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Glaxo settles record whistleblower case for $3 billion

Insurance Empire Strikes Back


"Insurance companies are profit making corporations operating in a market economy trying to outdo their competitors." - Donald Schwartz MD

"The very word insurance hints at the assumption that life can indeed be made secure, that the unsure can be made sure." - Charles Eisenstein

"All across the country, insurance companies of every sort have attempted to reduce their risk by increasing rates, dropping customers who submit claims and, as a final insult, denying legitimate claims. If there ever was a definition of a "criminal enterprise," the modern American insurance industry fits the bill!" - Carl Schellenberg 10/28/07

Insurance companies are owned and operated for the benefit of transnational elite, not to 'protect' the individual from financial calamity.


In the second quarter of 2007 Berkshire Hathaway Inc. reported record earnings, mostly from it's insurance division, of $3.1 billion ($3,100,000,000). Berkshire Hathaway Inc. made over a billion dollars a month basically by selling insurance.


Homeowner's Insurance


Two retired women, Linda Williams and B. Walker were sued by a neighbor, Juanita Wasson, who suffered a broken hip after being knocked down by their automatic garage door.

Farmers insurance defended the homeowners association, to which Williams and Walker belonged, but filed a cross compliant against them believing that they did not have the resources to fight in court. The two women maxed out there credit cards to hire lawyers and won a $ 8.3 million award against Farmers insurance as punitive damages for breach of good faith.


"I became aware that many adjusters employed by Allstate were engaging in conduct which was improper, unlawful, fraudulent, and in bad faith.

I became aware of cases in which the adjuster retained an engineer and requested that the engineer provide a report determining and detailing the cause and extent of the damage caused by the earthquake.

Allstate's adjusters were requiring engineers to provide a draft or preliminary report for the adjuster's review.

Where an engineer's draft report attributed any amount of damage, in the adjuster's opinion, that could possibly have been exacerbated by the earthquake and/or damage which may not be covered under the policy according to the adjusters, the adjuster would instruct the engineer to alter the report to reflect the adjuster's changes.

Engineers were repeatedly instructed to alter draft reports in order to minimize the damage attributable to covered losses in order to reduce any potential payments to the insured and in order to benefit Allstate's financial interests."- Allstate claims analyst Jo Anne Lowe commenting on the Northridge earthquake of 1/17/94 in California.


April 2007 Jury verdict rendered in a case against Allstate.

Allstate was ordered to pay over $2 million to a Louisiana homeowner who sued the insurer for manipulating an engineering report to reduce its payment in the aftermath of Hurricane Katrina.


November 7, 2007 Lousiana attorney general Charles Foti sues Allstate, State Farm, Lafayette Insurance Co., USAA Casulity Insurance Co., Farmers Insurance Exchange, Standard Fire Insurance and other insurance companies for colluding to reduce claim values.

A consulting firm, McKinsey & Co. was accused of being the architect of sweeping changes in the insurance industry beginning in the 1980s. McKinsey advised insures to "stop 'premium leakage' by undervaluing claims using the tactics of deny, delay and defend."

The insurance companies coerced policy holders into settling damage claims for less than their actual value by editing engineering reports, delaying payments and forcing policyholders to go to court to challenge insurance estimates of loss after Hurricane Katrina and Rita.


Vehicular Insurance

2007 23 year-old Ashley Ellis hits a man on a motorcycle two days after her auto insurance expired. Ashley Ellis is not impaired or speeding but is distracted by her dog which was riding in the car.

For her negligence Ashley Ellis was convicted of a misdemeanor and ordered to spend 30 days incarcerated. She lost forty pounds, originally 125, from the time of the accident waiting to be incarcerated - about two years. After two days in jail she died from lack of medical treatment which was provided by the independently contracted corporation Prison Health Services.

For Ashley Ellis a 30 day jail sentence became a death sentence.

"Profit-driven organizations are prone to cut costs. The system failed." - Matthew Valerio


Health Insurance

"The insurance contracts state clearly if anything in the application is incomplete, coverage may be rescinded." - Tom Epstein, BlueSheild

In California it is nearly impossible to purchase individual health insurance (not employer provided) unless you have never had surgery, allergies, asthma, ear infections, ulcers or been depressed.

