The Kaiser Papers Newsletter for August 2007 |  |
Is Kaiser Thriving?
 Examining Kaiser’s financial statements is an exercise in
frustration. There seems to be an extraordinary amount of lack of clarity and
non-disclosure.
Normally, insurers (of all kinds) have tremendous flexibility in controlling earnings. For example, insurers have a reserve fund for future contingencies based on their estimates. When they add to these reserves, it subtracts from earnings. Similarly, when these contingencies are over-reserved, they can be added back to earnings. There are also other ways to manufacture earnings such as additions or subtractions to pension funds. There are many “estimates” that can be used to affect earnings. Being a “non-profit,” Kaiser is exempt from SEC oversight so they have even more flexibility than a normal insurer in manufacturing figures for accounting purposes. According to one investigative reporter, Kaiser had
“reserves” 13 times more than what was required according to sound business
practices a few years ago. In the same piece, it was pointed out that Blue
Cross was brought before the insurance commissioner in California for having
over-reserved about 6 times. Yet, Kaiser was never investigated.
Insurers manipulate financial figures for a variety of purposes. One major purpose is to understate earnings to get a favorable review for a premium increase. Or they may report strong profitability to give the impression of financial strength. The financial figures released by Kaiser can be manufactured and have little analytical meaning. However, there are two figures that are more difficult to fudge and may hold some insights. One is the amount given as “operating revenues” and the other is member enrollment. Even operating revenues are not clearly defined in Kaiser’s
financial disclosures. But the primary source is made up of premium income
charged to the member, about two-thirds. Secondary sources are listed as
Medicare member dues, Medicare billings, member co-pays and other fees, and “contract
revenues from Health Plan Organizations” (this is not defined). No mention is
made of revenues resulting from research grants, probable sales of member
information to drug companies and government agencies, and other sources.
Since the year 2000, operating revenues were reported as follows; 2000 - $17.5 billion 2001 - 20.0 “ 2002 - 22.0 “ 2003 - 25.3 “ 2004 - 28.0 “ 2005 - 31.1 “ 2006 - 34.4 “ Since 2000, Kaiser’s operating revenues have increased by 97%! Membership numbers released by Kaiser are inconsistent. Some
figures are for “voluntary members (the public) and some also include 200,000
or so Kaiser employees. These are the figures Kaiser has reported since the
year 2000;
2000 – 8.1 million members 2001 – 8.3 “ 2002 – 8.4 “ 2003 – 8.2 “ 2004 – 8.3 “ 2005 – 8.4 “ 2006 – 8.7 “ Adding the member totals by area for 2006 yields less than
8.4 million members. Using the same basis for 2005, the total for that year was
8.2 million members.
In a nutshell, Kaiser’s enrollment has been more or less stagnant. Depending on whether one uses 8.4 or 8.7 million members for 2006, Kaiser membership has increased by either 3% or 5% in a span of 6 years. Kaiser’s “Thrive” advertising program seems to be a flop. Since revenues have essentially doubled since 2000 while
membership has almost flat lined, the growth in revenues must have been derived
from large increases in premiums and co-payments from Kaiser’s members. Since
the number of Kaiser physicians has remained about the same over these years
(11,000 or 12,000) and Kaiser’s treatment guidelines have not changed, it is
doubtful that quality of care has increased. So the Kaiser member is paying
much more for the same.
Kaiser is certainly thriving…but at the member’s expense. Kaiser Still Has Not Learned Their Lesson It is apparent
Kaiser has not learned their lesson with the recent $6K
fine. Kaiser Hospitalist Shahab Attarchi disregarded my
daughter, Robyn Libitsky's wishes to not donate organs in her Medical
Directive, a legal document in the chart. This is in violation of
probate code 4730. Although
this occurred in 2005, it took two years to obtain her medical records
to provide the proof for the complaint which was filed in June, well
after the DMHC investigation ended. DMHC Director Cindy Ehnnes
sent me a complementary response completely ignoring the
complaint! Increased regulation of state agencies must be
addressed in order to force them to do their job, otherwise,
Californians will be faced with continued violations by Kaiser
resulting in harm and death.Hillarie Levy may be reached at: Hillarie@kaiserpapers.info From Dina Padilla -  Because the state and federal government has not done
IT'S JOB for decades and the lack of regulation overseeing convalescent care is undeniable proof, HMO's
like Kaiser think it should be number 1 in health care reform in this
country????? That is inconceivable. Who is Kaiser to think it should be number 1
in anything?That's what they've been after for
several decades and the taxpayers are paying for all of it. David
Lawrence (former CEO of Kaiser) stated a few years ago, that Kaiser
wanted to take over the world. Maybe he was serious with that
statement after all. We're not only paying for our own demise but also for each others by condoning the current system! It's been going on for years
and the government lets them get away with it. For the government
Kaiser is a win - win corporation. They provide patient
statistics to present to Congress, they can track the population so you
have no where to go without being eventually monitored and they have a
registry on everyone beginning on the day you are born. So you
know that there is a tidy file all about you that can be manipulated at
will stored in the annals of the government for eternity. Kaiser is the
government's medical arm via
the military! If you don't believe me check out at NARA
government contracts and see what has had Kaiser going for itself. How many of you want "KAISER KILL" HEALTH CARE REFORM. What does
Democratic Presidential Candidate Hillary Clinton know that no one
else does? Or California Senator Sheila Kuehl? Why do we need universal healthcare anyway? Medical care worked
before HMO's like Kaiser and it can again if the government would again actually regulate
medical care as they did before the HMO Act of 1973.
We need to go back to real medical care, pre HMO (which is just
another acronym FOR insurance companies and their profits). We need to go back to when medical
care was to heal and not kill and maim for profit.
Just think of a possible time of when ALL
of government fails to enforce its own bureaucracy because of corporate indebtness. The elderly, the children and the sick are the prime targets for this corporate greed. Your children and Your family!
How many homes and other properties have been stolen outright by
hospitals for the government, including the DOD, by killing off patients?
Dept. of Health Services are the
police for abused and murdered patients - The Nancy Grace program
touched upon that matter just a few days ago! No one is minding
the shop anymore. Sounds like the nazi's have taken over to me. Same principles at least are evident. It is secretly done all in the name of money but publicly in the name of for the greater good of all.
Universal healthcare operated by governement WILL BE genocide of the
American people unless structured properly. Currently the government gains from your pensions, life
insurance policies, homes, life savings. As soon as you sign on the
dotted line for universal healthcare you will have reform run just like Kaiser!
To quote Vernon Sinn M.D.J.D. "It is the sickest who prey on the sick" Dina Padilla may be reached at: dina@comcast.net Be sure and read: The 50% Split of Profits by Dr. Charles Phillips  This is a summary of the development
of the sixty year profit split at Kaiser Permanente whereby the physicians get
50% of every dollar that is collected from patients and government and not
spent. This is really the split of “profits” though Kaiser uses every possible word to cover-up the use of such a word – net revenue, operating margin, etc. Even the bond companies paid by Kaiser to rate KP bonds have joined in to cloud the obvious presence of huge profits as well as the split with the MD partners. The creation of profits for the physicians is the single most import principle at the mammoth HMO and guides every decision. (CP) http://businesspractices.kaiserpapers.info/50.html Dr. Phillips may be reached via e-mail at: CPhil49401@aol.com A note to all from Vickie - In a couple of weeks it will be seven years that the KaiserPapers has been in existence. Shortly after it was begun I had an encounter with a Kaiser nurse. This woman told me that I didn't know what I was doing. She told me that I was ruining everything for the good of all. She told me of the Kaiser grand plans for the biggest contract of all - no matter what political party is in charge - HealthCare for All - Universal Health. She told me that I should keep my mouth shut. She told me that for the good of all I should keep my mouth shut about witnessing my father's murder. A murder set in