Michael Moore’s “Sicko” does two things very well.
First, the film makes it clear that in the U.S., even if you have health insurance, this does not mean that you are “covered.” Everyone knows that many Americans are uninsured. But now, millions of middle-class Americans are beginning to realize that they are UNDERinsured, and Moore drives that point home.
For-profit-insurers spend a great deal of time designing policies that will limit their “losses”—i.e. limit the amount that they have to pay out. These “Swiss cheese” policies are filled with holes: for example, a policy may pay for surgery, but not rehabilitation after surgery. And this omission is deliberate. As a former claims adjuster tells Moore, when an insurer denies payment, “You’re not slipping through the cracks. They made the crack and are sweeping you toward it.”
Secondly, “Sicko” underlines the signal difference between healthcare in the U.S. and healthcare in other countries: the citizens of other countries take a collective view of the problem. Or as Moore puts it, they realize that when it comes to sickness and dying, all of us are vulnerable. “In the end, we truly are all in the same boat . . . they live in a world of ‘we’ not ‘me.’”
Of course people in the U.K. Canada and France know that healthcare is not free. (And contrary to what some of Moore’s critics say, he does not pretend that it is.) But since they think of healthcare as a right—something we all deserve simply because we are human—it seems to them fair that, “You pay according to your means [through taxes] and receive according to your needs.” In this, national health programs that are funded by taxes resemble Medicare: the higher your salary, the more you pay into Medicare. The sicker you are, the more you will take out in benefits. If you’re lucky, you put in more than you take out.
What “Sicko” doesn’t do is focus on the waste in our system. As Jonathan Weiner observes below, we can’t afford to pay for everything that someone might possibly want. We need to be sure that we are getting value for our healthcare dollars. In one case, Moore tells the story of a man dying of kidney cancer. Desperate to save him, his wife valiantly tries to persuade insurers to pay for new treatments –including a bone-marrow transplant that the insurance company calls “experimental.” But the insurer refuses, and a few weeks later her husband dies. This is one of the saddest moments in the film—both husband and wife are very appealing.
Yet it is not clear that the insurer was wrong to refuse the cover the bone-marrow transplant. It is very difficult to tell from the few details given in the film whether it might have helped—but advanced kidney cancer is not curable. Even the newest drugs give the patient, at most, a few more weeks of life. At the same time, it is understandable that both the husband and the wife (and apparently Moore) assume that the insurer was merely trying to save money.
After all, when it comes to making coverage decisions based on medical evidence, for-profit insurers have a pretty spotty record. In the 1990s, when insurers said they were trying to “manage care,” many were simply “managing costs.” For example, some decided which drugs to include in their formularies based simply on whether the manufacturer would give them a deep discount. In return for the discount, the insurance company would assure the drug-maker that it would not cover a competing product.. This had nothing to do with which drug was more effective.
As I suggest below (see my most recent post on MedPac ) the public will always be suspicious of decisions made by for-profit insurers—even when their decisions are based on sound medical evidence. For-profit insurers just don’t have the political or moral standing to make these judgments. (By contrast, most patients are much more comfortable with Medicare’s coverage decisions—which is why we need a federal agency testing and comparing the effectiveness of new treatments. )
But if Moore skips over the problems of overt treatment it may be because he knows that this at this point more Americans are worried about undertreatment. And to be fair, no one could examine all of the problems in our dysfunctional healthcare system in a single film. What is important is that Moore says what he says loudly and clearly. He tells a vivid, memorable story—and in the process, he has managed to spur the national conversation about healthcare reform.
This is what scares people like Peter Chowka. If people begin talking about health care, they may begin to think about it. It may even occur to them that perhaps it wouldn’t be so terrible to borrow a few ideas from other countries. As Moore points out, “If another country builds a better car, we buy it. If they make a better wine, we drink it. If they have better healthcare . . . what’s our problem? “
"It’s conceivable, Moore suggests, that we might even learn something from Cuba, a country that spends 1/27 of what we do on care. Of course the film’s Cuban adventure is controversial—and purposefully so. I’ve written about it here on TPM café where I recount a very funny story Moore tells about his experience with Standards & Practices at NBC– a tale which shows that he knew exactly what he was doing when he took part of “Sicko’s” cast to Cuba.)
Looking back on “Sicko” Moore says, “I could have played it safe, I know. I could have gone to Ireland. . . . Everyone loves the Irish …. But you know you have to get people’s attention.”
And, as usual, Michael Moore has succeeded in doing just that.
UPDATE: A couple Moore on Sicko. A balanced enough review in the NY Times from Philip Boffey, and an interesting one (sadly firewalled) by Timothy Egan about whether Americans live better than Italians (My take has always been that rich Americans live better than rich Italians) — Matthew
http://hometown.aol.com/kstbylite1/myhomepage/business.html
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SICKO had U.S.Attorneys Worried, but alas, Mr. Moore didn’t expose them for thier crimes……
.
What Micheal Moore left out of his movie [ That apparently U.S.Attorneys got worried they would be exposed in thier part of Federal Health Insurance Fraud against Americans ] is how these ‘ Managed Care/HMO ‘ Contractors get away with Allowing HMOs to klll thier Federal and ‘ Private ‘ Beneficiaries by Denial of Medically Necessary Services – CITE: 42CFR417 DHHS HMO Grievance Service/Anti-dumping Violation/Fraud by Fright/white collar crime, to Force illegal State HCFA Medicaid kickback applications — ecomonic crime resulting in serious bodily injury or death to the American Citizen with an HMO Policy.