"According to regulators' postings, rejection letters and interviews with insurance brokers, conditions that can lead to outright rejection or a higher premium include:

AIDS, allergies, arthritis, asthma, attention deficit disorder, autism, bed-wetting, breast implants, cancer, cerebral palsy, chronic bronchitis, chronic fatigue syndrome, chronic sinusitis, cirrhosis, cystitis, diabetes, ear infections, epilepsy, "gender reassignment" (an impossibility in reality), heart disease, hemochromatosis, hepatitis, herpes, high blood pressure, impotence, infertility, irritable bowel syndrome, joint pain, kidney infections, lupus, muscular dystrophy, migraine, miscarriage, pregnancy, "expectant fatherhood," planned adoption, psoriasis, recurrent tonsillitis, renal failure, ringworm, severe mental disorders, sleep apnea, stroke, ulcers and varicose veins." - Lisa Girion

"Insurance companies are offloading sick people onto the county system. They want a guarantee that they are going to make money. That's why they won't take sick people. They are missing the point about assuming some risk." - Scott Svonkin

Insurance companies refuse to underwrite individual health insurance policies for people that are employed in - controlling air traffic; moving buildings; chemical and rubber manufacturing; circus or carnival work; concrete or asphalt work; crop dusting; firefighting; furniture and fixtures manufacturing; as a lumber jack; oil well and refinery operations; police work; roofing; sandblasting; sports; stables; stockyard; stunt work; telecom installation; transportation; tree trimming; tunnel excavation; war reporting and washing windows higher than three stories up.

2005 Insurance industry amassed record profits of $44.8 billion ($44,800,000,000) in a year of catastrophic loss.

"Unless insurers can get relief you are going to see a pullback by private industry."- Robert P. Hartwig, chief economist of the industry funded Insurance Information Industry

$44.8 billion profit is penny ante stuff to these rough riders of catastrophic calamity. $44.8 billion is just not the return that the insurance industry expected on their difficult to understand legalize laden, layers of lawyers approved insurance policies.


Barbara Fowler

2001 Senior analyst in charge of rescissions reviews for Health Net, was expected to cancel 15 policies a month. Barbara Fowler exceeded her quota by canceling 275 policies.

2003 Barbara Fowler saved Health Net $6 million by canceling 301 policies.

2005 Health Net set a goal for Barbara Fowler to save Health Net $6.5 million which she exceeded. Barbara Fowler's bonuses ranged from $1654 to $6300 for canceling health insurance policies of individuals experiencing expensive medical costs.

"It is disgusting how Health Net dropped a patient in the midst of chemotherapy. Barbara Fowler, Health Net's "senior analyst in charge of rescission reviews" profited from it through bonuses. How many years in medical school did Barbara Fowler study?" - Bill D. Holder

"No surprise that Health Net gave out bonuses to drop sick insurance policyholders. The for-profit health insurance industry will always be the winner, as it has to be." - Sheila Hoff

November 2007 Health Net agrees to pay a $1 million fine and promised to no longer link compensation to coverage cancellation.



drug insurance

"As long as the word "insurance" is a part of the American healthcare system, there will be no real reform. It is immoral and inhumane that we use healthcare as a vehicle to support private industry, specifically the insurance and pharmaceutical industries. These companies earn obscene profits and fat salaries for their leaders, who make huge donations to politicians to ensure their continued financial health." - Susan Guilford

Underwriting guidelines for several individual health insurance plans list certain drugs that are likely to render the user ineligible for health insurance. The question then becomes - are the drugs in and of themselves harmful or does use of the drugs truly point to underlying conditions that frighten insurers away?

Either way it seems to be in the individuals best interest to not be using any of the listed drugs unless it is quite obvious that not using the listed drug brings on life threatening conditions.

