Note: Come back next week  for more on this story inincluding excerpts from the complaint, including,  horrific quotes (e.g., Carr's refusal to deny that he and the insurers are denying patients life-saving treatments in the hope that they will die and save the insurance company money), nagging questions as to why the people responsible for saving the insurance companies money (e.g., Carr who works for the Health Care Financing Division in the Doyle administration) are making life and death decisions (especially when they have an attitude like Carr's). Such decisions in these wrongful denials are virtually always the opposite of what the patient's own physicians and specialists say is medically necessary, and  so much more . . . .

WISCONSIN, November 2, 2006

Corrupt Wisconsin Government Officials Assist Unethical Insurers In Wrongfully Denying Patients Life-Saving Treatment has learned that a series of complaints are being prepared by patients and patient advocates against several high-ranking state government officials in the Doyle administration who assisted several major insurers in the wrongful denial of life-saving treatments to patients. The first of these complaints is against the administrationèief Medical Officer, Dr. Richard Carr, and states that he assisted several insurance companies in wrongfully denying medically necessary life-saving treatments, and illegally removed incriminating document(s) from at least one patient's file as well as trying to cover-up his actions with fraudulent documents.

Assisting in the Carr's cover-up was a high-ranking state official and the head of one of the insurance companies, who in a meeting less than two weeks earlier had assured a patient and a state senator that they would investigate thoroughly the unethical activity that had already been occurring. Despite the attempted cover-up enough evidence (e.g., documents, recordings, emails) was obtained that in addition to the filing of ethics charges, it is anticipated that criminal charges may be filed in the future.

Unfortunately, though unusual in the degree of corruption and who is involved, this is not an isolated incident as there are insurance companies throughout the nation trying to unethically boost profits by utilizing these wrongful denials. Patients are being denied medically necessary chemotherapies, surgeries, and more because they know that few if any sick patients can make their way though the gauntlet of paperwork, timetables, and stacked appeals/grievance committees whose members are typically insurance company employees. It is no wonder that only a miniscule fraction of these wrongfully denials ever succeed in getting overturned.

What makes these wrongful denials so despicable is that they are often used to deny patients life-saving treatments which typically have been well studied, used to treat patients for years, are FDA approved, and are not considered experimental by the overwhelming majority of physician experts. One example is VNS (vagus nerve stimulation) therapy which is the only effective treatment for patients with a severe form of depression called TRD. Some unethical insurers are still calling it experimental despite it having been approved by the FDA over a year ago, used safely and effectively in thousands of patients, is the only effective treatment for TRD, and hundreds of physician experts have gone on record as saying unequivocally that it is not "experimental". Even a delay in getting these patients VNS can be dire since TRD has a high suicide rate, and at least one patient is known to have committed suicide after receiving one these wrongful denial by their insurer; a true tragedy because even though TRD has a high suicide rate, no VNS patient studied has yet committed suicide.

Additional Background Information: The patient in this story is a middle-aged, married, father of 5 who has been paying over $25,000 annually for his familyਥalth insurance and out of pocket expenses. It took him over four months before he was able get the life-saving surgery that he needed in his attempt to make the system work. Being a physician (now retired due to medical illness) and having worked as a medical director for a Wisconsin insurance company during the 90젨e felt that if couldnୡke the system work, then who could? About a week after he had thought he had succeeded, that he became aware of the corruption and cover-up that had subsequently taken place and he lost all hope. Though his depression had been severe for years, it did take a turn for the worse this past year but he was strong enough to fight the overwhelming urge to end his pain. The only thing that kept him alive was reminding himself what his suicide would do to his family; that love for his wife and kids kept him alive. But faced with a world where evil had the power to destroy others for the sake of money and self-preservation (most of Carr͊ criminal acts actually stems from trying to cover up his incompetence), it became too much and he nearly died a couple times before the surgery. If it were not for the available funds they had and his elderly parents taking out a loan using their retirement account as collateral so he could have the surgery, there is no doubt that he would be dead today. Though far from well, he and his family are thankful for his just being alive. We too are thankful that there are people like him and his family who are willing to risk the intimidation and threats from the rich and powerful so that others who have also been wrongfully denied, might have a chance in the future.

?  2006