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I live in Michigan, whereas our Governor and Attorney General are illegally using the Michigan ‘OFIS Office’ to conceal and allow Federal HMO Hospital Insurance Fraud [ Anti-dumping & Anti-kickback Violations ] against Michigans Elderly, to Force HCFA Medicaid kickback conversions. Evidence/Documentation Enclosed.
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The U.S.Attorneys and Office of Inspector General were probly PLEASED to see Mr.Moores film Promoting ‘ Universal Health Care ‘ because they want to get rid of the Evidence befor they are Exposed for Managed Care Fraud and Abuse/Economic Crimes, AND they can use the Fraudulent Amounts to Claim what Amount Universal Health Care would START at. Americans are currently paying about 400 BILLION for Denied Covered Services now – 2007.
.
Please help expose Public Official Criminal Misconduct – Economic Crime/Federal Hospital Insurance Fraud – America needs ‘rule of law’, Not organized crime denying us Civil and Criminal Rights for Due Process of Law through ‘ grievance services ‘ <~ this is NOT Law Enforcement.
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Sincerely,
Kimberly Kimball
10073 Bryce Road
Kenockee Twp MI 48006
1-810-384-1732
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The criminal liability of individuals [ Law Enforcement Officials ] through whom the entity [ Federal [ OPM FEHBP etal ] HMO Contractors & thier affiliates ] committed its acts [ Hospital Insurance Fraud T42CFR417 Anti-dumping Violation ] should be investigated and should be resolved separately from the entity's liability. Public Official Criminal Misconduct/Consumer fraud/etal.
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1998 –U.S.Attorney & DHHS Office of Inspector General – T18CFR371Crime Illegal Agreement – ecomonic crime T18CFR286 – Concealing & Allowing Federal Hospital Insurance Fraud, for illegal HCFA State Medicaid kickback conversions – Fraud by Fright / white collar crime – illegal denial of Medically Necessary Services of Federally 'Covered' Claims, through criminal use of the 'DHHS T42CFR417 HMO Government Grievance 'Service' – resulting in serious bodily injury or death.
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1998 –U.S.Attorney & DHHS Office of Inspector General Health Care Fraud and Abuse Control [ DHHS T42CFR417 ] Account would be established as an expenditure account within the Federal Hospital Insurance (HI) Trust Fund.
.
—————–
.
"SiCKO": The Profits of Life and Death
By Sari Gelzer
.
Moore shows the American healthcare system thru the lens of insurance
company whistleblower Dr. Laure Peeno, who testified before Congress that
she "denied a man a necessary operation and thus caused his death." She went
on to say that her actions were rewarded: "This secured my reputation and it
ensured my continued advancement in the healthcare field."
.
——————————————
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Why is it that the News Media refuses to show the White Collar Crime/Administrative Fraud regarding Felony Federal Health Care Offences against American Citizens ?
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We can't stop Federal Health Care Fraud & Abuse without your help.
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Denial of necessary services [ DHHS T42CFR417 ] is fraud by fright/white collar crime, whereas DHHS Employees, Federal HMO Employees and OPM FEHBP [ other federal contractors/TRICARE etal ] Employees are protected from federal prosecution for Federal HMO Hospital Insurance Fraud.
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1998 — HEALTH CARE FRAUD AND ABUSE CONTROL PROGRAM [ subject to prosecution ], under the Joint Direction [ T18CFR371-illegal agreement to induce forfiture of Hospital Insurance Benefits DHHS T42CFR417 Anti-dumping violation ] of the ATTORNEY GENERAL and the Secretary of [ DHHS ] the Department of Health and Human Services (HHS)(1), acting through the Department's [ OIG ] Inspector General (HHS/OIG), Designed [ HMO Grievance Procedure T42CFR417 criminal denial of covered Hospital Insurance claims/Volentary Disclousure/SELF-Audit Program ] to coordinate Federal, State and Local Law Enforcement activities [ misprison of a felony / defrauding federal health insurance programs OPM FEHBP CITE: 5CFR890.105 ] With Respect to ( Claims ) Health Care Fraud and Abuse. Misprison of a felony T18CFR24CRIME.
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1998 — The Health Care Fraud and Abuse Control Account would be established as an expenditure account within the Federal Hospital Insurance (HI) Trust Fund.
