Editor's Note -
Apparently, the following clipping is not a joke!
-SPC
Man Says He Killed His Wife Because He Couldn’t Pay Her Medical Bills
Ronnie Wiggs, of Independence, Mo., was charged with second-degree murder in the strangling death of his wife, who was in the hospital for dialysis treatment, records show.
by Jesus Jimenez - NYT - May 8, 2024
A Missouri man charged with strangling his wife told the police that he had killed her while she was lying in a hospital bed because he could not take care of her or pay her medical bills, prosecutors said.
The man, Ronnie Wiggs, 75, of Independence, Mo., appeared in court on Monday on a second-degree murder charge, records show. A hearing has been scheduled for Thursday to review his bond of $250,000.
Ellen Wiggs, 72, had been admitted to the Centerpoint Medical Center in Independence, a suburb southeast of Kansas City, Mo., for a new port for her dialysis, according to charging documents and other public records.
At about 7:30 p.m. Friday, Ms. Wiggs, was seen in her room “alert and oriented,” according to court records. Around an hour later, records show a “code blue” call, a hospital announcement that typically means a patient is in cardiac or respiratory arrest. She was unresponsive and did not have a pulse, according to charging documents.
Afterward, “suspicious injuries” were seen on Ms. Wiggs, including redness on her neck and a wound in the middle of her throat, charging documents said. A witness told the police that her injuries were not caused by efforts to save her, records show.
Ms. Wiggs was moved to the intensive care unit, where medical staff members were able to restart her pulse. But after she was found to have no brain activity, hospital workers began preparing to harvest her organs, records show. She was pronounced dead the following morning.
At some point, Mr. Wiggs was overheard by hospital workers saying, “I did it, I killed her, I choked her,” according to the charging documents.
A hospital spokeswoman did not immediately respond to a request for comment on Tuesday.
A lawyer for Mr. Wiggs had not been listed in court records. The Jackson County prosecutor’s office declined to comment on Tuesday.
Mr. Wiggs left the hospital after the attack, but he was later brought back by a relative after his wife was found unresponsive, according to the charging documents.
Mr. Wiggs told the police that he had killed his wife by choking her, placing his hands around her neck and his thumbs on her throat, and that he had covered her mouth and nose to keep her from screaming, according to court records.
Mr. Wiggs told the police that he was depressed, and that he had killed his wife because he could not take care of her or afford to pay her medical bills, according to the charging documents. He also told the police that he had previously tried to kill his wife on two occasions.
Once, Mr. Wiggs told the police, he had tried to kill her when she was in a rehabilitation facility, but she woke up and told him not to do so. Another time, he told the police, he wanted to try to kill her, but he didn’t get the chance because she was hooked up to several machines at a hospital.
https://www.nytimes.com/2024/05/07/us/missouri-wife-murder.html
A Hospital Heist Seeks Protection in the Ponzi-Friendliest Court in America
A massive chain of crumbling safety net hospitals that Sen. Elizabeth Warren (D-MA) has described as a “ponzi scheme” filed for bankruptcy protection today in the notoriously “debtor friendly” Southern District of Texas bankruptcy court, bringing new urgency to the glacial effort—inasmuch as one exists—to stabilize the hospitals’ finances and bring their jet-setting plunderers to justice.
The hospital chain in question is, of course, Steward Health, a Boston-born, Dallas-headquartered collection of about 30 nightmarish hospitals mostly located in Florida and Massachusetts, from which insiders have siphoned well over $1 billion. Steward now owes nearly $300 million in unpaid compensation to physicians and other staffers and about $558 million to its top 30 non-insider creditors, including the Center for Medicare and Medicaid Services.
The bankruptcy court is the Houston-based “complex cases panel” in Texas’s southern district, founded by the notorious Judge David R. Jones, who resigned in disgrace last fall after a small creditor in the bankruptcy of the oilfield services firm McDermott International revealed in a court filing that Jones was the live-in boyfriend of one of the attorneys working the bankruptcy, as well as dozens of others over which he had presided. In just one of the many details that connect the two scandals, McDermott’s then-chief financial officer John R. Castellano has been named Steward's chief restructuring officer.
