How BCBS Became Judge, Jury and Executioner for "Enemy" Doctors in Texas

[McCamy Taylor]

Introduction:

Just in case you have ever wondered why insurance companies and their representatives seem so cocky when dealing with individual physicians, maybe it is because they have so much power. All that money allows them to do things that you might think were impossible---like stifle the doctors who are supposed to be advocates for their patients by usurping control of the regulatory bodies that police doctors.

This is a real story. In happened in Texas between 2003 and 2007. The next time you hear a physician whistle-blower describe insurance abuses, remind yourself that he or she does so at great personal risk. Where there is money involved, there are likely to be a lot of unscrupulous people who will stop at nothing to protect that money---especially if the money is coveted by Blue Cross Blue Shield, the mega-behemoth of insurers which has been guilty, among other things, of lying about losses so that it can raise premiums and dump sick patients and defrauding Medicare (and yes, the links are easy to provide if you really want them. The NYT covers big stories like those). BCBS, whose MikeHightower was one of Bush's Pioneers. BCBS which counted among its board members Uncle Bucky Bush. BCBS which was the only non-bankster in the list of top donors to Bush in 2004. Bush---who bragged about the Texas Patient Protection Act (which he vetoed) in a 2000 debate with Gore then had Ashcroft get it struck down in federal court for his good buddies in the insurance industry. Bush, who set back the cause of universal health care for eight years.

Dirty Dealings in Texas (On The Texas State Medical Board)

http://www.txmedicallicensinglaw.com/2007/09/articles/texas-medical-board/member-of-texas-medical-board-resigns-amid-flood-of-criticism/

Remember Dr. Keith Miller? A Ricky Perry appointee. He served on the Texas Medical Board. The board that is supposed to keep the public safe by making sure that doctors practice good quality medicine. Turns out that Miller had a conflict of interest. He worked for BCBS, at a time when health insurers were attempting to control costs by rationing care. When an insurance company wanted to punish a doctor that it did not like, it would make an anonymous complaint. And then, no matter what the evidence, Dr. Miller would make sure that the doctor suffered.

However, critics of Dr. Miller’s tenure have further accused him of improperly using his position on the TMB to transform the Enforcement Committee into a virtual arm of the insurance industry. Board Rules allow anonymous complaints to be made to the TMB which can then serve as the basis of a disciplinary action. Aggrieved physicians have alleged that insurance providers who are dissatisfied with the level of care provided to a covered patient have used such anonymous complaints as a way to punish doctors and maintain low cost levels. Such physicians point out that it is not actually the standard of care which motivates these anonymous complaints but rather a doctor’s decision to supply care whose cost exceeds insurance company guidelines and therefore hurt profits. These maligned anonymous complaints originate from the insurance providers and not the actual patients. In fact the patients whose care is supposedly at issue are frequently surprised when notified of the pending disciplinary action and often testify in favor of their doctor.

Miller’s opponents specifically point to his position on the Texas Medical Advisory Committee of Blue Cross Blue Shield as evidence of his close ties with insurance providers. For instance, Dr. Steven Holtze president of the Project for Freedom of Access to Natural Solutions has alleged that Dr. Miller has used his position to sanction practitioners of environmental medicine, an area of practice disfavored by some insurance providers. This included disciplinary proceedings against Dr. William Rea, the founder of the Environmental Health Center in Dallas.[ii]

The Texas Medical Board initiated their investigation into Dr. Rea following an anonymous complaint which was later found to have been made by the insurance provider for five of his patients. Even though eighteen expert witnesses and all five patients testified in favor of Dr. Rea, the TMB, relying on a single anonymous expert witness, still ruled against the doctor. At the proceeding, Dr. Miller is alleged to have explicitly disregarded all of Dr. Rea’s rebuttal evidence and assured him that he was going to get his license no matter what.

http://theeprovocateur.blogspot.com/2008/05/blue-cross-blue-shield-vs-private.html

One of the doctors that got in BCBS's way was Dr. Shirley Pigott. She decided to help other Texas doctors organize to fight insurance abuses. BCBS did not like that. So, they used their doctors inside the Texas Academy of Family Physicians and the Texas State Medical Board to stop her. And, they sent a ringer--a patient to file a frivolous complaint so that their man, Dr. Miller on the Board could railroad her.

Too bad for them, she fought back.

http://www.personalconsult.com/articles/texasmedboardhenchman.html

Dr. Shirley Pigott was indefatigable in her investigations of Miller. Dr. Pigott uncovered Miller's relationship with Hughes, his work as an expert witness for plaintiff attorneys against physicians and his conflict of interest as a member of the Blue Cross Blue Shield Medical Advisory Committee which looks for ways to cut costs by limiting physicians' evaluations and treatment of patients. Dr. Pigott deserves our deepest gratitude.

This story had a happy ending...sort of. In 2007, doctors sued the entire Texas State Medical Board. Turns out another doctor on the Board had her husband "turn in" her competitors so she could drive them out of business.

http://www.aapsonline.org/press/122107.php

Dr. Miller tried to sue the whistleblowers. That did not get him very far.

http://www.jpands.org/vol17no1/huntoon.pdf

However, while everyone was properly horrified at doctors for working for BCBS to stab other doctors in the back in order to make sure that doctors were too afraid to fight back against insurance company abuses--which included denials of necessary services and care---I can not find anyplace where BCBS suffered at all for what they did. They continued to be the official insurer for the Texas Employee Retirement System until just a couple of years ago, when they screamed bloody murder because someone else got the contract. I guess they figured their good buddy Rick Perry had them covered.

Moral, never ever underestimate the lengths an insurance company will go to make a buck. There is absolutely nothing too low, too devious, too illegal. Just because they have the word "insurance" in their name, they are no more virtuous than Big Oil or the Banking Industry. The bottom line is still money.