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CITE- 18 USC Sec. 1518 01/02/01-EXPCITE- TITLE 18 – CRIMES AND CRIMINAL PROCEDURE PART I – CRIMES CHAPTER 73 – OBSTRUCTION OF JUSTICE-HEAD- Sec. 1518. Obstruction of criminal investigations of health care offenses -STATUTE
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1998 Health Care Fraud and Abuse Control Program –INDUCED FORFITURE — Hospital Insurance Fraud – enacted by Hospital DHHS Employees ' discharge procedures/anti-dumping violation/felony fraud/intent to harm- TITLE 42-[ DHHS ]-PUBLIC HEALTH HUMAN SERVICES PART 417-[ Federal HMO ]-HEALTH MAINTENANCE ORGANIZATIONS, [ Special Services / misprison of a felony ] Subpart B-( HMO )- Qualified Health Maintenance Organizations: " Services " (g) Grievance procedures: DENIAL OF Existing OPM FEHBP HMO Hospital Insurance Services [ DHHS Anti-dumping violation for criminal HCFA Medicaid kickback conversions ]. (h) " Special " rules : Enrollees ( Covered Individuals ) under the Federal Employee Health Benefits Program ( FEHBP ). An HMO that accepts enrollees under the ( OPM ) FEHBP (Chapter 89 of title 5 of the U.S.C.) may obtain and retain Federal qualification if….[ 1998 OIG Volentary Disclousure Program/illegal agreement to Induce Forfiture DHHS enactment T42CFR417-criminal denial of OPM FEHBP Hospital Extended Care Benefits w/OPM FEHBP CITE: 5CFR890.105 criminal denial of covered claims - approx Value $288,000 each defrauded individual / ' General Public ' - to force criminal HCFA Medicaid kickback applications/conversions -T42CFR417 DHHS employee and Federal HMO employee Hospital Dumping ]
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DHHS & Federal HMO T42CFR417 'grievance procedures' – denial of Covered Hospital Insurance Benefits & Services, to induce forfiture of existing Federal HMO Insurance to Force illegal HCFA State Medicaid kickback conversions. …..
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1999 RULES & REGULATIONS Part IV DHHS OIG 42 CFR Part 1001 . Federal Health care Programs: ( OPM FEHBP ) . Fraud & Abuse Anti Kickback Statutes Sect 1128B(b) of the Social Security Act provides criminal penalties for individuals [ DHHS employees ] or entities [ Federal HMO employees ] that knowingly & willfully [ DHHS & Federal HMO T42CFR417 Anti-dumping Violation ] offer [ illegal medicaid application ], pay, solicit [ illegal medicaid application ], or recieve renumeration to induce [ DHHS inducing forfiture Existing OPM FEHBP Hospital Insurance T42CFR417 for criminal HCFA Medicaid kickback conversions ] the referral of business reimbursable under a Federal Health Care Program ( including Medicare & HCFA Medicaid ). Section 2 of the Medicare and Medicaid Patient & Program Protection Act of 1987 ( MMPPPA )
.
The Federal HMO Programs affected by DHHS T42CFR417/T18CFR286 Hospital Insurance – Fraud by Fright / White Collar Crime – resulting in death by criminal denial of covered T42sec409.33/posthospital extended care Claims – are:
.
Medicare
Medicaid
OPM FEHBP
CHAMPVA
TRICARE (including coverage provided by the Uniformed Services Family Health Plan)
TRICARE-for-Life
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The criminal liability of individuals ( Law Enforcement Officials ) through whom the entity ( Federal [ OPM FEHBP etal ] HMO Contractors & thier affiliates ) committed its acts ( Hospital Insurance Fraud T42CFR417 Anti-dumping Violation ) should be investigated and should be resolved separately from the entity's liability. ( Public Official Criminal Misconduct/Consumer fraud/etal ).
.
DHHS OIG News Release 21 October 1998
Volentary Disclousure of Health Care Fraud > 1998 – ATTORNEY GENERAL and the Secretary of [ DHHS ] the Department of Health and Human Services (HHS)(1), acting through the Department’s [ OIG ] Inspector General (HHS/OIG), Designed [ DHHS HMO Grievance Service T42CFR417 Anti-dumping Violation/induce forfiture/criminal denial of covered Federal Hospital Insurance claims - Illegal Agreement T18CFR371 to defraud Federal Hospital Insurance Programs and Entitled Federal Beneficiaries with respect to Claims T18CFR286Crime ].
.
The 1999 DHHS OIG Beneficiary Outreach Program, in part, encourages [ General Public/entitled/covered ] individuals to contact the HHS/OIG Hotline, 1-800-HHS-TIPS, which receives complaints of improprieties in Medicare and other HHS programs.
.
Subj: RE: HHS OIG Hotline Web Submission – 1998 AG & OIG Health Care Fraud and Abuse Control Program – Volentary Disclousure-SELF-Audit Program – misprison of a felony/T18CFR371/1999 beneficiary outreach program.
Date: 2/13/2003 10:29:22 AM Eastern Standard Time
From: hhstips@oig.hhs.gov (Tips, HHS)
To: Kstbylite1@aol.com
Ms. Kimball:
This is in response to your email of February 5, 2003, regarding the [ DHHS -employee- Denied T42CFR417 ] health care coverage [ Federal HMO -employee- Denied T42CFR417 Region V HCFA ] for your [ OPM FEHBP Hospital Insurance Fraud/Dumping Victim ] deceased mother.
Although WE ACKNOWLEDGE that you have SERIOUS CONCERNS [ Hospital DHHS Workers conducting HMO Hospital Insurance Fraud - T42CFR417 Anti-dumping and Anti-kickback violations Against Retired FEHBP to Force criminal HCFA Medicaid kickback conversions ], it is our judgment that the issues [ Federal Hospital Insurance Fraud ] do Not fall under the Jurisdiction of the Office of Inspector General.
