Archive for May 5th, 2010

Carriers Fear Cost Plus – Why?

Wednesday, May 5th, 2010

There is no question that health insurance companies rely on secretive agreements with hospitals to establish insurance payment rates. These agreements are well guarded. Attempts to gain access to review these contracts takes perserverence and knowing the right people.  But it can be done if one is willing to spend the time and energy necessary to crack the Code of Silence.

So why are carriers reacting as they are to the growing phenonemon of cost-plus health plans that pay hospitals their cost as reported to CMS plus a 12% profit margin?  Carriers, it seems, are at their wits ends in fighting this “corrupt” method of paying hospitals. Career sales representatives for various health insurance carriers are  seemingly beyond psychiatric redemption in contolling their uncommon angst and desperation in losing business to the cost-plus bandwagon in Texas.

It now appears that some carriers are joining with hospitals to fight the cost-plus plague.

One would wonder why that is. Dont health insurance companies want to offer the lowest cost health care to their customers that are paying them millions of dollars? After all, who do these carriers represent; their loyal premium paying customers or profit driven hospitals?

Do secretive managed care contracts have anything to do with this?

We have reviewed various carrier contracts with hospitals over the past year. We know what is in them. Do you?

Wednesday, May 5th, 2010

Early Retiree Subsidy Program

Wednesday, May 5th, 2010






Early Retirees in the Affordable Care Act Web Chat Today at 11:30 EST and See Info Below

The U.S. Department of Health and Human Services today issued regulations establishing the Early Retiree Reinsurance Program in the Affordable Care Act.  This temporary program will make it easier for employers to provide coverage to early retirees. You can find more information about this important new program by going to their website at

The Affordable Care Act includes $5 billion in financial assistance to employers to help them maintain coverage for early retirees age 55 and older who are not yet eligible for Medicare.  The program will end in 2014, when Americans will be able to choose from additional coverage options through the health insurance exchanges.

Eligible employers can apply for the program through the Department of Health and Human Services. Applications will be available by the end of June.  Both self-funded and insured plans can apply, including plans sponsored by private entities, state and local governments, nonprofits, religious entities, unions, and other employers.

If you want to learn more tune into the next Affordable Care Act web chat at Secretary Sebelius and Department of Commerce Secretary Gary Locke will host a web chat on the new Early Retiree Reinsurance Program Wednesday, May 5, at 11:30 A.M. EDT at

The Interim final regulations with comment period were released in the Federal Regulations Vol. 75, No. 86, pg. 24450, May 5, 2010.  Please find them attached.

County Commissioner Claims to be Half Pregnant, Half Guilty

Wednesday, May 5th, 2010

Former county commissioner denies culpability as sentencing date approaches

Comments 32 | Recommend 5

May 04, 2010 9:45 AM
Jeremy Roebuck
The Monitor

McALLEN — Her sentencing date is nearly two months away. But the wrangling over how much time — if any — former Hidalgo County Commissioner Sylvia Handy should spend in prison has already begun.

The federal government continues to maintain that she concocted an elaborate scheme to avoid paying for housekeeping and babysitting services between 2001 and 2007 by putting her undocumented domestic help on the county payroll.

But in court filings last week, Handy’s defense shot down prosecutors’ descriptions of these so-called “ghost” government employees who never did any actual work for the county.

The commissioner never knew most of the women working in her home were in the country illegally, wasn’t aware they lied about their legal status to land county jobs and made no money off of their illegal employment, her attorney Al Alvarez wrote in an April 26 filing.

The dispute sets up an argument over what exactly Handy did and didn’t know and how much it hurt county taxpayers. The outcome of that fight could land her in prison for up to 10 years or let her off without spending a day behind bars.

“(Sylvia Handy) did not create a ghost employee scheme nor did she utilize funds from Hidalgo County,” Alvarez wrote. “Any employees of the county were hired by the county’s human resources department and were paid by the county treasurer.”


Handy, 52, pleaded guilty to one count each of tax evasion and conspiracy to harbor an illegal immigrant in March. But in entering her plea, she kept her admissions of guilt to a minimum.

The unusually detailed 65-page indictment in the case accused the four-term commissioner of putting the undocumented women who worked in her home on the payroll of her Precinct 1 office so that she wouldn’t have to pay them out of her own pocket.

To cover up her scheme she provided the women with fraudulent identification documents, conducted sham interviews and claimed credits on her federal tax returns suggesting that she was paying the women for their domestic work herself, prosecutors allege.

While the counts to which Handy pleaded only involved one of those illegal workers, she maintained during her re-arraignment hearing that both violations of the law were unintentional.

She claimed the child care tax credit under a false name not to hide the fact that her babysitter was an undocumented immigrant but because she had forgotten to change the name on her tax forms from that of a previous woman she paid to watch her children, she said.

As for immigrant harboring, Handy wasn’t aware of the worker’s lack of legal status when she helped her get a county job. And despite being here illegally, the woman dutifully performed the tasks of a precinct maintenance worker during the time of her employment, her attorney maintained.

U.S. District Judge Ricardo Hinojosa balked at these heavily qualified admissions during the March 8 hearing and warned the now-former commissioner to come to her sentencing prepared to accept full responsibility.

“The court’s not interested in you not admitting things that are so obvious anyone can see it,” he said. “If you don’t want to plead guilty just say so, but don’t stand there and lie about it.”


Sentences in the federal system are determined after the government prepares an advisory recommendation to the judge and defense lawyers have had a chance to object to prosecutors’ interpretation of the facts. While a defendant may plead guilty to only specific counts, federal judges are given broad leeway to consider other related criminal conduct when settling on a final sentence.

So while Handy’s attorney carefully selected the tax evasion and conspiracy counts to which she eventually pleaded, many of the government’s extraneous allegations against her could come into play in Hinojosa’s decision.

Alvarez, her attorney, has challenged a number of those accusations in objections filed with the court, including:

>> government claims that the commissioner tried to influence potential witnesses against her during the run-up to her trial. Alvarez argues that while Handy was told to have no contact with witnesses, no specific names were ever mentioned to her;

>> allegations that she provided fraudulent documents to help the women land county jobs. The lawyer denies this and maintains that ultimately it was the county’s human resources staff who failed to identify the documents as fake;

>> and accusations that the women never did any work for the county, bilking taxpayers out of more than $200,000 in salary and retirement benefits. Alvarez insists that each of them did actually perform the duties that came with their county jobs.

“There were no financial losses to Hidalgo County when an employee did the work, even though they had a false identity,” he wrote.

But as her June 23 sentencing date approaches, Handy herself seems to be attempting to hedge those bets — standing by her relative innocence through her attorney, yet attempting the show the judge’s she’s ready for whatever he hands down.

“I accept full responsibility for my actions,” she wrote in affidavit she filed with the court last week. “I am truly sorry for the trouble I have caused the government, family and myself.”

Handy’s sentencing is scheduled for June 23.


Jeremy Roebuck covers courts and general assignments for The Monitor.

Editor’s Note: This is the second convicted felon who has told Federal Judge Ricardo Hinojosa that they are only half guilty, half pregnant. (The other felon is Arnulfo Olivarez, insurance felon convicted of bribery). What is the Judge to do? He must feel tremendous anxiety in having to pass judgment on such complicated cases. What would Solomon do?

Pelosi Statement on Implementation of Early Retiree Reinsurance Program

Wednesday, May 5th, 2010

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