Individuals may be refused individual health insurance coverage if they use any of the following drugs:

cholesterol reducers - Lipitor®, Zocor®;
digestive tract problems - Nexium®, Prevacid®, Protinix®, Tagamet®;
asthma control - Advair®, Singulair®;
depression control - Zoloft®, Celexa®, Prozac®;
attention deficit disorder control - Concerta®, Ritalin®
allergy control - Allegra;
acne control - Accutane®;
arthritis pain control - Celebrex®;
herpes control - Famvir®;
angina control - Imdur®;
migraine control - Imitrex®;
fungal control - Lamisil®;
menstrual disorders - Parolodel®;
hyperthyroid disorder - Tapazole®;
epilepsy control - Topamax®.

"It is an egregious mistake to think that the mission of health insurance companies is to provide healthcare for the seriously ill. Commercial insurers fulfill their legal and corporate mission by making profits for their investors, not by providing care for the expensively ill. They do this by avoiding people who are or may become seriously ill. The most successful companies do this better than their competitors. Precisely because this is and must remain the true north of commercial insurance, every other developed nation pushes commercial insurance to the margins of their systems. When we learn this basic lesson in the United States, we will have taken a giant step toward radical reform." - John W. Glaser

"Unless stopped by law, insurance company death panels (rescission committees) will continue to operate. Large court judgements are just a cost of doing business. Last June, a congressional committee found that Fortis, now known as Assurant, and two other companies alone saved more than $300 million over five years by dropping policy holders when they became ill. The death toll from the inability of millions of Americans to obtain and keep affordable health insurance is unconscionable. An Institutes of Medicine report in 2004 estimated that "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the US." This national tragedy should shock us to the bone when we realize that every year, six times as many Americans die because they can't get medical insurance than were killed by terrorists on 911." - Andrew Skolnick, September 24, 2009



corporate fraud

medicare and corporate fraud

"Many national healthcare plans provide universal insurance at a lower per-capita cost than the American system with better results." - J.D. Hunley

"A jury might think $45 million is fair and just compensation to the family of the woman who died while hospital personnel ignored her cries of pain for nearly an hour. But the judge will automatically reduce any possible verdict to $250,000 - the most in non-economic damages anyone can recover for any injury or death caused by a healthcare provider. The cap was passed at the behest of the insurance industry and medical establishment more than three decades ago. Because it has never been changed or adjusted - even for inflation - we may be reaching a point at which letting patients die is more cost-effective than treating them." - Linda Fermoyle Rice

July 1994 National Medical Enterprises agreed to pay $379 million in criminal fines, civil damages, and penalties for kickbacks and fraud at National Medical Enterprises psychiatric and substance abuse hospitals in more than 30 states. After this settlement, National Medical Enterprises renamed itself "Tenet".

October 1996 First American Health Care of Georgia, Inc, later Integrated Health Services, Inc, agreed to reimburse the federal government $255 million for overbilling and making fraudulent Medicare claims. First American billed Medicare for costs unrelated to the care of patients in their homes, including the personal expenses of senior management, as well as marketing and lobbying expenses.

Epilogue: IHS filed for bankruptcy and never paid the settlement.

November 1996 Laboratory Corporation of America Holdings (LabCorp), agreed to pay $182 million to resolve charges that it submitted false claims for medically unnecessary laboratory tests to federal and state health care programs. The fraud involved bundled lab tests that were billed to Medicare as free-standing tests, resulting in an eight-fold increase in charges to Medicare.

March 1997 SmithKline Beecham Clinical Laboratories Inc. (SBCL), now GlaxoSmith Kline, was ordered to pay $325 million for filing of false claims which involved adding on laboratory tests not requested by doctors and which were not medically necessary, billing for lab tests that were not actually performed, giving kickbacks to doctors in order to get their business, and billing Medicare for dialysis testing already paid for by kidney dialysis centers.

July 1998 Blue Cross Blue Shield of Illinois (also known as Health Care Service Corporation) pled guilty to eight felony counts and agreed to pay $144 million. The nature of the fraud was that Blue Cross Blue Shield Illinois manipulated work samples and falsified reports to the Health Care Finance Administration in order to conceal evidence of its poor performance as a federally-contracted processor of Medicare claims.

