protect their market share,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research. “They see it as necessary to maintain good relations with the agencies and with the individuals who are involved in decision-making because that’s the way government works.”

    Billing Question Surfaces in Ohio

    Health care industry players — from insurers, to doctor lobbying groups, to drug companies — routinely make large political donations. Centene rival Elevance Health, formerly known as Anthem, has spent at least $21.8 million on state political contributions since 2015, according to KHN’s analysis.

    What makes Centene stand apart from competitors is the massive share of its business that is funded by taxpayers. Founded as a nonprofit in 1984 by a former hospital bookkeeper, Centene earned $126 billion in revenue last year — up from $5 billion a decade ago, according to the company’s annual reports.

    Its rocketing revenue has been fueled by its thriving Medicaid managed-care business, takeovers of competitors, and growth in its Medicare Advantage membership and in enrollment in health plans it sells via the Affordable Care Act health insurance marketplaces. Centene’s Ambetter plans, available on the exchanges, have the highest enrollment nationally. The company has also locked up lucrative deals to deliver health care to state prisoners, military members, and veterans.

    Centene has reported that two-thirds of its revenue comes from state Medicaid contracts that cover about 15 million people across the country.

    So when Ohio Attorney General Dave Yost sued Centene in March 2021 over what he called a complex scheme of “corporate greed” to “fleece taxpayers out of millions,” other states took notice.

    Ohio investigators accused Centene of overcharging the state’s Medicaid program through the company’s pharmacy benefit managers, which provided medications to Centene-managed Medicaid patients. Pharmacy benefit managers, known as PBMs, act as middlemen between drugmakers and health insurers and as intermediaries between health plans and pharmacies.

    Centene denied wrongdoing but faced immediate consequences. Ohio officials froze its application to renew its contract to offer insurance to state Medicaid enrollees.

    “Ohio had Centene over a barrel,” said Antonio Ciaccia, a consultant who worked with the state on the dispute.

    The company settled three months later for $88.3 million. Its application was soon unfrozen, and it won a Medicaid contract that summer for its subsidiary Buckeye Health, whose lobbyists include Michael Kiggin, a law school buddy of Republican Gov. Mike DeWine.

    Dan Tierney, a spokesperson for DeWine, said the state’s competitive bidding process was reviewed by a court, which “noted Buckeye Health Plan scored highly in the bid process.”

    Since last year, 12 other states have settled with Centene over pharmacy services: Arkansas, Illinois, Kansas, Louisiana, Massachusetts, Mississippi, Nebraska, Nevada, New Hampshire, New Mexico, Texas, and Washington.

    Of the states that have reached settlements so far, at least five have subsequently awarded government contracts to the company. Louisiana settled with the insurer in November 2021 for $64.2 million and just three months later awarded a statewide Medicaid contract to Centene’s subsidiary Louisiana Healthcare Connections. KHN learned of the settlement, which was not previously publicly announced, in October through a records request.

    Nebraska officials also hadn’t publicly announced the state’s $29.3 million settlement with Centene in December until they received a recent KHN public records request. Nine months after the settlement, the state awarded Centene subsidiary Nebraska Total Care a Medicaid contract.

    One reason Centene keeps winning contracts, Kominski said, is that such large insurers don’t have much competition in some parts of the country. “It’s not as if states can easily say, ‘OK, we’re going to have an open competition’ and then they have hundreds of insurers willing to participate in the marketplace,” Kominski said. “Health care is not, in general, a very competitive marketplace.”

    Some politicians are tired of that playbook. In Mississippi, the state House of Representatives voted in February to prohibit Republican Gov. Tate Reeves’ administration from awarding a contract to any company that the state had settled with for more than $50 million. Centene paid Mississippi $55.5 million the year before.

    “I am for doing away with our business to a company who took $55 million of our money that was supposed to be spent on the poor, the sick, the elderly, the mentally ill, the disabled,” Republican state Rep. Becky Currie, who authored the amendment, told her colleagues on the House floor.

    The House adopted Currie’s amendment, but the Senate stripped it out of the bill.

    Reeves’ gubernatorial campaign committee has received $210,000 from Centene since 2015, according to OpenSecrets data, and Mississippi lawmakers and party organizations have reaped at least $600,000. Reeves’ office did not respond to multiple requests for comment about the donations.

    In August, just over a year after the settlement, Mississippi awarded Centene subsidiary Magnolia Health Plan a new Medicaid managed-care contract.