Since your mother was a federal employee ( Covered Individual ), her FEHB would have been administered by the the Office of Personnel Management (OPM). If you contend that her FEHB [ Federal HMO Contractor ] insurer failed to [ Supply -DHHS and Federal HMO 'Service'-T42sec417 DENIAL of Existing OPM FEHBP Hospital Insurance ] pay for contracted services, OPM would be the proper agency to handle [ SELF-audit CITE: 5CFR890.105 criminal denial of COVERED Claims ] your ( Criminal ) complaint.
Inspector General’s Hotline – [ illegal agreement to induce forfiture of existing federal insurance for criminal HCFA Medicaid kickback conversions T18CFR371Crime ].
.
THE MEDICAID FALSE CLAIM ACT (EXCERPT)Act 72 of 1977
400.603 Application for, or Determining Rights to, medicaid benefits; false statement or false representation of material facts; concealing or failing to disclose certain events; felony; penalty. [M.S.A. 16.614(3) ] …………. DHHS T42CFR417 Hospital Insurance Fraud by Fright /Anti-dumping violation and OPM T5CFR890.105 Criminal DENIAL of COVERED Hospital Insurance Claims to Force illegal HCFA Medicaid Kickback Conversions – misprison of a felony ‘grievance procedures’ DHHS & Federal HMO Hospital Dumping.
.
1998 — The Health Care Fraud and Abuse Control [ DHHS OIG Volentary Disclousure of felony Federal Hospital Insurance fraud and abuse ] Program — subject to prosecution T18CFR1001 Color of Law/misprison of felony – Criminal Denial of posthospital extended care services T42CFR409.33 against the Elderly DHHS T42CFR417 results in death.
.
Read the October 2006 Health and Human Services (HHS) Office of Inspector General report on Medicaid payments for deceased beneficiaries – for more insite into the Criminal Abuse [ Federal Hospital Insurance Fraud T42CFR417 ] Against Elderly American Citizens with Federal HMO Policies.
.
The Largest Retirement Savings Plan in the U.S.A. with 1.8 million FEDERAL EMPLOYEE contributiors. treated as a ‘ trust ‘ fund, exempt from taxation ( Tax Reform Act of 1986 Section 1147 Title 26 U.S.Code 7701 ( j ). THRIFT SAVINGS PLAN ( TSP ) G Fund ( gov securities investment fund )
.
Retired OPM FEHBP Health Insurance Preiums are taken out of Retiree Checks Befor they recieve thier checks. These ‘ Federal Beneficiaries ‘ are paying for ‘Hospital Extended Care Benefits’/Services, that has not been available to them since the 1998 DHHS OIG Volentary Disclousure Program was created to defraud them of that benefit – DHHS T42CFR417 automatic denial of Hospital Insurance Benefts, to force illegal HCFA State Medicaid kickback conversion – eligibility / Poor.
.
CALL THE HEALTH CARE FRAUD HOTLINE
202-418-3300
OR WRITE TO:
The United States Office of Personnel Management
Office of the Inspector General Fraud Hotline
1900 E Street, NW, Room 6400
Washington, DC 20415
.
Office of Inspector General – Misprison of a felony – T42CFR417 ‘ grievance service ‘ Hospital Insurance Fraud
Office of Personnel Management – CITE: 5CFR890.105 criminal denial of Covered Claims
Joseph Frech investigator – illegal agreement w/U.S.Attorney General & DHHS OIG Volentary Disclousure / Self-Audit / misprison of a felony – Program
dtd: 9 may 2002
.
” The matters discribed [ Anti-dumping and Anti-kickback Violations - Hospital Insurnce Fraud resulting in Death of a Retired FEHBP ] in your letter are not within the jurisdiction of this office. The OIG had also recieved information regarding your case in September 2000. At that time we determined that the [ OPM FEHBP ] Health Benefits Contracts Division has sole jurisdiction over [ SELF-Audit ] your ( criminal ) complaint. The decision made by the contracts division is final and The OIG will NOT Investigate. ” [ OPM FEHBP Contracting Divisions assisting, allowing & concealing CITE: 5CFR890.105 felony federal health care offences against Retired FEHBP ].
.
OPM FEHBP [CITE: 5CFR185.104] PROGRAM FRAUD Sec. 185.104 Investigation. (d) Nothing in this section modifies any Responsibility of an Investigating Official ( OIG ) to Report Violations of Criminal Law [ DHHS Anti-dumping & Anti-Kickback Violations T42CFR417 Against Retired 'Entitled' Federal Beneficiaries CITE: 5CFR890.105 for criminal HCFA Medicaid kickback conversions T18CFR286 ] to the U.S.Attorney General.
.
Office of Inspector General – Misprison of a felony T42sec417 Hospital Insurance Fraud
Office of Personnel Management – CITE: 5CFR890.105 criminal Denial of Covered Claims
Dated: 14 May 2003
Joseph Frech Investigator – T18CFR371 illegal agreement to defraud Entitled Individuals and Federal Health Care Programs with respect to claims
C 03-206 Quote:
.
” Your only recorse is to file suite against the Office of Personnel Management in Federal Court. ”
.
1998 – ATTORNEY GENERAL and DHHS OIG Designed [ illegal agreement to induce forfiture of Existing Federal Hospital Insurance Services ] the HMO Grievance Service T42CFR417 criminal denial of covered Federal Hospital Insurance claims – misprison of a felony federal health care offence
.
