08/12/2024
Health Insurance Executive Targeted in New York
6 December 2024
A top health insurance executive was killed in what seems to be a targeted shooting in New York’. It seems that he was threatened over ‘health insurance issues’.
Every day I see patients who have their perfectly reasonable treatment requests refused by workers comp or CTP (Compulsory Third Party = Green Slip) insurers. The ‘case managers’ who are grandly titled case clerks have little power and follow protocols dictated by more senior folk in the organisati0on. I am unsure if they get bonuses for cases costing less than some statistical average for that type of claim, but nothing would surprise me. Sometimes it seems that they just refuse treatments because they think that they will get away with it, but the odds are stacked that they will often succeed anyway. The case clerks (Case ‘Managers’) cop a lot of abuse and are rotated frequently, perhaps to prevent their abuse or perhaps to prevent them getting to know their ‘clients’, who some of us would call ‘patients’. The case clerks have very little discretion and the system is very slow and seems designed to ensure that absolutely no one could ever be overpaid. The clerks follow their protocols, and are often unavailable and do not return calls. Most use their first names and a letter (presumably the first letter of their surnames) presumably so that they will not be personally targeted by those whose treatments they are refusing. (One would have thought that as people handing out money to people in distress that they might be very popular). It is as if one side are playing a game with money, but for the other side it is deadly serious.
Given that about a third of the population live from paycheck to paycheck, the fact that insurers have 3 weeks to accept or reject the whole claim, then 3 weeks to approve or deny any treatment, and longer if it is a difficult case, a huge amount of human misery can be created without even stressing any protocols. Governments are keen to keep premiums low and seem keen to support any insurer –suggested legislative amendments that achieves this aim. Interestingly the NSW Parliamentary Committee reviewing the NSW Workers Compensation legislation in 2022 had no input for either patients or doctors or their organisations. Presumably they did not seek such input and there was no publicity for the inquiry.
I see in my practice many distressed people whose lives are destroyed by these treatment denials. Now with the insurers only liable for the first 5 years after injury, if they can delay treatment longer than that, they are off the financial hook and the patients need to be treated by Medicare if that is possible. When I say ‘if that is possible’, many specialists will not do any Medicare work as it pays less than half the private rate. The waiting list is usually over a year for non-emergencies and the specialists are even more reluctant to treat cases that should have been paid by workers comp or CTP insurers. Even that assumes that the patients have Medicare; overseas students or people on working visas do not.
My belief is that insurers want to control medicine and the WC and CTP insurers, now with considerable input from the American Health insurance industry are preparing for the (very soon) day when Medicare is irrelevant and insurers tell doctors what they may do.
The patients whose lives are destroyed by the insurer denials of their reasonable treatments are upset and angry, often shattered physically and by the loss of their homes, properties and marriages do not think through how this has all happened. They are angry with the ‘case manager’ but not those higher up in the organisation who set the protocol that was the basis of their treatment denial.
Years ago, when I went to tobacco control conferences in the USA, there would sometimes be discussions among doctors about how to treat various medical conditions. Amongst the non-Americans, the talk was about what regimes were best. The Americans were usually concerned with what the insurers would pay for to the point that it was sometimes frustrating to have them in the conversations. I won a Fellowship in 1985 to study workplace absence and got some flavour of the way treatments were denied. I now see it all unrolling in Australia.
In the US guns are easy to get. When I saw a US health executive had been shot by an unknown person, I did not find it hard to find a motive, and thought that there could probably be a very large number of suspects. I Australia the case managers do not dare give their surnames, but the top executives are still all on the company websites.
If we continue to let Medicare be defunded because of private health donations to the major political parties and put money ahead of people’s reasonable needs, we will follow the Americans.
Here is the Reuters article in the SMH 6 December 2024
Health executive shot dead on New York street
Brian Thompson, the chief executive of UnitedHealth’s insurance unit, was fatally shot yesterday outside a Midtown Manhattan hotel in what appeared to be a targeted attack by a gunman, New York City police officials said.
The shooting occurred in the early morning outside the Hilton on Sixth Avenue, where the company’s annual investor conference was about to take place. Thompson was rushed to a nearby hospital where he was pronounced dead. The attacker remained at large, sparking a search that included police drones, helicopters and dogs.
“This does not appear to be a random act of violence,” New York City Police Commissioner Jessica Tisch said. “Every indication is that this was a premeditated, pre-planned, targeted attack.” The suspect, wearing a mask and carrying a backpack, fled on foot before mounting an electric bike and riding into Central Park, police said. Law enforcement authorities said the gunman appeared to use a silencer on his weapon, CNN reported.
UnitedHealth Group said Thompson was a respected colleague and friend to all who worked with him. “We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time,” it said in a statement. “Our hearts go out to Brian’s family and all who were close to him.”
UnitedHealth Group is the largest US health insurer, providing benefits to tens of millions of Americans who pay more for healthcare than in any other country.
Video footage showed the gunman arrived outside the Hilton about five minutes be
fore Thompson. He ignored several other people walking by, NYPD Chief of Detectives, Joseph Kenny told reporters.
When Thompson approached the hotel, the gunman shot him in the back with a pistol and then continued firing, even after his gun appeared to jam. “Based on the evidence we have so far, it does appear that the victim was specifically targeted, but at this point, we do not know why,” Kenny said. The shooting happened not long before the scheduled investor conference at the Hilton.
UnitedHealth Group chief executive Andrew Witty took to the stage about an hour after the event started to announce the rest of the program would be cancelled.
“We’re dealing with a very serious medical situation with one of our team members, and as a result, I’m afraid we’re going to have to bring to a close the event today,” he said.
Police tape blocked off the area on 54th Street outside the Hilton, where blue plastic
gloves were strewn about, and plastic cups appeared to mark the location of bullet casings.
Thompson’s wife, Paulette Thompson, told NBC News that he told her “there were some people that had been threatening him”. She didn’t have details but suggested the threats may but suggested the threats may
have involved issues with insurance coverage. Eric Werner, the police chief in the Minneapolis suburb where Thompson lived, said his department had not received any reports of threats against the executive. The killing shook a part of New York that is normally quiet at that hour, about four blocks from where thousands of people were set to gather for the city’s Christmas tree lighting. Police promised extra security for the event.
“The police were here in seconds. It’s New York. It’s not normal here at seven in the morning, but it’s pretty scary,” said Christian Diaz, who said he heard the gunfire from the nearby University Club Hotel where he works.
Police issued a poster showing a surveillance image of the man pointing what appeared to be a gun and another image that appeared to show the same person riding on a bicycle. Minutes before the shooting he stopped at a nearby Starbucks, according to additional surveillance photos released by police. They offered a reward of up to $US10,000 ($15,500) for information leading to an arrest and conviction.
Governor Tim Walz of Minnesota, where the company is based, said the state was praying for Thompson’s family and the UnitedHealth team. “This is horrifying news and a terrible loss for the business and healthcare community in Minnesota,” he said in a statement. Thompson, a father of two sons, had been with UnitedHealth since 2004 and served as chief executive for more than three years. Thompson was appointed head of the company’s insurance group in April 2021 after working in several departments, according to the company’s website.
“Sometimes you meet a lot of fake people in these corporate environments. He certainly didn’t ever give me the impression of being one of them,” said Antonio Ciaccia, chief executive of healthcare research non-profit 46brooklyn, who knew Thompson. “He was a genuinely thoughtful and respectable guy.”
Reuters, AP
There was considerable follow up: