10/27/2022    Chris Robertozzi, DPM

MCR Advantage Plan Again Found with its Hand in the “Cookie Jar” (Paul Kesselman, DPM)

Medicare Advantage Plans’ deceit is the new game
in insurance fraud. Back in 2007 or 2008 Aetna and
Cigna were convicted of insurance fraud for not
reimbursing their insurers for lab fees that were
a covered service. The amount of money that should
have been paid to insurers was over a billion
dollars for each insurance company. Aetna and
Cigna were fined $250,000 each and did not have to
compensate the insurers for the money that was
inappropriately withheld.

Of course, they were told to stop and desist that
practice. When the CEO of Aetna was interviewed,
his response was that it’s just a business
decision. Two years later, they were back in court
for the same thing. The outcome of that trial
never received any press.

Now the insurance companies have found a new way
to return money to their stockholders. APMA and
its members lobby on Capitol Hill as do all the
other medical associations. Those of us that have
gone year after year have seen minimal results for
our efforts and are tired. Sure, every now and
then a bone gets thrown our way, but it never
addresses the large issues. We are burnt out
doing the same old thing and expecting a different
result. Doing the same thing and expecting a
different result has been called insanity.

Borrowing Dr. Jon Hultman’s phrase, we need a game
changer. There are numerous examples of national
health care associations with legitimate concerns
that have been ignored. AMA worked hard to
include tort reform in Obamacare. There is not
one sentence in the Affordable Care Act 2000+
pages on tort reform. At the 2022 APMA House of
Delegates, it was unanimously voted to have APMA
organize a health care alliance that includes
every national association that provides any type
of health care. Unless health care comes together
with one voice, we will not be taken seriously.
Since that has never happened, the ability to do
that will make everyone, not just Congress, stop
and look. The three parties that are involved
with this dilemma need to be at the table. They
are the health care providers, the insurance
companies and representatives for the general
population. We each need to listen and understand
each other’s issues before we can put together a
solution to this very complex problem. The
penalties need to be the same across the board.
If a doctor will lose his license for fraud, then
so should an insurance carrier. It must be
enforced. The only way to insure that is if the
entire process is an open book. That way nothing
can easily be swept under the rug.

With that being said colleagues, contact Scott
Haag, JD (shaag@apma.org) at APMA and let him know
that you are in support of APMA helping to form an
alliance of health care associations. CC the APMA
President, Dr. Laura Pickard (lpickard@apma.org)
and the Chief Delegate in your state association.
Certainly, you are welcome to also cc me at
drrobertozzi@afacare.com. It doesn’t have to be a
long email. A sentence or two stating that you
support the APMA Policy Proposition 1-22:
Participation in Health Care Reform. The game
changer that will win this battle is the
unification of health care.

Chris Robertozzi, DPM

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