motion by a Kaiser nurse with a legal history of harming patients who had figured out how to make money off of taking part in a Medicare scam. That is what she told me to remain quiet about. I still consider that woman someone that should not be in the health care field to put it mildly . For seven years I have known quite clearly that this health care for all plan was nothing more than another Kaiser government contract score. I just didn't realize then what a cancer on American society Kaiser Health Plan, Kaiser Hospitals and Permanente Medical Group really was. Today I do. Let me digress and clarify - It would be wonderful to have healthcare for all provided by our government if they could assure us that the criminals would not take part in setting it uIn a couple of weeks it will be seven years that the KaiserPapers has been in existence. Shortly after it was begun I had an encounter with a Kaiser nurse. This woman told me that I didn't know what I was doing. She told me that I was ruining everything for the good of all. She told me of the Kaiser grand plans for the biggest contract of all - no matter what political party is in charge - HealthCare for All - Universal Health. She told me that I should keep my mouth shut. She told me that for the good of all I should keep my mouth shut about witnessing my father's murder. A murder set in motion by a Kaiser nurse with a legal history of harming patients who had figured out how to make money off of taking part in a Medicare scam. That is what she told me to remain quiet about. I still consider that woman someone that should not be in the health care field to put it mildly . For seven years I have known quite clearly that this health care for all plan was nothing more than another Kaiser government contract score. I just didn't realize then what a cancer on American society Kaiser Health Plan, Kaiser Hospitals and Permanente Medical Group really was. Today I do. Let me digress and clarify - It would be wonderful to have healthcare for all provided by our government if they could assure us that the criminals would not take part in setting it up, administering and providing accountability for it. But that just isn't going to happen because it isn't in the plan. Since that day, that woman's statement has been repeated to me over and over and over again in various ways. Last year, when several Federally ordered investigations were openly denied by California's Department of Health Services because as a director in charge at that time stated to me "We don't have to" I have noticed an intentionally created public crisis in all fields of health care. When several of us were advised by a director with CMS who was overseeing another set of investigations that she was ordered to stop immediately I learned further information on how insidious this great plan is. What a shame that these people are standing back and allowing this to happen. I suppose that they feel somewhat helpless and want to continue drawing a paycheck. I bet that their concern is more about their paycheck than being helpless. Seven years ago I would not have considered saying these things nor considered that anyone making these types of statements could be reciting much more than fantasy. Unfortunately, all of us have learned to see the world and our elected officials for what they are. It is not what we were all raised to believe. There are very few people in elected positions that are actually idealistic and subscribe to the tenets of our constitution. Instead many are out for just about anything they can get for themselves or to keep their jobs for decades. In short what I was told was happening seven years ago is becoming reality and we all are standing back and allowing it to happen for their own financial gain. Certainly there are several elected officials that are also taking part in making this happen. Certainly there are several officials that are pretending that they have not received any telephone calls nor letters, nor e-mails from those that they promised to represent regarding this issue. There are just as many that will claim that is all that they hear about from their constituents. They also all claim that they have no power and that their little hands are tied. If the citizens of this country do not peacefully do something to take a stand and at least attempt to stop what is taking place then you all will have to have the end result on your conscience and will later beg forgiveness from your children because no one tried to stop it. All the material you need to become informed is within the KaiserPapers web site and it's affiliated sites. But you have to participate and you will have to dare to stand up and speak out or you will have to accept some responsibility for what is befalling our country. Vickie Travis may be contacted via e-mail at: vickie@kaiserpapers.info |  Not All Medical Tests Are EqualBy Sharon Rushford