As the Prospect explained in our investigation of the court, the complex cases panel has for years been the foremost destination of ponzified companies seeking to avoid questions and accountability. In the alleged name of speed and “efficiency,” Judge Jones and his former law partner Marvin Isgur quickly canceled all kinds of debts owed to small businesses, asbestos-poisoned retirees, unionized workforces, and retail investors. In the process, they let off the hook private equity firms and other corrupt insiders that had looted oil and gas drillers, retailers, restaurant chains, a prison health care contractor and at least one hospital chain, Pipeline Health, whose dubious 2022 bankruptcy plan was financed by a real estate investment trust called Medical Properties Trust, which also has deep financial ties with Steward.
Enabling all this reverse wealth redistribution was the bankruptcy juggernaut Kirkland & Ellis, which the aforementioned creditor, Michael Van Deelen, has sued along with Jones for racketeering. An anonymous letter sent to the Prospect in March alleges that judges Jones and Isgur actually traveled to Chicago just before they established the complex cases panel in 2016 to explicitly promise Kirkland’s senior restructuring partners in person that if they began filing major cases, they would “be pleased with the result/outcome.” Not long afterward, Jones and Isgur—the only two judges in the court allowed to handle “complex” cases—were handling more big bankruptcies than any other judge in the country; in 2020 nearly half of all major corporate bankruptcies were filed in the district.
Since then, all the big-time bankruptcy law firms got into the action, many of them using a local firm in Houston called Jackson Walker. Liz Freeman, Jones’ former clerk and then mistress, became a partner at Jackson Walker and argued numerous cases in Jones’ court.
Steward’s firm is Weil Gotshal, which has filed the Chapter 11 cases of Apollo Global Management portfolio company Chuck E. Cheese, Advent International's Serta Simmons and a half dozen PE-controlled energy companies over the past few years. The Serta Simmons bankruptcy, in which Judge Jones endorsed an (allegedly illegal) deal Advent made to cram down haircuts on certain senior bondholders while privileging others, was particularly controversial, and after Jones resigned creditors sued to appeal the settlement. Steward’s lead bankruptcy attorneys, the $1,500 an hour Gabriel Morgan and the even pricier Ray Schrock, also handled the Serta Simmons restructuring.
Jones resigned from the bench in October, but his replacement is unlikely to differ too much from him ideologically: Alfredo Perez is a former Weil Gotshal partner. Steward’s bankruptcy has been assigned to Christopher Lopez, the panel’s rookie third judge, but Lopez frequently assigns his fellow bankruptcy judges to mediate disputes between creditors. So it’s possible that Perez will be invited in to deal with matters pertaining to a case brought by his former firm.
Steward is based in Dallas, not Houston, though unlike Sorrento Therapeutics and other recently bankrupt companies whose only asset in the district when they filed Chapter 11 was a UPS mailbox rented by a Jackson Walker attorney, the chain still operates a troubled hospital in downtown Houston that has been sued for nonpayment by five different vendors in 2024 alone.
AS THE PROSPECT has detailed extensively in previous articles, Steward was the 2010 creation of a narcissistic cardiac surgeon named Ralph de la Torre and the private equity firm Cerberus, which even at the time had a well-established track record of bankrupting portfolio companies for profit. Together they bought up distressed hospitals from Boston to Youngstown to Utah, mortgaged their assets to the hilt, and stiffed doctors, construction contractors, staffing agencies and even the lunchmeat company at one hospital cafeteria to make their interest payments and pay De La Torre’s inflated salary, which one individual familiar with Steward’s finances estimated at around $16 million per year.
The hospitals languished without the substantial capital investment required to maintain and upgrade facilities. De La Torre’s supposedly disruptive “business model” began to look increasingly like a dangerous kickback scheme, and then in 2016 Cerberus sold its hospital buildings to Medical Properties Trust for more than twice their assessed value and pocketed the proceeds for their investors. The hospitals themselves were left reeling under the weight of impossible lease payments.
