Andy Weisskoff’s new blog investigates possible Medicare fraud at Kaiser

November 18th, 2014

I’m halfway through my second round of blogging for 90daystochange.com. Now that I no longer work for Kaiser, it’s both easier and trickier to hold the monolithic HMO accountable for how poorly they treat people with mental illness. It’s easier because I’m not experiencing the everyday tension that came from implementing tier after tier of confrontation. Will it be today, after emailing hundreds of physicians throughout California, that my chief finally yells at me to stop? (He never did.) Will it be today, after documenting risk in my client’s permanent medical record, that I’m fired? (That was, it seems, the final straw that led my bosses to escort me off campus.) This every day anxiety is blessedly over.

Even so, it’s tricky staying engaged with the struggle because I’m no longer in daily contact with the clients and staff who motivated the risk-taking in the first place. I live my life, mostly seeing my wife, my son, my Westie, my new private practice clients, and only occasionally my former colleagues still at Kaiser, many of whom are retiring to get away from the conflict. Without daily contact, the problems of Kaiser clients and staff have, understandably, receded.

As a compromise between completely letting go of my old life and staying too attached, I decided to pick a specific front to pursue, and to pursue it at a leisurely pace. Though I’m no longer a Kaiser employee, an NUHW member, nor a Kaiser member, I am still a taxpayer. I still have standing, therefore, to track how my federal tax dollars are spent. Which brought me to consider the intersection between Kaiser mental health clients and Medicare funding.

Though Medicare clients account for a relatively small percentage of the Kaiser funding pie, The Permanente Medical Group (TPMG), the for-profit leg of the Kaiser system, has created one structure for all its members. While they’re providing a level of care to get reimbursed by Medicare, they are providing at least the same standard to everyone else. As goes Kaiser Advantage (Kaiser’s Medicare program), so goes Kaiser. And as goes Kaiser, so, in large part, goes the future of mental health care in the United States. It seems worthwhile, therefore, to appeal to the agencies that oversee the Kaiser Advantage program, to encourage them to investigate the gaps in mental health services persistently advertized by Kaiser therapists and confirmed by the California Department of Managed Health Care (DMHC).

What I’ve learned so far is that Medicare pays Kaiser incentives above baseline monthly premiums to care for special needs members. For people with “physical” illness these include conditions like hypertension and diabetes. For people with “mental” illness the parity diagnoses like major depression and panic disorder trigger this additional funding. One of my colleagues let me know of at least one on-going federal investigation into the inappropriate collection of these incentives. I’m hoping that by providing additional information about mental health care at Kaiser I can get the feds to consider the whole system of incentives faulty.

In my posts and in direct communications with regulators, I’ve been asserting that by misrepresenting the care they provide, Kaiser has been involved for years in Medicare fraud, and that they owe us taxpayers a ton of money for services paid for but never rendered. At the same time, I’m hoping to engage the quality of care oversight people to enforce stricter standards for internal review of mental health services. Without meaningful review of protocols Kaiser can and will continue to claim that they’re providing state of the art mental health care while in fact providing far less than minimal care.

So that’s what I’m up to. I’m contacting various branches of the Centers for Medicare and Medicaid Services (CMA) to see who might be willing to hold Kaiser more accountable. I’ve given myself ninety days again in order to to make the pursuit a little more exciting. And to hold myself accountable as well.

The first ninety days of my blog garnered over 25,000 views. This allowed for a broad dissemination of information and provided encouragement to clients and staff on the front lines. It helped create the sort of visibility that influenced the DMHC to enforce their initial fines and promise more fines in the near future if Kaiser doesn’t continue improving. With any more luck, the current ninety day campaign will have a similar effect, but on the agencies overseeing Medicare.

Follow 90daystochange.com from now until the new year to see how far the feds are willing to go… with a little nudging.

— Andy Weisskoff