CareFirst Continues Open Enrollment Program Until February 2008

DISB announced that the Group Hospitalization and Medical Services Inc. (GHMSI), administered by CareFirst BlueCross BlueShield has decided to extend its Open Enrollment Program until February 2008 for those District residents who are unable to obtain health insurance from the market.

“DISB is pleased that GHMSI has agreed to continue providing health coverage to District residents who otherwise may not have access,” said Commissioner Thomas E. Hampton. “Studies have shown that those without insurance are more likely to delay seeking care and more likely to report being in worse health.” GHMSI will keep its Open Enrollment Program going until February 2008; or until a legislative solution takes effect.

GHMSI, the District-based affiliate of CareFirst BlueCross BlueShield, has operated as a nonprofit health insurer in the District since 1939. In addition to providing health insurance to District residents and businesses, GHMSI also sells its products in Maryland and Northern Virginia. The Open Enrollment Program (not to be confused with the employer-sponsored health insurance open enrollment season) is the carrier of last resort in the individual market, but it makes it possible for otherwise uninsurable individuals such as recent graduates, those between jobs, part-time workers, early retirees or those whose employers do not offer group health insurance, to have basic health coverage. According to the US Census Bureau, the number of people in the United States without health insurance increased from 45.3 million to nearly 47 million from 2004 to 2005; the District has more than 70,000 residents without health insurance.

“Health insurance is critical to the peace of mind of most Americans, but it has become increasingly complex and expensive,” said Hampton. “It is especially troubling as so many District residents are without health coverage.”

By law, GHMSI must advertise quarterly in local newspapers to inform District residents of its product (Individual Blue Preferred Open Enrollment Program). This is available to District residents under age 65 or over 65 and not receiving Medicare benefits, regardless of health condition. Benefits include:

• Physician office visits (24,000 participation providers to choose from) 
•  Hospital care and benefits for medical and surgical care (42 participating hospitals to choose from)
• Prescription drugs
• Vision Care with a $10 copay for routine eye examinations and 30 percent discount on eyeglasses/frames/lens.

Rates are 125 percent over standard health insurance rates and the 10-month pre-existing condition has been waived for all enrollees. The coverage is based on the Blue Preferred PPO.

	In-Network	Out-of-Network
Deductible	$750 (80/20)	$1,500 (60/40)
Out-of-Pocket	$3,500	$7,000
Prescription:	$10 Generic Copay, $25 Preferred Brand Copay, $45 Nonpreferred Brand    Copay $100 Deductible, $1,500 Annual Maximum

For additional information, call (800) 544-8703 to speak to a product specialist.

March – Upcoming Events with DISB's Participation

• AARP Capital Hill Chapter 2881 and Foundation’s Campaign for Wise and Safe Investing
  Tuesday, March 13, 2007, 1:15 – 2:15 pm
  Liberty Baptist Church, 15th and Kentucky Avenue, SE
• Presentation on Insurance Products: How much do you really know
  Wednesday, March 14, 2007, Noon to 1 pm
  Great Hall at the Martin Luther King Jr. Library
• Presentation on Insurance Fraud: Learn how not to fall victim to fraud
  Wednesday, March 21, 2007, Noon to 1 pm
  MLK Library. For more information on both programs, call (202) 727-1171
• DISB’s consumer protection activities at the LeDroit Park Civic Association meeting
  Tuesday, March 27, 2007, 7 to 9 pm
  Florida Avenue Baptist Church, 623 Florida Avenue, NW
• 5th Annual Health Fair
  Saturday, March 28, 2007, 12:30 – 4 pm
  Carroll Manor Nursing and Rehab Center, 1150 Varnum Street, NE

DISB’s Core Services Check credentials of the financial service providers you do business with; File complaints if you think you have been defrauded or treated unfairly by any service providers; and Get consumer information on financial products, services and resources.

The DCSaves Campaign—Build Wealth, not Debt

Currently, the national savings rate is 0 percent, something that has not occurred since the Great Depression. A recent study commissioned by Consumer Credit Counseling Services revealed that overall consumer debt has increased by 38 percent for households at all income levels over the last year.  A growing number of households in Washington, DC, are taking on more debt and saving less than ever before. In light of these statistics, the DC Department of Insurance, Securities and Banking (DISB) has joined the Capital Area Asset Building Corporation (CAAB) and other District businesses and organizations—for profit and nonprofit—to promote greater household savings. As part of DCSaves, in April, DISB has committed to a wide range of activities promoting household savings such as distributing literature, holding workshops, credit-counseling services, investing in savings products and enrolling employees in retirement savings plans.