Steward launched a quixotic expansion effort largely financed by MPT, picking up hospitals discarded by other private equity-owned chains and launching an international division supposedly aimed at converting state-owned hospitals overseas to destinations for “medical tourism.” Steward International’s first big venture involved privatizing three hospitals owned by the government of Malta, where prosecutors would eventually accuse Steward of defrauding the government of 400 million euros and using much of it to pay off various shell companies linked to cronies of the then-prime minister and his corrupt chief of staff Keith Schembri, who worked closely with Steward execs to fast-track the deal and was later charged with fraud, corruption and money laundering. In 2017 a friend and business partner of Schembri's paid two men to assassinate an investigative journalist who had been scrutinizing the hospital deal on her blog; Steward was eventually exiled from the tiny country.
Steward stiffed doctors, construction contractors, staffing agencies and even the lunchmeat company at one hospital cafeteria.
Back at home and flush with cash from the sale-leaseback, Cerberus was eager to exit Steward, which it finally managed to do in 2020 and 2021 with the help of a byzantine deal orchestrated by MPT, whereby De La Torre “bought” Steward from Cerberus for $335 million, then immediately turned around and used Steward's cash to pay himself a $100 million dividend, with which he purchased and renovated a $40 million mega-yacht. The company also acquired at least two business jets and a private suite at Dallas’s AA Arena, where the NBA’s Mavericks play.
The hospitals continued to hemorrhage cash, and cope with their problems by simply not paying their bills. Dozens of small businesses sued Steward for nonpayment of services that had been rendered well over a year or more earlier. MPT, meanwhile, used a blend of deceptive accounting tricks, slow-walking and outright fraud to conceal the fact that Steward wasn't paying its $440 million annual rent bill.
The hospitals devolved into conditions a Louisiana physician interviewed by a federal health inspector described as “Third World.” In one Florida hospital where more than a half dozen nurses contacted the Prospect, no fewer than 5,000 bats infested the top floors, forcing the intensive care unit to move down to the second floor, where a burst pipe caused most of the sinks to back up with sewage. At another Steward hospital 30 miles down the highway, a physician described being pressured by Steward brass to refuse care to Medicaid patients and remotely supervise nurses via teleconference software who were performing complex procedures they were woefully unqualified to do. In Massachusetts, a new mother died during surgery after experiencing extensive blood loss at a Steward hospital shortly after the medical device supplier Penumbra repossessed an embolism coil designed to control postpartum bleeding.
Last week, a judge in Malta ordered authorities to seize the assets of De La Torre, two Steward executives and a whole host of the cronies to whom Steward had wired funds as part of its contract to run the Maltese hospitals. But in the United States, authorities have mostly dealt with Steward by sending angry letters. Sen. Warren has penned letters to Steward, De La Torre, Cerberus, MPT and the Australian investment firm Macquarie, asking pointed questions about how many dividends they’ve collected from Steward's carcass. After badgering MPT to disclose Steward's financials to its investors for years, the SEC finally sent the REIT one final irate letter announcing it was making public all its previous letters.
Upon learning about the bankruptcy filing, the Massachusetts Attorney General Andrea Campbell issued a bland statement almost identical to one she issued four months ago about asking “questions” and demanding “accountability,” with one unintentionally amusing additional sentiment: “We expect the bankruptcy process to bring greater transparency and stability, as well as greater legal oversight over Steward’s operations than before.” Isn’t it pretty to think so!
Sadly, because bankruptcy courts supersede all other civil proceedings, “greater legal oversight” will not be an outcome of Steward’s chapter 11 filing unless someone, somewhere decides to charge De La Torre, Cerberus, Medical Properties Trust and/or their many conspirators for some of the many crimes they have committed in the process of driving more than three dozen direly needed community hospitals into the ground. If only the Massachusetts Attorney General had the power to do something like that.
In Battle Over Health Care Costs, Private Equity Plays Both Sides
As medical practices owned by private equity firms fuel overbilling, a payment tool also backed by such investors helps insurers boost their profits.
by Chris Hamby - NYT - April 27- 2024
Insurance companies have long blamed private-equity-owned hospitals and physician groups for exorbitant billing that drives up health care costs. But a tool backed by private equity is helping insurers make billions of dollars and shift costs to patients.
The tool, Data iSight, is the premier offering of a cost-containment firm called MultiPlan that has attracted round after round of private equity investment since positioning itself as a central player in the lucrative medical payments field. Today Hellman & Friedman, the California-based private equity giant, and the Saudi Arabian government’s sovereign wealth fund are among the firm’s largest investors.
The evolution of Data iSight, which recommends how much of each medical bill should be paid, is an untold chapter in the story of private equity’s influence on American health care.
A New York Times investigation of insurers’ relationship with MultiPlan found that countering predatory billing is just one aspect of the collaboration. Low payments have burdened patients with unexpectedly large bills, slashed pay for doctors and other medical professionals and left employers that fund health plans with high, often unanticipated fees — all while making the country’s biggest health insurance companies a lot of money.
Often, when someone gets insurance through an employer and sees a doctor outside the plan’s network, the insurer routes the bill to MultiPlan to recommend an amount to pay. Both MultiPlan and the insurer receive processing fees from the employer, usually based on the size of the final payment: the smaller the payout, the bigger the fees.
This business model has made Data iSight a cash cow. Of the handful of tools MultiPlan offers insurers, Data iSight consistently makes the most frugal recommendations, typically resulting in the highest fees.
MultiPlan, which has been publicly traded since 2020, did not respond to detailed questions about Data iSight. A statement issued by an outside public relations firm said MultiPlan’s payment recommendations were fair and “widely accepted.” It said the company was “committed to lowering out-of-network costs,” including by using “data-driven tools to determine fair reimbursements.”
In recent years, concern over private equity’s investments in medical practices has grown, as studies have documented rising bills. Insurers and MultiPlan say that Data iSight is a necessary counterweight.
Caught between these moneyed interests are patients, who are mostly in the dark. If they encounter Data iSight’s name, it is typically in the fine print of dense paperwork. Those who have complained said they got little more than assurances that the calculations were rigorous and fair.
For Mary Lavigne, who has chronic pain, chiropractor appointments near Irvine, Calif., almost doubled in cost. Nadia Salim’s Boston-area therapy appointments also became almost twice as expensive. And Andrew Faehnle was on the hook for more than two-thirds of an ambulance bill after his 14-year-old was rushed to an emergency room in Anaheim, Calif. In each case, insurance statements cited Data iSight.
“I thought, ‘Who the heck are these people?’” Mr. Faehnle said. “I started Googling, ‘What’s Data iSight?’”
‘The Time Seemed Right’
MultiPlan’s business model is based on simple math: Take the amount a doctor charges, subtract MultiPlan’s recommended payout, and you have what the firm identifies as a savings or discount. Usually, MultiPlan and the insurer each collect a percentage of that declared savings as a processing fee.
This arrangement helps insurers profit from the most common way Americans get health coverage: through an employer that pays medical claims with its own money, using an insurer only as an administrator. Using MultiPlan, insurers cut medical bills, then charge employers for doing so.
For decades, MultiPlan determined payments primarily through negotiations. The discounts were modest but came with an agreement not to collect more from patients.
After MultiPlan’s founder, Donald Rubin, sold it in 2006, the company’s new private equity owners began a move toward automated pricing that executives would later call “MultiPlan 2.0.”
In 2010, it bought Viant, an Illinois-based firm that used algorithms to recommend reimbursements. But for some types of care, Viant’s calculations used a database of billed amounts. So if medical providers charged more over time, the recommended payments were also likely to rise.
A small firm in Grapevine, Texas, had developed an alternative strategy. Rather than start with a bill and negotiate it down, Tom Galas, a former insurance executive, wanted to calculate the cost of care and negotiate it up.
Mr. Galas bought an analytics firm called Data Advantage in 2005 and assigned a team at his company, National Care Network, to execute his vision. The result was Data iSight.
It drew on data that medical facilities submitted to the federal government and techniques developed by Medicare to estimate treatment costs. It then threw in some extra money, meant to allow a fair profit. The goal was to save insurers and employers money without paying so little that providers would sue them or go after patients for the balance.
In 2011, Mr. Galas sold to MultiPlan.
“The industry was condensing,” he said. “The time seemed right.”
Though he considered Data iSight revolutionary, he said, even he didn’t anticipate what it would become.
‘MultiPlan Is Magic’
Executives from the country’s major insurers gathered in Laguna Beach, Calif., in 2019 and heard from Dale White, a MultiPlan executive vice president.
He presented a slide showing the cover of a self-help book, “Life Is Magic,” that had been digitally altered to show Mr. White’s face and to read “MultiPlan Is Magic.” The slide added: “We have a few things up our sleeve, too.”
The firm’s annual revenues had reached about $1 billion, and three sets of private equity investors had cashed in. After buying MultiPlan for just over $3 billion in 2010 from the Carlyle Group, the firms BC Partners and Silver Lake sold it for a reported $4.4 billion in 2014 to Starr Investment Holdings and Partners Group, which sold it two years later to Hellman & Friedman for a reported $7.5 billion.
Hellman & Friedman, which owned the company when it went public in 2020, declined to comment.
Fueling the growth was Data iSight. The annual revenue it brought MultiPlan grew from $23 million in 2012 to more than $323 million in 2019, according to an investor presentation in 2020. The next year, the chief executive, Mark Tabak, told investors that Data iSight was MultiPlan’s top moneymaker among its biggest insurance customers.
While the company continued to offer other tools, it pitched Data iSight as an “industry-leading” and “state-of-the-art” way to “maximize savings.”
For insurers, the tool came with trade-offs: lower payments but potentially more patient complaints. They rolled it out gradually. The nation’s largest insurer by revenue, UnitedHealthcare, began using it in 2016 for certain plans and treatments, documents show.
As Data iSight spread, patients, doctors and medical facilities began receiving unwelcome surprises. Some practices that had negotiated contracts with MultiPlan found that they no longer received their agreed-upon rate, and patients were no longer protected from big bills.
Brett Lockhart had spine surgery at a facility near Cocoa, Fla., that had a negotiated rate with MultiPlan. When his insurer used Data iSight, he found himself on the hook for nearly $300,000. The bill is the subject of litigation and remains unpaid.
‘Crazy Low’ Payments
There was more to MultiPlan’s rising fortunes than just an increase in the number of claims. The average fee from each claim also grew, executives told investors.
In a presentation shortly before it became a publicly traded company in 2020, MultiPlan stressed that its tools were “scalable”: Reducing payments by just half a percent could yield an additional $10 million in profits, the company said.
After MultiPlan fell short of a revenue target in 2022, Mr. White, who had become chief executive, assured investors that the company had an “action plan” that included “aggressively implementing new initiatives with our customers to help them cope with accelerating health care costs.”
A change to Data iSight’s methodology, he said, should produce an additional $6 million in revenue.
MultiPlan has told investors it plans further “enhancements” to the tools, including use of artificial intelligence.
As patients and providers have demanded an explanation for declining payments, MultiPlan has fought to keep details about Data iSight confidential, contending in lawsuits that the information is proprietary.
Interviews and documents, some obtained after The Times petitioned federal courts, offer some insights.
Data iSight starts by using Medicare’s methods for setting rates. But subsequent calculations are less transparent. MultiPlan says it applies multipliers that allow for a fair profit for hospitals and something approximating a fair market rate for physicians. The documents show that MultiPlan allows insurers to cap prices and set what they consider fair profit margins for medical facilities.
MultiPlan has pitched Data iSight as an alternative to simply paying marked-up Medicare rates, an option some insurers offer. Paying around 120 percent of the government-set rate “sounds fair, maybe even generous,” one MultiPlan document said, but this is “inherently misleading” because “the average consumer does not understand just how low Medicare rates are.”
