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In Connecticut, Attorney
General Richard Blumenthal has filed a lawsuit in an attempt to stop a
large HMO from denying mental health care for its customers. According
to Blumenthal, Anthem Blue Cross and Blue Shield of Connecticut and
Psych Management Inc. (PMI), the company it hired to manage behavioral
health claims for some 600,000 HMO enrollees, arbitrarily denied
medically necessary mental health care for vulnerable patients.
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According
to Blumenthal's March 2002 report, Anthem should have known that Dr.
Richard Benet — a Hartford physician that had a controlling financial
interest in PMI — made decisions that "repeatedly" caused denial of medically necessary coverage
and care to Anthem. Blumenthal has called on the State Department of
Public Health to initiate proceedings to suspend or revoke the license
of Dr. Benet to practice medicine on the grounds of "negligent conduct
in the practice of medicine." He is also initiating litigation to
ensure that Connecticut patients enrolled in managed care plans
administered by Anthem and PMI are protected from "arbitrary and unfair
coverage determinations."
According to Blumenthal, Anthem must share the
blame for the "misdeeds" of PMI and Dr. Benet. "When Anthem
subcontracts, it remains responsible for keeping the promises it makes
to its enrollees," says Blumenthal. "Any failure by PMI is also
ultimately Anthem's failure."
A March 2002 report from Blumenthal says Dr. Benet
was eventually forced out of PMI, after Anthem learned that he had been
consistently lying about the financial operations of PMI. However, the
report also finds that "despite his years of mismanaging PMI into a
dangerous deficit, injuring enrollees, and lying to Anthem and PMI
Board members, Dr. Benet received a $400,000 golden handshake paid for
by Anthem."
Blumenthal says that even more disturbing than the
payout to Dr. Benet is that Anthem continues to contract with PMI for
its behavioral health program. "Although Dr. Benet is no longer with
PMI, the arbitrary coverage caps and guidelines apparently are still in
use by PMI and Anthem, conflicting with Anthem's contractual
obligations," says Blumenthal. "In fact, Anthem's written promises and
assurances, in light of the facts now known, are affirmative
misrepresentations to patients concerning the coverage available under
its plans, and the circumstances of plan administration."
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