Saturday, February 26, 2022

FY-2021 Update of NYCERS Admin Spending - History

The following is a chart of NYCERS administrative expenses from 2000. The information comes from NYCERS Comprehensive Annual Financial Report. As a point of reference NYCERS had an annual budget of $8.8M in FY-1996, the last year NYCERS was part of the city budget.

NYCERS Admin Expenses
Fiscal Year Personnel Expenses Contracts & Consultants Phone, Mail, & Printing Rentals Software, Hardware, Support, Supplies, & Maintenance Depreciation & Credits Total
FY-2021 $48,693,043 $14,058,975 $1,290,546 $6,617,040 $16,753,334 $0 $87,412,938
FY-2020 $45,736,806 $11,337,750 $1,173,896 $6,870,614 $12.548,240 $0 $77,667,306
FY-2019 $43,717,712 $15,884,418 $1,114,263 $6,637,959 $14,719,873 $0 $82,073,325
FY-2018 $40,444,145 $4,310,427 $1,072,077 $6,348,888 $7,513,233 $0 $59,688,770
FY-2017 $39,505,894 $3,829,758 $1,561,282 $5,909,352 $8,864,342 $0 $59,670,628
FY-2016 $37,950,289 $4,687,929 $1,360,397 $5,453,383 $7,230,989 $0 $56,682,988
FY-2015 $37,368,409 $3,652,,154 $1,336,002 $5,037,893 $7,239,560 $0 $54,635,018
FY-2014 $33,571,938 $3,773,082 $1,269,387 $4,863,720 $6,952,691 $0 $50,430,818
FY-2013 $33,064,087 $3,102,385 $1,078,411 $4,674,442 $6,797,095 $0 $48,666,420
FY-2012 $32,623,085 $3,088,256 $1,096,186 $4,796,584 $9,780,637 $0 $51,384,748
FY-2011 $31,748,443 $4,108,186 $995,415 $4,741,621 $4,780,811 $0 $46,374,476
FY-2010 $31,527,659 $5,434,495 $1,041,471 $4,278,903 $6,678,071 $715,000 $49,675,599
FY-2009 $30,187,604 $4,043,775 $914,311 $4,047,949 $8,198,354 $1,430,000 $48,821,993
FY-2008 $28,344,427 $6,401,744 $997,316 $4,138,211 $6,687,716 $1,430,000 $46,999,000
FY-2007 $27,123,219 $2,677,793 $1,055,233 $5,203,902 $4,205,095 $1,430,000 $41,695,242
FY-2006 $24,992,543 $3,124,688 $1,497,895 $4,797,895 $4,472,246 $1,406,132 $40,291,469
FY-2005 $24,474,710 $3,039,970 $827,277 $4,454,258 $3,118,356 $1,392,296 $37,306,867
FY-2004 $22,631,504 $3,124,800 $845,391 $4,192,543 $3,375,187 $1,430,000 $35,559,081
FY-2000 $15,990,745 $1,587,290 $718,686 $1,531,536 $2,691,719 $725,000 $23,244,976

Monday, February 21, 2022

The Reason for the Medicare Advantage Scam

In a December 27, 2021 memo from the OLR Commissionet to the Mayor (with 4 daya in office), Ms Campion made the following statement reporting on Health Savings in FY-2021:

Memo from OLR to Mayor December 27, 2021

Most recently, the Tripartite Committee was tasked with looking at the status of the Stabilization Fund. An Agreement to set up this Fund was executed in 1983 to help the City and the MLC equalize the costs of the premium-free CBP-PPO and HIP HMO plans offered to active employees and pre-Medicare retirees.

Under the equalization formula, when the HIP rate exceeds that of the CBP, the Stabilization Fund receives a contribution from the City, and when the CBP is higher, the Stabilization Fund has to cover the increased CBP cost over that of HIP.

Over the years, by agreement between the City and the MLC, excess money in the Fund has also been used to cover many of the escalating costs of health care, including the

  1. City’s PICA program (which covers injectable and chemotherapy drugs),
  2. additional contributions to union welfare funds, and
  3. the costs of preventive care mandated by the Affordable Care Act.