January 2000 Fresenius Medical Care of North America, the world's largest provider of kidney dialysis products and services, agreed to pay a fine of $486 million for a scam involving National Medical Care, Inc. (NMC), a kidney dialysis subsidiary owned by Fresenius which included fraudulent and fictitious blood testing claims by LifeChem, Inc. and fraudulent claims submitted to Medicare for intradialytic parenteral nutrition (IDPN), a nutritional therapy provided to patients during dialysis treatments.

February 2000 Beverly Enterprises Inc., the nation's largest assisted living facility chain, agreed to pay $175 million to resolve civil and criminal charges that it defrauded Medicare by fabricating Medicare patient records.

December 2000 HCA The Healthcare Company (formerly known as Columbia HCA), the largest for-profit hospital chain in the US, pled guilty to criminal conduct and agreed to pay more than $840 million in criminal fines, civil penalties and damages for unlawful billing practices. Fraud included: billing for lab tests that were not medically necessary and not ordered by physicians, "upcoding" medical problems in order to get higher reimbursements for more serious medical issues, billing the government for advertising under the guise of "community education," and billing the government for non-reimbursable costs incurred in the purchase of health agencies around the country. This agreement does not resolve allegations that HCA unlawfully charged the government for the costs of running its hospitals, and that it paid kickbacks to physicians to get Medicare and Medicaid patients referred to its facilities.

March 2001 Vencor Inc., one of the nation's largest assisted living facility chains, and Ventas Inc., a related real estate investment trust, agreed to pay the US $104.5 million to resolve claims for failure to provide the promised quality of care to assisted living facility patients due to inadequate staffing, improper care of bedsores, and failure to meet resident's basic dietary needs.

October 2001 Taketa-Abbott Pharmaceutical Products Inc. agreed to pay $875 million to resolve criminal charges and civil liabilities in connection with fraudulent drug pricing and marketing of Lupron®, a drug sold for $500 per dose for the treatment of prostate cancer under Medicare Part-A.

2002 Pfizer paid $49 million to settle state and federal Medicaid fraud charges involving Lipitor®.

April 2003 Bayer paid $257,200,000 to settle Medicaid fraud charges involving a "lick and stick" scheme in which Bayer sold re-labeled products to an HMO at deeply discounted prices, and then concealed this price discount in order to avoid paying additional rebates to the government.

June 2003 AstraZeneca agreed to pay $355,000,000 for providing free drug samples to doctors and telling them to bill Medicare and Medicaid hundreds of dollars per sample.

HCA agreed to pay the US $631 million in civil penalties and damages arising from false claims, including cost report fraud and the payment of kickbacks to physicians, submitted to Medicare and other federal health programs.

July 2003 CG Nutritionals, Inc. pled guilty to obstructing a criminal investigation and defrauding the Medicare and Medicaid programs and agreed to pay $400 million to resolve civil claims. In addition, the subsidiary of Abbott Labs, CG Nutritionals, Inc., agreed to a criminal fine of $200 million in relation to the sale of products which pump special foods into the stomachs and digestive systems of patients who are not able to ingest meals in a normal manner.

2003 GlaxoSmithKline signed a corporate integrity agreement and paid $88 million in a civil fine for overcharging Medicaid for the antidepressant, Paxil® and nasal allergy spray, Flonase®.



2003 medicare prescription drug law

"Let's end the hypocrisy of having people with perpetual, uncancelable, taxpayer-funded health insurance telling us that private, for-profit insurers are the answer." - Stacy Bermingham

2003 Corporate special interests, including HMOs and pharmaceutical corporations, dished out $141 million for 952 lobbyists - nearly twice as many lobbyists as there are members of Congress - to make sure that the Medicare bill was written for the benefit of large insurance and drug companies, as opposed to the health needs of American citizens.

Nearly half of these lobbyists were former employees of the federal government, including 30 former members of Congress, and at least 11 top staffers who left federal administration to lobby for the pharmaceutical industry and HMOs.

Many of the government officials who worked to get the legislation approved by Congress went on to jobs in the very corporations that will profit from the legislation.

Tom Scully, a former administrator of the Medicare program, actually negotiated future employment with corporations that stood to benefit handsomely from the pharmaceutical law, while actively promoting the legislation.

Another six top congressional staffers at the center of negotiations over the Medicare bill became lobbyists for pharmaceutical companies or HMOs.