OPM TITLE 5 > PART III > Subpart G > CHAPTER 89 > Sec. 8912. Prev | Next Sec. 8912. – Jurisdiction of courts – The District Courts of the United States have Original Jurisdiction, concurrent with the United States Court of Federal Claims, of a civil action or claim against the United States founded on this chapter.
.
UNITED STATES DISTRICT COURT
FOR THE EASTERN DISTRICT OF MICHIGAN
Chambers of Honorable George Caram Steeh
United States District Judge [ Appointed by Clinton 1998 ] 1998 AG and DHHS OIG ‘Health Care Fraud and Abuse Control / Volentary Disclousure of Health Care Fraud Program’ for Federal Contractors to defraud the United States and Covered Federal Beneficiaries -DHHS T42CFR417- with respect to Federal Hospital Insurance Claims T18CFR24CRIME.
.
Kimberly Kimball
vs
Office of Personnel Management OIG
& The State of Michigan
.
Case # 03-75161
.
The lawsuite was dismissed [ Obstruction of Justice - misprison of a felony ] by the District Court, SUA SPONTE [ without the litigants having presented the issue for consideration / T5CFR890.105 denial of Entitled Judicial Review ],for amoung other things ‘Lack of Jurisdiction’ in JANUARY 2004.
.
EASTERN DISTRICT OF MICHIGAN Chambers of Honorable George Caram Steeh -T18CFR371Crime misprison of felony: DHHS T42CFR417 Federal Hospital Insurance Fraud.
.
MAY 2004
.
Subject: FBI Response
Date: 5/26/2004 10:26:33 AM Eastern Daylight Time
From: tips11@fbi.gov
Reply To:
To: LawISAmootIssue@aol.com
CC:
BCC:
Sent on:
Sent from the Internet (Details)
.
Dear Ms. Kimball,
.
THIS IS NOT AN AUTOMATED RESPONSE
Thank you for your submission to the FBI Internet
Tip Line. After a careful evaluation of your
information, it is our determination that your
complaint should be reported to your Local Law
Enforcement authorities or District Attorney’s
office. If you wish pursue legal matters against
the hospital you should contact an attorney.
.
LOCAL LAW ENFORCEMENT: Government/Grievance/Inquiry Unit -T42sec417 illegal agreement Misprison of a felony / Hospital Insurance fraud
.
Michigan Attorney General – health care fraud division # 2002-04-0925 – Mike Cox / Jennifer Granholm <~ Former U.S.Attorney / Current Governor
Health Care Fraud Division # 99-05-1034 January 2000 Linda Damer
Insurance Bureau [ OFIS ] #31302-001 March 2000 Cindy Mielock , Kristie Tabor
Liscensing Division #68-99-3073-00 april 1999 Cynthia Samuel – victim still living
Bureau of Health Systems #990759 april 1999 Mary Duncan – victim still living
ACE Eastern District Ellen Christensen USAO refused to investigate 2001 – T18CFR286/T18CFR371.
.
USAOs continue to cooperate closely with numerous federal, state and local law enforcement agencies who are involved in [ 1998 AG & OIG - ' Health Care Fraud and Abuse Control / Volentary Disclousure of Federal Health Insurance Fraud [ induced forfiture for illegal kickback conversions into Other Federal Programs ] Program – T18CFR371 illegal agreement / misprison of a felony T18cfr24crime ] the prevention, evaluation, detection, and investigation of health care fraud. In addition to the HHS/OIG and HCFA, these agencies include the State Medicaid Fraud Control Units; Inspectors General Offices of other federal agencies; the Drug Enforcement Administration; Department of Defense, Defense Criminal Investigative Service; and the TRICARE Support Office in the Department of Defense.
.
1998 –U.S.Attorney & Office of Inspector General – Health Care Fraud and Abuse Control Account would be established as an expenditure account within the Federal Hospital Insurance (HI) Trust Fund.
.
18 USC Sec. 24 01/02/01-EXPCITE- TITLE 18 – CRIMES AND CRIMINAL PROCEDURE PART I – CRIMES CHAPTER 1 – GENERAL PROVISIONS-HEAD- Sec. 24. Definitions relating to Federal health care offense-STATUTE-
.
U.S.Justice Department workflow number 7 1998 2
.
14 February 2005
U.S.Department of Justice
Executive Office for United States Attornies
Washington DC 20515
.
Dear Congressman Stupak:
.
Regarding: CITE: 5CFR890.105 Filing for Denied Covered Claims/misprison of a felony
.
Judicial Review Denied – CITE: 5CFR890.105 misprison of a felony/T18CFR371
.
Violation of Crime Victims Rights – Under federal law [42 U.S.C.10606(b)] and also 42 USC 1983. Civil action for deprivation of rights and The U.S. Constitution: Fourteenth Amendment.
.
" This is in responce to your letter to William E. Moschella, Assistant Attorney General for Legislative Affairs, on behalf of your constituent, Mrs. Kimberly Kimball. We apologize for any inconvience our delay in responding may have caused. "
.