In FY 21 and FY 22, the CBP rate was higher than that of the HIP rate so the Fund will have to cover increased costs, accelerating the decline of the Stabilization Fund which we had anticipated would occur in the next few years. This could affect the City’s ability to recover recurring savings from the CBP plan in the future, as they are derived from offsets to the Stabilization Fund assets.

For this reason, the FY 21 withdrawal from the Fund, and therefore the savings, were limited to $600 million so that any further CBP-derived savings will remain in the Fund.

To address the Stabilization Fund, the City and the MLC agreed to implement a new retiree Medicare Advantage program which is expected to save about $600 million a year due to Federal subsidization of Medicare Advantage programs. The Medicare Advantage program will provide NYC retirees with a continuation of premium free coverage while providing important enhancements including free telehealth visits, transportation benefits to and from doctor appointments, fitness benefits, meal delivery after a hospitalization, wellness rewards and coverage while traveling.

The City and the MLC agreed to use the savings from that program to help support the Stabilization Fund. Because this $600 million savings is earmarked for the Stabilization Fund, it does not count as budget savings towards the FY 19 – FY 21 savings target but was not necessary to meet the target.

Right Out in the Open

The City openly admits that the reason that it is forcing Medicare eligible retirees into a Medicare Advantage plan is so that the City can take money that should used to pay for the retirees health insurance and give it to the Stabilization Fund. The benefit of this transfer goes to employees and non-Medicare eligible retirees and none to Medicare eligible retirees

It was not done because the Medicare Advantage plan is a better plan than the current GHI Senior Care plan. The City is doing this only because it can walk away from its stautory requirement to pay the entire cost of older retirees health insurance and dump it on the federal government.

OLR claims that the City is saing $600M because of a federal subsidy. Not exactly. The federal goverment does not subsidize Medicare Advantage plans. Instead of paying 80% of medical costs directly, Medicare gives that same money to private insurance companies to pay 100% of medical costs, admin expenses, and profit. So how do you think an insurance company does that magic trick? Somebody is getting the short end of the stick.

The MLC has no basis to interfere with current retirees health insurance benefits. The MLC only represent current workers, not current retirees. The fact that the unions control the Stabilzation Fund is an actual conflict of interests.

In addition, the City claims it is going to save $600M per year. It will be lucky to save $375M per year. Of course MAP(Anthem/Eblemhealth) will be increasing its profit tremedously but not as much as it thought since 45,000 retirees have already opted out of the junk MAP plan.

Just stop and consider that 45,000 retirees have chosen to walk away from the "free" and "better" MAP plan and are willing to pay the $191.57 per month for their old free plan. Does anyone have any doubt that the MAP plan is junk.

In fact, Medicare Advantage plans are all schemes by insurance companies to extract money from the Medicare Fund. You only have to consider Anthem's problem with the Department of Justice over Medicare Advatage fraud.

Friday, February 4, 2022

Anthem - US Department of Justice - Medicare Advantage Scam

I just stumbled on the following notice from DOJ. Within the press release you can find 112 page complaint. You can read the opening paragraph below:

Department of Justice
U.S. Attorney’s Office
Southern District of New York
FOR IMMEDIATE RELEASE
Friday, March 27, 2020

Manhattan U.S. Attorney Files Civil Fraud Suit Against Anthem, Inc., For Falsely Certifying The Accuracy Of Its Diagnosis Data

Geoffrey S. Berman, the United States Attorney for the Southern District of New York, announced that the United States filed a civil fraud lawsuit today against ANTHEM, INC. (“ANTHEM”), alleging that ANTHEM falsely certified the accuracy of the diagnosis data it submitted to the Centers for Medicare and Medicaid Services (“CMS”) for risk-adjustment purposes under Medicare Part C and knowingly failed to delete inaccurate diagnosis codes. As a result of these acts, ANTHEM caused CMS to calculate the risk-adjustment payments to ANTHEM based on inaccurate, and inflated, diagnosis information, which enabled ANTHEM to obtain millions of dollars in Medicare funds to which it was not entitled.