Lets say your car has a maintenance program where anything will be fixed for $20 at the dealership where you bought the car. You take your car in every six months for diagnostics. Nothing is ever found to be wrong with your car but after a few years a major engine problem occurs due to a perfectly preventable problem. Now you need a whole new engine when the dealership could have just replaced a gasket a couple of years ago and prevented this whole problem. Let’s say the cost of the engine replacement is $2000 and the cost to replace a gasket is $200. If the dealership does not find the 1000 cars who need the gasket replaced they save $200,000. Then when 1 car actually breaks down, the dealership says the engine died because the owner probably failed to keep sufficient levels of oil in the car, thereby refusing to provide a new engine as agreed. If it is blatantly obvious they might pay the $2000 for a new engine if the customer can prove that the gasket was what caused the engine to die (an expensive process,proof). Now pretend you have an illness. You go to your HMO for diagnostics several times because you are experiencing symptoms or maybe it’s just preventative testing. Your HMO uses diagnostics that do not identify your illness. By the time your illness is ravaging your body, any simple test will pick it up, but now it’s end stage. Now it’s too late to provide much treatment and besides you have gone elsewhere for your healthcare because you now see your HMO for what it is. Now multiply this happening to say 1% of the insured population and see how much your HMO saves by not testing you with quality tests. They will say they did all “tests” to diagnose your illness, but what they won’t tell you is the tests they did would probably would not find your illness. They won’t tell you there are other better tests that would have. So beware the “all clear” from Kaiser Permanente. Kaiser continually demonstrates a lack of compassion for our most vulnerable of people – the ailing. By making better choices when selecting a Health Care Provider and demanding universal health care where profit can not play a part in the equation can we finally start to hope for a better health care system in this country. “Only if we understand can we care. Only if we care will we help. Only if we help shall all be saved.” - Jane Goodall Sharon Rushford may be contacted at: From Patricia Easley Carpenteri : Kaiser
has pushed everyone into and illegal arbitation system where there is
no chance of justice = Kaiser hires the arbitrator and the Independent
Administrator = "He who pays the piper calls the tune". I
recently had trouble getting my correct records from Kaiser when I
applied for a Social Security Disability Status for early Medicare (the
health insurance premiums are draining my life savings) - they sent incomplete and only recent records totally ignoring my written request for my MRI report, Kaiser claims my records only go back to when my plan type changed because after they botched the operation, killing my husband. I
had to go to individual coverage and they treat that as a
"new"patient/member so they can justify "high-use" premiums on the
grounds of "preexisting conditions" - none of the conditions existed
when I really joined Kaiser back in 1971. They never sent my MRI to
Soc.Sec. When I re-requested my records to be sent to me, specifying in writing and by phone that I needed only the type diagnosing my disabilities they sent a mishmash of many past records most which were totally useless today. Kaiser better not be hoping to be paid for every page they copied. Kaiser
gouges members for more money by making them see multiple doctors in
the same dept and using that as an excuse to charge them "high user"
premiums than they advertise. They have me seeing a doctor for my
shoulders bursitis, another for my tennis elbow, another for my hands -
all in the same Ortho Dept and another doctor in the Physical Medicine
Dept for my neck (she sent me to Phys. Therapy) certainly all are parts
of the same body. My late brother-in-law was a Orthopedic Surgeon with
the Army Air Force, when a wounded soldier was brought to him he did
not refuse to work on him because the injury was in the left leg and
the doctor "only works on right arms" - he treated the whole body.
(Coincidentally Dr. Charles Phillips worked with my
brother-in-law in the 1970's). Another
example of gouging, my recent tailbone injury Kaiser wanted me to go to
the ER, but admitted they could do nothing for me, the tailbone can't
be cast or splinted and they do not operate to fuse it unless there Patricia Easley Carpenteri may be reached at:is nerve or spinal damage but they were willing to charge me $100.00 co-payment for doing nothing. Not surprising that I refused "take their advice" stating that I would only suffer greater pain from driving myself in and sitting for hours in the ER for no treatment (because of my back I have pain medications at home) and then more pain when I drove back home. ppc26@juno.com  From the desk of Jupirena Stein:Friday, August 24th, 2007 Mr. George C. Halvorson Chairman and Executive Officer Kaiser Foundation Health Plan, Inc. 1 Kaiser Plz. Ste. 2600 Oakland, California 94612 RE: Medical Crime, Dr. Timothy W. Wild, DDS, MD, ENT Surgeon-Kaiser Permanente Redwood City, Ca. (1999) and Medicare Fraud; Mr. George E. Clause Kaiser Permanente’s defense attorney.