Insurers accused of filing false state reports

Tensions rose this week between private insurance companies doing business in Maine and a nonprofit consumer organization that works closely with the governor’s health office on Dirigo Health reforms.

Monday afternoon, attorney Joe Ditre, executive director of Consumers for Affordable Health Care, announced he had filed a letter with state officials requesting a formal investigation into insurance companies’ alleged failure to file financial information with the state’s insurance bureau as required by Maine law.

Specifically, Ditre said that for the past two years, insurers have not listed the total amount they spend on lobbyists, their contracted representatives before the Legislature.

Insurance lobbyists have been working overtime recently to defeat legislative proposals that would benefit consumers but work to the disadvantage of insurance companies, Ditre said.

One such measure, LD 1845, would allow the Dirigo Health Agency, which currently contracts with Anthem Blue Cross and Blue Shield to provide coverage for about 10,000 Maine residents, to self-insure, presumably resulting in lower costs to consumers by eliminating the need to generate a profit.

Another, LD 1935, would prohibit companies from raising their rates to consumers to reimburse themselves for the so-called “savings offset payment,” an annual assessment based on savings achieved in the health care system over the previous year through Dirigo Health initiatives aimed at reducing costs.

According to Ditre’s letter – sent to both state Attorney General Steven Rowe and Insurance Superintendent Al Iuppa – the omission is more than an oversight. Because the companies have filed the same information in a different format with the Maine Commission on Governmental Ethics, but filed either nothing or “$0” on the insurance office form, the omission constitutes “a knowingly false material statement and, as a such, a violation of the law subject to its full penalties.”

The information filed with the ethics commission is fragmented and not easily compiled, Ditre said in an interview. He said the law is intended to make it easier for the public to know how much money insurers spend pursuing their legislative agendas instead of providing health care, and, he said, the industry doesn’t want that information easily accessible. “This is an industry that believes it’s above the law,” he said.

A call to the Attorney General’s Office was not returned by the end of the day Tuesday. Insurance superintendent Iuppa would not comment on the situation other than to say he had received Ditre’s letter and was looking into the matter.

Maine’s four primary health insurance carriers were cautious in their responses. Anthem spokesman Mark Ishkanian said the reporting forms were filed last Friday under deadline pressure and were considered “preliminary.” The information will be amended to reflect lobbying expenses, he said. Ishkanian denied any intent to conceal information on the part of the company, and suggested that Ditre might have found a “less grandiose” way to express his concerns.

At Massachusetts-based Harvard Pilgrim, operations director Robert Downs said it was unclear whether the company’s report to the insurance office was in error. “Harvard Pilgrim doesn’t hire external lobbyists,” he said. “It’s unfortunate that if Joe [Ditre] had a question he didn’t just contact the insurance companies for clarification before sending a letter to the Attorney General’s Office.”

Aetna spokeswoman Wendy Morphew said her company had every intention of complying fully with the Maine reporting law and would make any changes necessary after reviewing the situation.

Cigna did not return calls by the end of the day.