Wendell Potter, author, journalist and former corporate public relations executive, spent more than two decades in the health insurance industry, leaving in 2008 after a crisis of conscience. 

Keeping insurance companies honest.

That was one of the main reasons President Obama said he supported a public option. Here’s what he told members of the American Medical Association at their annual gathering in 2009:

“A public option will give people a broader range of choices and inject competition into the health care market…force waste out of the system and keep the insurance companies honest.”

They’re not to be trusted

Obama—and the rest of us—had good reason not to trust insurance companies. Take it from me, a former insider, they’re not trustworthy. This is how I began my testimony at a Senate hearing in June 2009:

“My name is Wendell Potter, and for twenty years I worked as a senior executive at health insurance companies. I saw how they confuse their customers and dump the sick—all so they can satisfy their Wall Street investors.”

Cheating the taxpayers

They also cheat taxpayers out of billions of dollars. Every single year.

The latest evidence of that are the smoking gun documents made public last week when the U.S. Department of Justice joined a whistleblower suit against UnitedHealthcare, the nation’s biggest health insurer. The suit accuses the company of overcharging Medicare by manipulating a system the government uses to determine how much to reimburse insurers participating in the Medicare Advantage program.

 

 

Ripping Off Medicare

The original lawsuit was filed in 2011 by a former UnitedHealthcare executive. It claims the insurer overstated how sick its Medicare Advantage members were to get more money from the government. We’re talking “hundreds of millions—and likely billions—of dollars,” according to the lawsuit. The whistleblower was Benjamin Poehling, who served as finance director for UnitedHealthcare’s Medicare and Retirement subsidiary. At that level of responsibility, Poehling could see what was going on.

And it’s not just UnitedHealthcare. Poehling also accused 15 companies, including Aetna, Humana and Health Net, of doing the same thing. You no doubt have seen these companies’ TV commercial companies geared toward seniors. The marketing has worked: all the big for-profit insurers now get more of their revenue from the government than from their private customers. And, as the litigation claims, far more than they’re entitled to get.

Government audits have also shown the same cheating, as have a series of investigative reports by my former colleagues at the Center for Public Integrity.

Manipulating the system

Poehling said he and other employers were given financial incentives to manipulate “risk adjustment” scores in a way that would generate additional and unwarranted money from the government.

Attached to Poehling’s complaint was an email from another UnitedHealthcare executive urging staff members “to really go after the potential risk scoring that you have consistently indicated is out there. Let’s turn on the gas?”

 

Dumping the Sick

Insurers like UnitedHealthcare, Aetna, Humana and Cigna, where I worked for 15 years, not only have cheated taxpayers in this way, they also have dumped their Medicare enrollees when they weren’t happy with what the government was paying.

I was serving as head of Cigna’s health care PR department when the company decided in 1999 and 2000 to temporarily get out of the Medicare business. Several other companies did the same thing, leaving hundreds of thousands of seniors scrambling to find alternative coverage.

Americans—and our politicians—should be outraged. If ever there was justification for legislative hearings in Sacramento and Washington, this massive and widespread cheating is it. And, since Senator Ricardo Lara introduced a California Medicare for All-style bill (SB 562) in Sacramento this week, a great place to start is during the hearings on his bill.

— Wendell Potter      

 

From the HEAL Team:

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