"We have carefully reviewed the issues raised in Mrs. Kimball's letter, " [ FEHBP killed during the commission of a felony as threatened - T42CFR417 federal health care offence, anti dumping / anti kickback violations ]" but have found no issue upon which DOJ can provide assistance."
.
"Mrs. Kimball alledges that the ( Federal HMO ) Health Maintenance Organization that provided ( DENIED ) health care coverage ( OPM FEHBP Hospital Insurance Benefits ) for her Mother IS Engaging in Medicaid [ kickback ] Fraud, and caused [ & are concealing ] her mothers ( murder ) death, by it's use of Managed Care [ DHHS Federal HMO Service T42CFR417 Hospital Insurance Fraud - misprison of a felony T18CFR371Crime ] Grievance Procedures. "
.
" It is our understanding that Mrs. Kimball refered her allegations [ because of Public Official Criminal Misconduct T18CFR371 ] to federal law enforcement agencies charged with investigating health care fraud and that they ( OIG's ) have declined further investigation after due consideration. " [ Obstruction of Justice T18CFR1518 ]
.
"In addition, we note that public records reflect that your constituent filed a lawsuite in the Eastern District of Michigan [ PER CITE: 5CFR890.105 Judicial Review ] asserting these and other allegations ( RICO ) against the Office of Personnel Management ( OPM ), which contracted with the health insurance carrier [ OPM Hospital Insurance Service Contractor - affiliate - Health Alliance Plan Detroit MI ] that Apparently Denied coverage of her mother. " [ Felony Hospital Insurance fraud resulting in death by criminal denial of covered claims/posthospital extended care services- Fraud by Fright/White Collar Crime ]
.
"As you may be aware, the United States Attorney's Office generally do NOT investigate allegations of crimes [ LIE ], but rather Prosecute cases developed by investigative agencies."
.
The criminal liability of individuals [ Law Enforcement Officials ] through whom the entity [ Federal [ OPM FEHBP etal ] HMO Contractors & thier affiliates ] committed its acts [ Hospital Insurance Fraud T42CFR417 Anti-dumping Violation ] should be investigated and should be resolved separately from the entity's liability. Public Official Criminal Misconduct/Consumer fraud/etal.
.
"We are sorry that We Cannot be of further assistance ( Title 18 U.S.C. § 4. Misprision of felony/T18CFR371 illegal agreement to Allow fraudulent insurance acts against Elderly Hospitalized American Citizens with Federal HMO Policies ) in responding to your constituent. Please do not hesitate to contact the Department of Justice if we can be of assistance in other matters."
.
Sincerely,
Marry Beth Buchanan, Director
Executive Office for United States Attornies
.
T18CFR1518 Obstruction of Justice T18CFR371– 1998 DHHS OIG & U.S.Attorney – Health Care Fraud and Abuse Control / Volentary Disclousure Program: criminal denial of covered / Existing Federal HMO Hospital Insurance Claims resulting in death of Federal Beneficiaries
.
Subj: RE: US Attornies conceal Hospital HMO Insurance fraud
Date: 9/22/2005 1:47:54 PM Eastern Daylight Time
From: NewCase.ATR@usdoj.gov
To: LawISAmootIssue@aol.com
Sent from the Internet (Details)
Dear Ms. Kimball:
Thank you for contacting the Antitrust Division of the U.S. Department of Justice. Upon review of your email, we have determined that your complaint does not fall under the purview of the Division.
Thank you for your interest in the enforcement of federal antitrust laws, and we wish you the best in resolving your concerns.
Sincerely,
New Case Unit
Antitrust Division
.
Homeland Security and Governmental Affairs
.
Subj: Re: Your Concerns
Date: 3/26/2007 1:16:37 PM Central Standard Time
From: senator_levin@levin.senate.gov
To: JustmyOpnion@aol.com
Sent from the Internet (Details)
Dear Mrs. Kimball:
Thank you for sharing your thoughts with me regarding HMO [ Hospital ] dumping. I will certainly keep your thoughts in mind should this issue come before the Senate.
Best wishes.
Sincerely,
Carl Levin
.
Sincerely,
.
All Entitled Federal Employee Health Beneficiaries being criminally denied [ DHHS T42CFR417 ] Existing Federal Health Insurance Coverage Title18CFR1001Crime
I wonder if anyone would find it interesting to read the court decision regarding Michael Moore’s indictment of Kaiser Permanente? Look it up on the web under Dawnelle Barris versus Los Angeles County.
See, King/Drew hospital and the doctor on duty were found guilty of malpractice and “dumping” in the Mychelle Williams case. Mychelle mother, Dawnelle Keys (later Barris) won the case. King/Drew hospital is a government owned and operated facility. Wonder why Moore didn’t mention that?
Wonder why Moore didn’t mention many other facts too? Experimental treatments are no way to prove a case for UHC.
Consumerism and Wellness Programs are the Solution to the National Healthcare “Crisis”
“The topic that is currently receiving a large portion of media attention is healthcare” explained Rick Knox, Vice President of Knox Associates “I honestly do not look at our country as having a healthcare crisis; With one out of every eight national healthcare dollars being spent on the treatment and management of diabetes (estimated at $79 billion dollars) coupled with who knows how much is being spent on the treatment and management of heart disease – both conditions having a high percentage prevention rate – I look at our country as having a “Lifestyle Crisis.”