Would it surprise anyone that 21 executives and lobbyists from HMOs and the pharmaceutical industry served as major fundraisers for George Walker Bush's presidential campaigns, collecting at least $100,000 ("Pioneers") or $200,000 ("Rangers") for the 2000 or 2004 campaigns?


May 2004Pfizer/Warner-Lambert agreed to pay $430 million to resolve civil and criminal charges that it defrauded Medicaid by engaging in an aggressive and complex scheme to illegally promote Neurontin® for at least 11 off-label uses.

July 2004 Schering-Plough agreed to a criminal fine of $52.5 million, $117 million to settle state claims, and nearly $176 million to settle federal claims for fraud in the pricing of Claritin® sold to the Medicaid program.

December 2004 HealthSouth, the nation's largest provider of rehabilitative medicine services, agreed to pay a fine of $325 million to settle allegations that the company systematically defrauded Medicare and other federal healthcare programs.

Gambro Healthcare agreed to pay $310.5 million to resolve civil liabilities stemming from alleged kickbacks paid to physicians, false statements made to procure payment for unnecessary tests and services, and payments made to Gambro Supply Corporation, a sham durable medical equipment subsidiary.

The Gambro Supply Corporation is permanently excluded from the Medicare program.

October 2005 Serono agreed to pay $704 million to settle a fraud case involving Serostim® which included kickbacks to doctors for prescribing Serostim®, kickbacks to specialist pharmacies for recommending Serostim®, illegal off-label marketing, and non-FDA approved diagnosis equipment designed to spur more Serostim prescriptions. Serostim® costs $20,000 for a three-month regime.

June 2006 St. Barnabas Healthcare agrees to pay $265 million for inflated "outlier" Medicare payments.

July 2006 Tenet Healthcare agrees to pay the Federal Government $900 million for billing violations that include manipulation of outlier payments to Medicare, as well as kickbacks, upcoding, and bill padding.

August 2006 Schering-Plough agrees to pay a total of $435 million to resolve criminal charges and civil liabilities in connection with illegal sales and marketing programs for brain tumor medication Temodar®, and Intron-A® which is used in the treatment of bladder cancer and hepatitis C. The Schering settlement also covers best price violations related to Claritin RediTabs® (an antihistamine), and K-Dur®, which is used in the treatment of ulcers.

September 2007 Bristol-Myers Squibb agreed to pay $515 million to settle allegations involved pricing and promotional activities for more than 50 drugs, 13 drugs of which made up 69% of Bristol-Myers' 2007 pharmaceutical revenue of $10.7 billion, including the blood thinner Plavix®, antiPsychotic Abilify®, the cholesterol treatment Pravachol®, the cancer therapy Taxol®, and the antidepressant, Serzone®.

January 2008 Under the False Claims Act Merck settled $650,000 for pricing fraud, taking kickback and violating Medicaid best price regulations for Vioxx® (an arthritis drug), Zocor® (a cholesterol drug), Pepcid® (an acid-reflux drug), Cozaar® (a hypertensive medication), Fosamax® (a bone loss drug) Maxalt® (a migraine medication) and Singulair® (an asthma medication).

March 2008 Amerigroup was found liable for discriminating against pregnant women who were supposed to be recruited into a state-sponsored Medicaid HMO. Amerigroup settled allegations for $225,00,000.



Wendell Potter

"I'm the former insurance industry insider now speaking out about how big for-profit insurers have hijacked our health care system and turned it into a giant ATM for Wall Street. In recent years I had grown increasingly uncomfortable serving as one of the industry's top PR executives. I also served on a lot of trade association committees and industry-financed coalitions, many of which were essentially front groups for insurers. So I was in a unique position to see not only how Wall Street analysts and investors influence decisions insurance company executives make but also how the industry has carried out behind-the-scenes PR and lobbying campaigns to kill or weaken any health care reform efforts that threatened insurers' profitability.

What I saw happening over the past few years was a steady movement away from the concept of insurance and toward "individual responsibility," a term used a lot by insurers and their ideological allies. This is playing out as a continuous shifting of the financial burden of health care costs away from insurers and employers and onto the backs of individuals. If they are unfortunate enough to become seriously ill or injured, many people enrolled in these plans find themselves on the hook for such high medical bills that they are losing their homes to foreclosure or being forced into bankruptcy.

