Dave Jones for Attorney General 6/5/2018 CA

Some thoughts from Joan and Josie before casting a vote or Attorney General this Tuesday...
Josie Herndon and I, Joan Borsten Vidov, took two important messages away from the "Dave Jones for Attorney General" fundraiser last Friday evening.  
1) Dave Jones has only 6 more months as Insurance Commissioner and there are still many facilities that have yet to be paid by Health Net; probably because their lawyers are waiting to see if the next Insurance Commissioner will be more supportive of Health Net
2) Having an Attorney General who understands the health insurance insurance industry would be a very good thing for the addiction treatment industry.
Our State, unlike let's say New York, is painfully under regulated because oversight is divided between the Department of Insurance (with an elected commissioner) and the Department of Managed Health Care (which reports to the Governor).  Additionally a third agency, the US Department of Labor's Los Angeles office, oversees California employer funded plans.  While Commissioner Jones was eager to explain his position on serious issues like access to addiction treatment for those exiting the criminal justice system, ATAC members were more focused on whether as Attorney General he could find a way to end the regulatory disfunction in California that is impacting all who pay premiums to health insurance carriers, out-of-network addiction treatment facilities and probably the in-network as well.   Jones was well aware of the problem, if not the solution.  He explained the creative ways he found to resolve some of the thorny problems that faced him even when he lacked the legal authority and that gave us some hope.   Thanks to Ken Seeley and Eric McLaughlin from Intervention 911 for sponsoring the event with West Hollywood City Council member John Heilman.  Other ATAC members in attendance were Alex Van Kovn from Alta Centers and Erin Burke from Hansei Billing and a member of the Underpayments Steering Committee.
Joan and Josie

Addiction Treatment Advocacy Coalition

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ATAC waged a public relations campaign to demonstrate the damage Health Net has done to their insured and addiction treatment facilities in California. this included stories in Kaiser Health Newsletter, in a financial publication, and in the Los Angeles Times.
We also produced two videos demonstrating the impact on the insured and providers of Health Net's long term failure to pay for treatment.  We believe that Health net has settled with over 100 facilities and others are still in negotiation.  
The Insight video got 60,000 views. https://www.youtube.com/watch?v=v5cxwqfTqmg&t=73s
The Patti Mitchell story 100,000.  https://www.youtube.com/watch?v=AoKLX3BOqrw&t=643s
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LAFD Introduces Another New Innovated Pilot Program; The Sober Unit


In the Los Angeles Fire Department's continuing efforts to meet the challenges of our increasing EMS call load and the increasing number of homeless individuals, our EMS Bureau is in the process of implementing a pilot program called the LAFD SOBER (Sobriety Emergency Response) Unit. This pilot project is anticipated to be staffed by a Firefighter, working alongside a Los Angeles Homeless Services Authority (LAHSA) outreach worker.



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Arizona Lawsuit Opens Window into Lucrative Drug Rehab Business and Allegations of Fraud


Ken Alltucker, The Republic | azcentral.com

The only "Obamacare" health insurer in metro Phoenix and Pima County is ensnared in a legal dispute with several addiction treatment centers over the cost of care amid an Arizona opioid epidemic that is taking an average of two lives each day.

Nine alcohol and drug rehabilitation centers claim in a Maricopa County Superior Court lawsuit that the health insurance company Health Net of Arizona improperly withheld or delayed lucrative payments for treatment of people struggling with addiction.

But Health Net says in a counterclaim that there was widespread fraud among Arizona and California drug rehab centers in 2015 and 2016, when it alleges"teams of brokers" recruited out-of-state clients to fraudulently obtain insurance policies and to seek treatment in Arizona.

Those actions have cost the insurance company — and Arizona consumers through higher monthly premiums — tens of millions of dollars, the Health Net counterclaim says.


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Department of Managed Health Care's $5 Million Enforcement Action Against Blue Cross of California


Dear Substance Use Treatment Provider and Other Companies in the Industry:

The following article is a cautionary tale about being organized in how an industry deals with insurers. While Anthem was fined for not addressing client grievances in a timely manner by the Department of Managed Health Care, the lesson is what drove DMHC to act was the fact that subscribers and providers filed grievances. As you know, ATAC has asked your organization to file grievances, now you can see the result of those organizations within our industry that did, as well as of those other providers in other parts of healthcare that were experiencing the same problems. Did you file a complaint with DMHC in 2016 when ATAC requested you to complain?

While ATAC applauds the actions of the Department of Managed Health Care, shouldn't the fact that 70% of denials are eventually overturned be considered an unfair payment pattern as defined by the Health and Safety Code 1371.37? Aren't the denials simply a payment delay tactic?

ATAC will be pursuing further action by the Department of Health Care to ensure that Anthem is held fully accountable for all violations of the Health and Safety Code with respect to their actions. 

Please read the entire article:


For those who want to know all the details, here is the actual case:



What do you have to complain about today? Underpayments, lack of timely response to contested claims, or ever-changing coding requirements? You must complain to call attention to issues!


Strength in Numbers,
ATAC Board of Directors
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How Big Pharma Keeps Drug Prices High


Find out more about the lobbying, games and manipulation the drug industry uses to keep the cost of your prescription drugs rising — and what you can do about it.


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ATAC Letter to New York Attorney General Ed Schneiderman




ATAC's President and Vice President has written a letter to inform New York Attorney General Schneiderman about the Centene & Health Net acquisition and how it has impacted California's substance use treatment community.
Click the button below to read it in detail.




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Google Sets Limits on Addiction Treatment Ads, Citing Safety




As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.

But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.

This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.

Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.

In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.



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Insight Treatment Center Struggles with Health Net’s Failure to Pay


For 25 years Insight Treatment Center’s highly regarded drug and alcohol program for teenagers has kept thousands of kids off the streets, out of the legal system, and back to their families to lead healthy and productive lives. Now this valuable program is threatened by health insurance company Health Net’s refusal to pay legitimate insurance claims.

Insight’s doors are on the verge of closing due to Health Net’s failure to pay claims for almost two years.

In 2008, a New Jersey Federal Judge found Health Net guilty of obstruction of justice for using “scorched earth” litigation tactics to avoid admitting they had been underpaying out-of-network providers by using a database purposely skewed in favor of insurance companies. In 2009, the judge accepted Health Net’s offer to settle the case for a record $250 million. Also in 2008, a California judge ordered Health Net to stop the controversial practice of canceling sick policyholders and to pay more than $9 million to a breast cancer patient dropped in the middle of chemotherapy.

The New Jersey Federal Judge believed she had changed the way Health Net would do business but by 2015 Health Net was at it again. The Addiction Treatment Advocacy Coalition (ATAC) believes Health Net’s failure to pay legitimate bills of hundreds of addiction treatment providers since August 2015 is directly related to Health Net’s successful efforts to merge with the Centene Corporation, ranked number 66 on the Fortune 500. If you agree, contact Insurance Commissioner Dave Jones and Attorney General Xavier Becerra. Health Net needs to pay the claims of Insight and other legitimate facilities without further delay.C\

Click here to see the youtube video about the devastation Health Net's dragnet audit has wreaked on Insight Recovery Center, one of California's premiere addiction treatment facilities for teenagers. 


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Riverside County rehab center owner going to jail for insurance fraud

By CITY NEWS SERVICE | via The Press-Enterprise

The owner of a southwest Riverside County drug and alcohol rehabilitation center, who filed fraudulent medical insurance claims that netted her more than $231,000 in ill-gotten gains, pleaded guilty Wednesday, July 5 to insurance fraud and was immediately sentenced to about nine months in county jail.


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