“This so called “healthcare crisis” that is being sold to the America public is just more political propaganda. I am not saying that we do not have issues with American healthcare, but the “fix” is not a single payer socialized program. A significant portion of the fix is Americans taking responsibility for their own actions and behaviors, and unfortunately a large portion of Washington Politicians do not believe in the American People.” explained Knox.
Consumerism, wellness and disease management programs start at the employer level. Consumerism is defined as anytime the insured/employee has a choice. The best example of how this works is with prescription drugs. Health insurance carriers are providing more and more information on drug pricing and drug alternatives. When the consumer sees the true cost of prescription drugs they are more likely to try a lower priced alternative or generic option. When the alternative drug is successful in treating their ailment – the consumer wins by saving money. In the more traditional co-pay type health plans, the consumer has zero incentive to move to a lower cost alternative and the drug companies win.
With wellness and disease management, the employer implements a program that provides incentives for the employee to visit a doctor for annual check-up’s and take Health Risk Assessments (HRA’s). Those employees who are at risk would then enroll in disease management programs through a Health Coach in order to better his/her lifestyle. Taking Type II Diabetes as an example, an employee would work with the coach (usually a registered nurse) to implement a diet and exercise program that would help the employee manage their condition. Through early detection and diagnosis we prevent those large dollar claims that are causing our healthcare spending to spiral out of control.
Thanks for the great article and information about health insurance. More and more employers are going with higher deductible plans to make health insurance costs more affordable. Some people still go with low deductible or HMO plans, but PPO is more popular lately.
As many emails my family and I have received across America, I can tell you one thing America needs healthcare reform. There are way too many people who have insurance and find they are not covered or better yet find they have a pre-existing condition…some can’t even afford healthcare. Isn’t it the moral thing to do and make sure all citizens of our great country get the healthcare they so desperately need?
My family and I are actively trying to have H.R. 676 endorsed. If you believe every American has the right to healthcare please sign our petition! We are presenting to several state representatives in September and need support on this ongoing problem.
Wake up folks. We are supposed to be the greatest nation in the world and yet Europe is leaving us in the dust. We overwork our employees to the point of exhaustion. We give them little or no vacation (compare with Europe), we expect them to be ultra-productive and when we manage to squeeze more productivity out of our workforce + productivity = more work = more profit. In other words, we do not reward the worker, we find more work for them.
Insurance is out of hand. Hard working people cannot afford the policies and if you have a pre-existing condition or get cancer or another life-threatening conditon. Good luck fightng with the insurance company and good luck trying to figure out your bills. God help you.
I ran a successful consultancy in the UK. We paid NI & PAYE for ourselves and our employees. They received 4 weeks holiday the moment they were hired.
National Health Insurance? If you go to the physician, there is no bill, no paperwork. If there is a medical emergency, you are cared for immediately. If you need something that isn’t life-threatening, you may need to wait a month or so (depending on the problem/treatment), but it will be sorted.
You cannot be denied healthcare. You keep your insurance if you lose your job. You do not have to worry about losing your home if you get sick – due to high healthcare expenses. There is no co-pay. Prescriptions are supplied at your physicians office. No pre-approval crap. So what do you dislike about that folks????
I love the US and I am a patriot, but I would also love to know that I had care that was as good as what I received in the UK. Why should Europe have it better than us?
For those of you who think Canadians complain about waiting in line, etc. That is the constant drip from the Insurance industry, corporate America and Fox News. They are brainwashing you.
Go to Canada, take a poll and ask if they want to give up National Healthcare for a US profit-making insurance type healthcare system. They’ll laugh in your face.
We have a rapidly aging population and we need to get this sorted. We have way too many lobbyists (healthcare industry, drug industry, etc.) paying our politicians (campaign contributions, etc.) to vote in THEIR best interest – not the way that is best for the US citizen. Washington is heaving with bought off politicians that are political puppets for corporate America. The average citizen has no representation in Washington. This is why nothing has been done to close the border. This is why nothing has been done to ensure that high paying positions go to US workers before foreign workers. This is why corporate America demands cheap labor and the US Government hangs spanish signs in our social security offices – to help the illegals.
This is why nothing has been done to stop the sucking sound of our unloyal greedy corporations moving to China. For several years now, legislation, manipulation of the currency market, etc. has been designed to profit the rich. The middle class and poor are left in the dust. In the next couple of years, watch the rich buy up all the foreclosed properties. Soon the rich will own you and you will be their slaves.
So for those of you above who dog Moore and praise corporate America, you OBVIOUSLY are doing fine financially. Let’s face it, those folks driving their luxury cars, bypassing the poor neighborhoods to get to their luxury homes – do not give a monkeys ass about the Middle and lower classes which is why they have adopted the attitude “I’m fine Jack and that’s all that counts”. Until they end up on their backsides, they will fight aganst change. Bravo Michael Moore, you got it right this time.
I agree with Gooby. Health care in one thing (perhaps of many things) the for profit system cannot do right.
Doctors, CEOs, and all others at the top of this food chain make way more than they should.
The result, less care for more money. At least for the poor.
The biggest misconception I find at health-care reform meetings is this “We all pay for the unisured’s bills” Not true. I am unisured and believe me, most of us pay more than those with insurance. If you own anything, you will pay that bill in its entirety.