  • Supreme Court’s abortion decision puts doctors in legal limbo : Shots

    Supreme Court’s abortion decision puts doctors in legal limbo : Shots

    Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

    JASON CONNOLLY/AFP via Getty Images


    hide caption

    toggle caption

    JASON CONNOLLY/AFP via Getty Images

    Dr. Kara Beasley protests the overturning of Roe vs. Wade by the U.S. Supreme Court, in Denver, Colorado on June 24, 2022.

    JASON CONNOLLY/AFP via Getty Images

    Historically, doctors have played a big role in abortion’s legality. Back in the 1860s, physicians with the newly-formed American Medical Association worked to outlaw abortion in the U.S.

    A century later, they were doing the opposite.

    In the 1950s and 1960s, when states were liberalizing abortion laws, “the charge for that actually came from doctors who said, ‘This is insane, we can’t practice medicine, we can’t exercise our medical judgment if you’re telling us that this is off the table,’ ” explains Melissa Murray, law professor at New York University.

    The Supreme Court ruled in doctors’ favor in Roe v. Wade in 1973. The majority opinion spoke of “the right of a woman in consultation with her physician to choose an abortion,” Murray says.

    Yet doctors and patients are all but absent from the latest Supreme Court majority opinion on abortion in Dobbs v. Jackson Women’s Health Organization. In fact, in the opinion, Justice Samuel Alito uses the derogatory term “abortionist” instead of physician or doctor or obstetrician-gynecologist.

    Legal experts say that signals a major shift in how the court views abortion, and creates a perilous new legal reality for physicians. In states where abortion is restricted, health care providers may be in the position of counseling patients who want an abortion, including those facing pregnancy complications, in a legal context that treats them as potential criminals.

    For doctors, abortion restrictions create an 'impossible choice' when providing care

    “Alito’s framing is that abortion is and was a crime – that’s the language he uses,” says Mary Ziegler, a law professor at the University of California, Davis. There’s no dispute, she says, that “the result of a decision overruling Roe in the short term is going to be the criminalization of doctors.”

    Roe v. Wade was doctor-centered

    Doctors were at the heart of the court’s first landmark ruling on abortion, Roe v. Wade.

    “The original Roe decision – it was very, very doctor-centered – extremely so,” says Ziegler, who has written extensively on the legal history of abortion. “At its inception, this was a right that was very much about health care and about the doctor-patient relationship.”

    Roe and the abortion decisions that came after it like Planned Parenthood v. Casey, “had the framework that abortion is some sort of individual right, but it’s also health care,” explains Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School.

    The court essentially told states: “You can put restrictions on abortion services and on provider qualifications as you do for other types of health care, and as long as they are not so onerous that we think they’re implicating Roe and Casey, we’re fine with that,” Shachar says.

    State legislatures that wanted to restrict abortion did so using the apparatus of health care regulation, she says.

    Those restrictions have included informed consent laws, waiting periods, telemedicine restrictions, clinic regulations, hospital admitting requirements for providers, insurance restrictions and more.

    The effort to restrict abortion through medically unnecessary regulations – “was simultaneously, I think, treating abortion as health care and delegitimizing the idea that abortion is health care,” Ziegler says.

    These regulations often tried to control the details of how doctors provide abortions more strictly than other areas of medicine, she notes. “The anti-abortion movement’s framing was basically, ‘We’re protecting women from the ‘abortion industry’ by regulating the way abortion providers work.’ “

    A new legal framework

    A more recent abortion decision – Gonzales v. Carhart in 2007 – previewed the Supreme Court’s move away from deferring to doctors in the context of abortion, Ziegler says. At stake was the legality of so-called “partial birth abortion,” a procedure used to perform late-term abortions, which Congress had banned in 2003.

    “The fight in that case was about whether doctors get to define what this procedure is and whether it’s needed for patients or whether Congress does,” she says. “The Supreme Court in the case essentially says, if there’s any kind of disagreement about science – legislators get to break the tie.”

    In Dobbs, the latest decision about abortion from the Supreme Court, “it’s an even bigger breach because there’s not even the pretense of caring about doctors,” she says.

    Supporters of the Dobbs opinion don’t see the absence of physicians as an omission. Abortion “really doesn’t have any place in the practice of medicine,” Dr. Christina Francis of the Association of Pro-Life Obstetricians and Gynecologists told NPR after the decision was released. Her group submitted an amicus brief in the Dobbs case, which urged the court to overturn Roe v. Wade.

    In his opinion for the majority, Alito quotes the Mississippi law banning abortion after 15 weeks, which called abortion “a barbaric practice, dangerous for the maternal patient, and demeaning to the medical profession.”