(2001) Dear Mr. George C. Halvorson: My name is Jupirena Stein, I am a former patient at Kaiser Permanente Redwood City, California. I am writing this open letter and demanding your response. Please tell me if you are aware of the crime and Medicare fraud mentioned above on this letter RE. Before you took office on March 2002, I took my suspicions about these facts to the attention of Mr. David Lawrence. He ignored its importance. It is now your turn. Medical Crime On November 19Th, 1999, Dr. Timothy Wilfred Wild, (unbeknown to me at that time,) performed a needless Parotidectomy surgery and an invasive, life threatening vascular surgery on several of my right cervical vessels for his own gain , without medical need, without my knowledge and without my permission. I became severely ill. I saw 8 medical specialists at KP Redwood City, California, but none of them “were able to figure out” what was wrong with my health. Why didn't’t they just simply asked Dr. Wild, -What have you done to this patient? But instead, these physicians simply chose to cover up his crime against my health. Even I, think they can’t be that incompetent! Subsequently, I filed a lawsuit; Stein vs. Kaiser. vickie@kaiserpapers.info Medicare Fraud. KP was represented by Mr. George E. Clause, a partner at Ropers. Majeski, Kohn & Bentley, in San Jose, California. Mr. Clause claims in his Law Firm’s website (www.rmkb.com) that he is an experienced Health Care attorney, a member of many reputable legal institutions and that he have represented KP on medical malpractice cases. Because of this public information, one would think that Mr. Clause clearly, wouldn't’t have to seek to the use of Medicare fraud when defending Kaiser Permanente in matters involving Medicare and medical malpractice health insurance legal liability. But in my case, he chose to. By doing so, he saved KP money by reversing future medical legal liability from Kaiser to our Federally Funded Health Care System, Medicare. Of course, Mr. George E. Clause can not claim this illegal shifting of the burden of ALL my future medical care from Kaiser’s future liability to our tax payers, - an act of his own. Mr. Bruce Albion Bailey (my representing attorney) cooperated with him by choosing not to correct Mr.Clause’s Legal Brief fraudulent information about my health insurance coverage legality to retired judge Rebbecca Westerfield from JAMS San Francisco, Ca. (“,,, who is known for her ability to grasp legal and factual issues quickly,”) cooperated with Mr. George E. Clause by choosing to stay silent about the subject of future medical care, when signing her final award.AMS San Francisco, Ca. (“,,, who is known for her ability to grasp legal and factual issues quickly,”) cooperated with Mr. George E. Clause by choosing to stay silent about the subject of future medical care, when signing her final award. And finally the involvement of the Department of Managed Health Care (DMHC) through Mr. Lewis Chartrand’s Legal Department and his illegal destruction of my files, when I asked them for help in these matters. I often ask myself if Ms. Lucinda Ehnes, DMHC Director (she will receive a copy of this letter) is aware of KP’s involvement in medical crime and fraud, - in my case or in any other. It seems to me that neither Kaiser nor the DMHC worry about whose credibility is in danger to be damaged. Medicare as a secondary payer is protected by federal laws and must ALWAYS be properly observed in cases such as mine, and be considered as such. Section 1862(b) of the Social Security Act 42 USC Section 1395Y(b)(5) Applicable regulations found at 42 CFR part 411 (1990.) Retired judge Rebecca Westerfield, the attorneys Mr. Bailey and Mr. Clause chose not enforce federal laws, as well as neglect KP’s rules and regulations contents found in Kaiser’s Evidence of Coverage Book pertaining to Medicare health care coverage liability of patients such as myself. In my opinion, Kaiser Permanente could never be successful in such matters, (fraud and crime) if they would handle things on their own. Kaiser had to have the complete cooperation and the blind loyalty of all these professionals mentioned in this letter. Without this kind of cooperation and loyalty, this HMO could be considered safe for ALL their patients. Mr. Halvorson, you may wish to clear these facts with me by using our legal system. I invite you to do that. After all, my claims of medical crime of this serious nature and of Medicare fraud, are NOT something Kaiser Permanente nor the DMHC should take lightly. I know, -I don’t. Dr. Wild has the mental and physical capability plus he has the medical knowledge to commit such a horrendous crime, and he is willing to take chances with his medical license and with his Board Certification. Dr. Wild, should NOT be permitted to perform surgery. Watch my words: chances are, - he will do it again (if I am indeed the first one) No wonder Kaiser and their attorney Mr. Clause, couldn't find Dr. Wild for his deposition, even though he was still working at KP. As a resident (a non-board certified physician in training) he would have never been allowed to perform such rare non emergency-surgery, unsupervised as per court documents. Besides, if Dr. Wild had been present in the arbitration it would have prevented him from obtaining his board certification. These serious matters involving Dr. Wild showing his clear intentions other than helping me with my health, and Kaiser Permanente Mandatory Binding Arbitration System involvement (in my case, through their defense attorney) in Medicare fraud, is, as you receive this letter, being announced to the world. If you chose to stay silent as KP’s executive officer, and chose NOT take a position of ethics and legality, I will take it as your public admission of guilt and as reckless disregard to protect Kaiser Permanente‘s patients health and safety. Evil prevails when the good people are silent, or take no action.” Regards, Jupirena Stein Jupirena Stein may be contacted via e-mail at: j_u_stein@yahoo.com CC: Open letter © Kaiser Papers 2August2007.html007 |