Interviews and documents, however, indicate that Data iSight’s recommended prices are sometimes about 160 to 260 percent of Medicare rates — amounts former MultiPlan employees described as “ridiculously low” and “crazy low.”
Even rates that may sound reasonable can strain medical practices. For example, UnitedHealthcare, citing Data iSight, offered Dr. Darius Kohan roughly 350 percent of the Medicare rate for a surgery to repair a patient’s eardrum. It amounted to $3,855.36.
Dr. Kohan, who has a small practice in Manhattan, said skimpy payments were forcing him to consider joining a large hospital system or private-equity-backed group.
“I am a dinosaur, but my patients like that,” he said. “I may not be able to sustain it.”
Markey targets private equity in health care
Bernie Sanders speaks at UNE graduation, says U.S. health care system is broken
by Rachel Ohm - Portland Press Herald - May18, 2024
The U.S. health care system is broken, costs more than in other countries, and has resulted in underserved and unhealthy citizens, Sen. Bernie Sanders, I-Vt., told a crowd at the University of New England’s commencement Saturday.
More than 1,500 undergraduate and graduate students graduated Saturday from the university, which is Maine’s top provider of health care professionals and home to the state’s only medical and dental colleges.
“I wish I could tell you that the system you are entering is a system designed to allow you to do the important work you are trained to do,” Sanders said to graduates, their friends and families gathered at the Cross Insurance Arena. “I wish I could tell you that, out there, you are going to be able to move aggressively to take care of the people of our region and country in the best way possible – but if I told you that, I would be lying to you.”
Sanders, who ran for president in 2016 and 2020, delivered a commencement speech in which he spoke about the need to reform the U.S. health care system and called for change.
The 20-minute speech largely focused on the problems facing the system, though he also highlighted the graduates’ future work as an important bright spot.
“Your job – and we desperately need you – is to go out into the world and provide the best quality care you can,” Sanders said. “That’s your job, your mission, and I know you can do it.”
Sanders came as the keynote speaker after he invited the university’s president, James Herbert, to testify before a Senate subcommittee last year about the health care labor shortage.
The senator lamented on Saturday the high cost of health care in the U.S. – which he said costs almost twice as much per capita as in other countries – while noting that, at the same time, millions of Americans have no insurance or are underinsured and thus cannot access care.
As a result, the U.S. has a lower life expectancy than in other countries and a larger gap in life expectancy between the rich and poor, Sanders said. And millions of people go bankrupt because of medical debt. Others may have good insurance but are shut out from care because they live in rural and underserved parts of the country amid a shortage of doctors and other providers.
Yet despite the workforce problems, students often must take on hundreds of thousands of dollars in debt to get trained in their professions. “Between you and me, that is insane,” Sanders said to a round of applause.
Another problem Sanders sees is the employer-based insurance system, which forces people to stay at jobs they might not otherwise and which favors people who work for wealthy corporations over those in the service industry and lower-paying jobs.
“Is the worker at McDonald’s or Walmart less in need of health insurance than someone who works at a large company?” Sanders asked. “The answer is: of course not.”
Sanders, who is known for his advocacy of a national health-insurance-for-all plan, said there are some solutions to the current problems. First, he said there need to be more investments in primary and preventive care.
He also said the Medicare program can serve as a foundation for expanded insurance coverage for all Americans and all kinds of health care services, including dental and mental health care.
“We can create a system in which people can go to any doctor they want, any hospital they want, and not have to take out their wallets,” Sanders said. “That, in fact, exists in many countries around the world.”
Along with Sanders, local developer, entrepreneur and philanthropist Arthur P. Girard was recognized with an honorary degree. Girard and his family have made significant contributions to the university, including the gift of Ram Island in Saco Bay in 2014, which is used for field research by the university’s marine sciences programs.
Herbert, the university’s president, called on graduates to be innovators and find creative solutions to problems.
“Each of you has made your own special mark on our campuses and programs, and they won’t be quite the same without you,” he said. “But we know you’re ready to head into the world and apply your knowledge and skills to important endeavors.”
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