DCSaves, a local offshoot of the America Saves campaign, is a new initiative to motivate Washingtonians to reduce debt, save money and build wealth. Federal Reserve Chairman Benjamin Bernanke recently encouraged all America Saves campaigns to expand efforts and combat the low savings rate. In response, DCSaves will focus on promoting savings and motivating individuals, particularly those in low- and moderate-income households, to take financial action. Launched in 2001 with one city, Cleveland, Ohio, America Saves now has 53 local, state and national campaigns. Currently, more than 61,000 Savers list their top savings goals for emergency funds, savings and investment, homeownership and retirement savings. The goal of Saves Week and DCSaves is for a change in behavior among individuals and families when it comes to wealth building. For more information on strategies for reducing debt and maximizing your savings, visit www.americasaves.org and become an American Saver. To find out more about the DCSaves program, please contact CAAB at www.caab.org.

Updates to DISB Fraud Cases

Former District government attorney sentenced for fraud
A Springfield, Va., man and former DC government attorney for nearly 30 years, was sentenced Jan. 19, for interstate transportation of stolen property in a scheme to defraud clients in his private law practice by stealing their insurance settlement checks.

 The US District Court for the District of Columbia sentenced the perpetrator to eight consecutive weekends of intermittent imprisonment in DC jail. Then, he will serve 180 days of home detention with electronic monitoring. His sentence will be followed by two years of supervised probation including a substance abuse program and drug testing. In addition, the accused must reimburse the defrauded insurance carriers and a District resident a sum of $26,100. In addition, he has been disbarred from the practice of law in the District of Columbia for five years.

 Starting in the 1990s, the accused ran a private law practice in northwest Washington, DC. He represented clients in small civil tort cases, taking them on a contingency fee basis, receiving a percentage of the overall settlement or jury award. Often, he paid medical bills for his client out of the settlements. Usually, he made demands on insurance companies, settling the cases with the insurance company, typically out of state, which would send settlement checks to his law office requiring his and his clients’ signatures.

 From early 2000 through 2001, the accused engaged in the scheme to defraud clients by settling lawsuits with insurance companies on their behalf, without telling them about the settlement. He had the companies send the settlements to him and forged the clients’ signatures on the checks and deposited the money into his law firm bank account. He failed to pay his clients or their medical bills. The Enforcement and Investigation Bureau of the DC Department of Insurance, Securities and Banking led the investigation, with the assistance of the Federal Bureau of Investigation. The case was prosecuted by the US Attorney’s Office.

Owner of DC dental clinic sentenced for $164,000 fraud
The owner of a local dental clinic was sentenced early February to six months community confinement and six months home detention as part of three years supervised release; and ordered to pay restitution of $164,000 and a fine of $40,000 for submitting false claims for payment to private insurance companies. The woman of McLean, Va., was sentenced by the Honorable Henry H. Kennedy Jr. in the US District Court for the District of Columbia. In November 2006, she pleaded  guilty to the charge of health care fraud. The defendant is the owner, president, vice president, secretary and treasurer of the dental clinic in northwest Washington, DC. She employed licensed dentists to perform dental procedures and services to patients. Between 2000 and 2004, she submitted or caused to be submitted false claims for payment to private insurance companies, including Aetna and Metlife, for dental work performed or allegedly performed by dentists in her clinic. Aetna and Metlife are health care benefit programs, in that they are private plans or contracts affecting commerce, under which medical benefits or services are provided to individuals. These claims were false because they asserted that dental procedures had been performed on patients when, in fact, no such procedures were performed, or because they sought payment for the same procedures that already had been billed to and paid by another insurance company. Aetna and Metlife paid for false claims by mailing checks to the woman’s dental clinic. The Enforcement and Investigation Bureau of the DC Department of Insurance, Securities and Banking jointly investigated this case with the US Attorney’s Office, the Federal Bureau of Investigation’s Washington Field Office and the District of Columbia Department of Health.