Why is the notice significant? Well, Anthem is the company NYC has contracted with to ramrod NYC retirees into a Medicarae Part C plan (aka Medicare Advantage). You can read the opening of the proposed NYC/Anthem contract below. This raises serious questions about the integrity of this whole process.

Medicare Advantage Group Agreement

This NYC Medicare Advantage Plus Plan Group Agreement (hereinafter "MA Agreement") is entered into as of January 1, 2022 (hereinafter “Effective Date”) by and between

the City of New York (“City”) acting through Mayor’s Office of Labor Relations – Employee Benefits Program on behalf of the Labor Management Health Insurance Policy Committee for the New York City Health Benefits Program with an office at 22 Cortlandt Street, 12th Floor, New York, NY 10007 (hereinafter "Group") and

Anthem Insurance Companies, Inc. doing business as Empire BlueCross BlueShield Retiree Solutions, on behalf of itself and the Alliance, defined below (hereinafter “Empire” or the “Alliance”) sponsor of the NYC Medicare Advantage Plus Plan (hereinafter "MA Plan"). Empire and The Group each are sometimes referred to herein as a “Party” and collectively as the “Parties.”

WHEREAS,

the City and Municipal Labor Committee (“MLC”), an umbrella organization for municipal unions, negotiate on a variety of matters, including collective bargaining regarding health benefits pursuant to their obligations under the New York Collective Bargaining Law;

WHEREAS,

to aid in the administration of the negotiated health benefits agreements, the City and the MLC established the Labor Management Health Insurance Policy Committee (“Committee”) for the MLC and City representatives to meet on a regular basis to discuss City health insurance benefits; and

WHEREAS,

the Employee Benefits Program (“EBP”) is a division of the Mayor’s Office of Labor Relations (“OLR”), and OLR is acting under the authority of the New York City Administrative Code Section 12.126(d) as the administrator of the New York City Health Benefits Program (“HBP”); and

WHEREAS,

on October 30, 2020 OLR’s request for authorization to enter into a Negotiated Acquisition to solicit a Medicare Advantage plan under Medicare Part C for the Medicare eligible retirees and dependents of the City of New York who are eligible for the City’s Health Benefits Program was approved by the City Chief Procurement Officer; and

WHEREAS,

OLR issued a public notice for a negotiated acquisition (EPIN:0021N002) in conformance with the New York City Procurement Policy Board Rules (“PPB”) and had otherwise advertised in order to solicit vendors through the Notice of Intent to provide health benefits services in the form of a Medicare Advantage plan under Medicare Part C for the Medicare eligible retirees and dependents of the City of New York who are eligible for the City’s Health Benefits Program; and

WHEREAS,

the Retiree Health Alliance (“the Alliance”), a strategic alliance between Empire and EmblemHealth Plan, Inc. (“EmblemHealth”) and their affiliates, submitted a response for such services, as provided for in the public notice for a negotiated acquisition, in the form of an expression of interest to OLR; responses were evaluated by an evaluation committee pursuant to PPB Section 3-04; and

WHEREAS,

OLR determined the Alliance’s proposal to be most advantageous to the City, taking into consideration technical expertise, price, contract terms, M/WBE Utilization Plan and other factors set forth in the negotiated acquisition solicitation; and

WHEREAS,

the City desires to appoint the Alliance to provide a Medicare Advantage Plan Under Medicare Part C for City of New York Retirees, and their Dependents, and

NOW, THEREFORE,

in consideration of the terms and conditions contained herein, the parties hereby agree as follows:

  ARTICLE 1 - PURPOSE
The Alliance will provide health insurance coverage to the Group’s eligible retirees and other eligible individuals as described in this MA Agreement. Empire is accountable for the operations, compliance, and performance of the MA Plan. EmblemHealth is an entity contracting with Empire to administer portions of this co-branded product to help ensure the City’s retirees receive continuity of care and membership support.

Specifically, EmblemHealth will co-manage the account, provide a professional network in the downstate New York area, deliver care through Neighborhood Health Centers, and support Empire in multiple areas of plan performance. ...