As an industry spokesman, I was expected to put a positive spin on this trend that the industry forged and euphemistically refers to as "consumerism" and to promote so-called "consumer-driven" health plans. Insurers want to preserve the image they are working so hard to cultivate - as a group of kind and caring folks who think only of you and your health. I ultimately reached the point of feeling like a huckster.

I thought I could live with being a well-paid huckster and hang in there a few more years until I could retire. I probably would have if I hadn't made a completely spur-of-the-moment decision a couple of years ago that changed the direction of my life. While visiting my folks in northeast Tennessee where I grew up, I read in the local paper about a health "expedition" being held that weekend a few miles up US 23 in Wise, Virginia. Doctors, nurses and other medical professionals were volunteering their time to provide free medical care to people who lived in the area. That 50-mile stretch of US 23, which twists through the mountains where thousands of men have made their living working in the coal mines, turned out to be my "road to Damascus."

Nothing could have prepared me for what I saw when I reached the Wise County Fairgrounds, where the "expedition" was being held. Hundreds of people had camped out all night in the parking lot to be assured of seeing a doctor or dentist when the gates opened. By the time I got there, long lines of people stretched from every animal stall and tent where the volunteers were treating patients. That scene was so visually and emotionally stunning it was all I could do to hold back tears. How could it be that citizens of the richest nation in the world were being treated this way?

I realized that the reason those people in Wise County had to wait in long lines to be treated in animal stalls was because our Wall Street driven health care system has forged one of the most inequitable health care systems on Earth.

I did not make a final decision to speak out as a former insider until recently when it became clear to me that the insurance industry and its allies (often including drug and medical device makers, business groups and even the American Medical Association) were succeeding in shaping the current debate on health care reform. I heard members of Congress reciting talking points like the ones I used to write to scare people away from real reform. Whenever you hear a politician or pundit use the term "government-run health care" and warn that the creation of a public health insurance option that would compete with private insurers (or heaven forbid, a single-payer system like the one Canada has) will "lead us down the path to socialism," know that the original source of the sound bite most likely was some flack like I used to be." - Wendell Potter


"Americans for Quality and Affordable Healthcare" (AQAH) is a "secretive" group that organizes "below-the-radar" activities to drum up opposition to health care reform. AQAH is operated by one of the largest law firms in North Carolina, Moore and Van Allen.

The pharmaceutical industry-funded front group Center for Medicine in the Public Interest (CMPI) is helping its corporate funders fight health care reform by disseminating misinformation and orchestrating campaigns to generate fear about health care reform. CMPI arose out of the Pacific Research Institute, a corporate front group that worked with Philip Morris in the past to fabricate academic support for the tobacco industry.

The US Chamber of Commerce sponsored online pop-up ads to generate the appearance of "grassroots" opposition to health care reform. The Chamber contracts with a public relations firm which in turn subcontracts with an online marketing firm that coordinates the tasks of generating the ads and signing people up for the Chamber's campaign. The ads tell readers that if they complete a survey and give their names and personal information, they will get a $150 American Express Gift Card for use at Hooters Restaurants.



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This website defines a new perspective with which to engage reality to which its author adheres. The author feels that the falsification of reality outside personal experience has forged a populace unable to discern propaganda from reality and that this has been done purposefully by an international corporate cartel through their agents who wish to foist a corrupt version of reality on the human race. Religious intolerance occurs when any group refuses to tolerate religious practices, religious beliefs or persons due to their religious ideology. This web site marks the founding of a system of philosophy named The Truth of the Way of Life - a rational religion based on reason which requires no leap of faith, accepts no tithes, has no supreme leader, no church buildings and in which each and every individual is encouraged to develop a personal relation with the Creator and Sustainer through the pursuit of the knowledge of reality in the hope of curing the spiritual corruption that has enveloped the human spirit. The tenets of The Truth of the Way of Life are spelled out in detail on this web site by the author. Violent acts against individuals due to their religious beliefs in America is considered a "hate crime."

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