In NYC it’s easy to get treated for anything you want.
All you have to say is one word………LAWSUIT.
Think I’m kidding?Half of the hospitals in NYC are now bankrupt.
Health care fraud is a booming industry. Something needs to be done about it as we, the taxpayers, end up paying for all of it.
Here’s a great article on the newest form of healthcare fraud and scams – monopolistic in house laboratory and medical services – you need to read this as it will affect you:
New health care frauds and what to watch out for from Bestbraindrain.com
B. Tish
I agree with most of the review provided above. The key point that you and Moore point out is that “we are all in the same boat” (i.e. we’re all human and will get sick and die).
For our society, with all its power and money, to have 46 million uninsured people is absolutely insane.
Healthcare is broken. Can someone please develop a “needs to be radical” plan to fix it???
I’m not sure this was covered, but I do want to comment on the MD salary in the USA, and why it is actually important to keep it high.
Every country has a limited amount of natural resources, be it coal, gold, ability to grow crops, etc… Well one of these natural resources that is frequently over looked is the hard working brilliant mind.
What we choose to do with these resources is vitally important to our way of life. If we squander our fuel sources we become increasingly dependent on foreign interests. If we let all our crops die we starve. If we do not encourage our best and brightest to choose a field like medicine they will likely seek other interests (like law school). The problems with that don’t need to be mentioned.
So how do we keep our best and brightest pointed in the right direction??? Money. The great motivator. How else are you going to get these men and women to work really hard and sacrifice for four years hoping to be good enough to get into medical school, only to work even harder and sacrifice even more to get a good residency, only to be paid near minimum wage to work 100 hr weeks for 3-5 years??? Not to mention the $100,000 plus debt you inherit while going through these 12+ years of higher education. The only way to do it is the promise of a fancy sports car and 6 bedrooms in their houses.
I agree that health care should be affordable and available to all, but if it has to be done in a way that does not lower the MD salary. If this happens you will have no one in the hospital to give the health care, and the country will be full of brilliant lawyers doing what they do best.
Funny, I always felt the same way. I opened a practice in a small town with the ideal that I was a community resource and if I provided the community with health care I would be taken care of. Two and a half years later I had to close (after about six months of paying myself $143/wk) because the reimbursement system is no where close to sports cars and six bedroom houses. To straighten out the numbers a bit, your average medical school student has a school loan debt of $250,000!!! that is about 2K a month in repayment. Because I tried to open a pracitice and support it while I got it going I actually owe about 3/4 of a million and I am bankrupt. By becoming a Doctor in this society I have not only mortgaged my future but also that of my children.
Looking for some passionate people with web cams,
to join the debate answer this question, in a video.
The Federal Government should provide free health care for all Americans.
Do you agree? yes or no,
Tell us why, make a video. Use a web-cam or camcorder be funny be creative use animation, clay-mation, wear a mask, make a sock puppet or just stand in front of a blank wall and make your point. Post the link in the comment section on:
http://videodebater.com/?p=17
Health care | VideoDebater.com
In a single payer universal healthcare system, a possible solution to the physician reimbursement question is to have most physicians salaried or to create a salary cap. Not popular for sure, but clearly effective in eliminating “overtreatment”. Such is the case in various provinces in Canada, for example.
As a first-year medical student, getting a combined MD/MPH degree, I am learning about and debating these same issues in my public health classes with my co-degree classmates. The decaying state of our nation’s health care system and the national burden of health spending is appalling and disheartening. From reading “To Err is Human” to discussing the different insurance and payer systems, we are learning the key basics to health services in the US, and how they differ from comparable foreign systems. What is even more shocking, however, is that my fellow medical students in my school and in schools across the nation, are not learning this too. Medical school curriculums do not include any courses on the health care system, health financing, or health policy. The national board exams ask no questions about these topics. Yet all doctors will be facing these issues every day they practice, and thus we are graduating top physicians who lack an understanding about the system they are working in. It is no surprise to me that some of the resistance to a single-payer system and finance reform is coming from within the professional community. Physicians are isolated from these issues until they are fully engrained in the profession and are benefiting from the existing institutions, and thus it is no surprise that they are hesitant to have their system reformed from outside forces.
Taken with a grain of salt, I even wish at least “Sicko” was shown on the first day of classes. We need something as a wake-up call. Regardless of differing opinions of its political message, it can be agreed to be an important film for starting a conversation about the health care crisis we face, and there is no better time to start talking about it then when we first enter the field. Fundamental change must include change from within the profession, and an essential piece is that we start educating our physicians about the system they work in.
As a veteran, I had to wait 8 months after I came back from OEF to receive sub-standard care for a minor injury, and now I believe universal health care isn’t something we should be paying for- it is a right to be treated fairly, especially medically. Between Medicare and the beauracracy of the Veteran’s Administration Health Care System, we are already paying a lot of the cost that could go to universal health care.
If we also had a universal health care system, many of the individuals that don’t have health care would be paying into it anyways. There would be less sick and more working which would cause a stronger economy. That would feed back into paying for itself.
You know, I may be a little wrong, I might be a little right in what I’m saying, but one thing is for certain- what we have now is wrong. It is not okay for this system to carry on like it is. Too many people are dying over stupid things that could be taken care of.