    Ziegler says the idea has been percolating for years in the anti-abortion movement “that abortion was not medicine, was not health care.” She says it was fueled in the 1980s when Bernard Nathanson, a doctor who formerly provided abortions, had a political and religious conversion.

    “He wrote this book in the ’80s called Aborting America, which was what he called an exposé of the ‘abortion industry,’ ” she explains. “That term really caught on with the anti-abortion movement – that essentially abortion was a for-profit industry, kind of like the tobacco industry.”

    That idea has continued to be powerful and its influence is apparent in Dobbs, she says. Alito’s opinion reflects the idea that “abortion providers are not doctors in the sense we usually understand – that they were historically thought of as criminals and what they’re doing is unprotected.”

    A ‘glaring’ omission

    Many doctors and legal analysts adamantly disagree with Alito’s view. Two dozen medical groups, including the American College of Obstetricians and Gynecologists and the American Medical Association, told the court that abortion is a key part of reproductive health care, that it is safe, and that doctors need to be able to treat patients without government interference.

    “I think the failure to consider the interests of the pregnant person and of the clinicians that treat them [in the majority opinion] was glaring,” says Molly Meegan, chief legal officer and general counsel at ACOG. She adds the use of the term “abortionist” in the opinion was “inflammatory, inaccurate – these are clinicians, these are providers, these are medical professionals.”

    Shachar at Harvard takes issue with the “history and traditions” approach Alito used in his analysis to determine that abortion is not a protected right, focusing on statutes from the 19th century.

    “Medical care has just changed so dramatically from – bite a bullet and we’ll amputate your leg,” she says. “It’s really shocking to say, ‘We need to go by the historical conception,’ when we have all agreed that we want to live in a modern society that has medical care, that doesn’t treat women like chattel.”

    Michele Goodwin, who directs the Center for Biotechnology and Global Health Policy at UC Irvine, says Dobbs and the state abortion laws that can now take effect single out physicians who provide abortions “for disparate treatment amongst various other kinds of care.”

    “That would be one thing if, in fact, these were very risky procedures that led to high rates of mortality, but, in fact, it’s just the opposite,” she says. Abortion is very safe, she adds, pointing out that pregnancy leads to death 14 times more often than an abortion. That means that doctors who provide abortions “are absolutely essential, actually, in the provision of reproductive health care,” she says.

    The role of doctors ahead

    Physicians who provide abortions are in an incredibly difficult spot as they try to navigate the new legal landscape, especially in cases where a pregnant patient is sick or has complications. Intervene, and you risk violating the law and being sued, losing your medical license, even going to jail. Don’t intervene and you could be risking your patient’s life, and potentially being sued by the patient or family.

    “We are hearing from our doctors on the ground at all times of day and night,” says Meegan of ACOG. “They are scared, they are in an impossible situation, and they don’t know how to define laws that are happening by the minute.”

    Dr. Katie McHugh is an OB-GYN who provides labor and delivery and abortion care at several clinics around Indiana, where abortion is currently still legal. Since the Supreme Court decision, she’s seen a wave of new patients coming from Ohio, Tennessee, and Kentucky for abortion care. She’s trying to keep track of the laws in these neighboring states to know what she can do for these patients.

    “We’re trying to be very, very careful,” she says. “Especially as things are evolving, I’m sure that I have made a mistake. And it is so scary to me to know that I’m not only worrying about my patients’ medical safety, which I always worry about, but now I am worrying about their legal safety, my own legal safety.”

    “The criminalization of both patients and providers is incredibly disruptive to just normal patient care,” she adds.

    The legal landscape is very much in flux. Bans are going into effect, some have been blocked by judges, and new restrictions are being drafted by state lawmakers. The laws that are in effect are often confusing and unclear, and doctors warn that is likely to affect care beyond abortion, including miscarriage care and treatment for ectopic pregnancy and more.

    It could be that doctors’ groups like the American Medical Association and ACOG get involved in the legal fight here and again play a role in pushing to liberalize abortion laws, just like they did decades ago.

    “I think that medical societies have a responsibility and an influence that should be used right now,” says Meegan. She notes AMA recently adopted a resolution that defines abortion as a human right, and that many organized medical groups across specialties are united in fighting against the criminalization of medical care.

    “Recent political and legal mobilizations around abortion have not been led by doctors,” notes Ziegler. “Historically, doctors have been a really big reason abortion was decriminalized before, and if [they’re] going to be again, I think you have to have the medical profession potentially be more outspoken and united in talking about this than it has been to date.”