A Las Vegas attorney who is suing the Silver State Health Insurance Exchange has revealed documents that he said could shed light on some of the exchange’s website troubles.
Now, he wants the anonymous source of those papers to go public to help consumers who have had trouble getting health insurance they’ve paid for.
Matthew Callister of Callister, Immerman and Associates released the paperwork at a Wednesday news conference to encourage its unknown source, apparently a Nevada Health Link employee, to come forward so the claims can be verified. In a letter to Callister, the unknown employee describes closed-door talks about how to fix problem files. The letter was accompanied by printouts of e-mails between officials with the exchange and its contractor, Xerox.
Callister said he’s 80 percent certain of the documents’ authenticity. He also said the writings “have the ring of truth,” and sound as if they’re coming from “someone fairly high up” who is “baring their soul.” Among the allegations: The state’s health insurance exchange at least discussed secretly dumping all enrollees from its system to start fresh on botched accounts.
The documents aren’t yet usable in Callister’s lawsuit because the person who sent them has not been subpoenaed or properly deposed.
“They’re fugitive documents, but they tell us what we’ve believed all along — that there are thousands of instances in which Nevada residents have paid premiums and not received coverage,” Callister said.
Callister filed a class-action lawsuit on April 1 alleging that two plaintiffs went uncovered even after paying several months’ worth of premiums through Nevada Health Link, the website through which Nevadans can buy insurance to comply with the Affordable Care Act.
Consumers have reported issues ranging from incorrect effective dates to coverage that’s missing altogether, and technical glitches helped hold enrollments through March 31 to less than 30,000, a fraction of the 118,000 sign-ups the exchange projected in its first year.
Callister also said the documents indicate more than 6,300 people may have paid for coverage they do not have.
Callister, who said about 60 plaintiffs in Southern Nevada have joined his lawsuit so far, said he received the anonymous documents about a week ago. Wednesday morning he made a rare public appeal for the source of the paperwork to come forward, noting that state law protects whistle-blowers from retaliatory action if the information they give is true and in the public interest. In any event, Callister’s firm plans to use the documents as a guide to discovery for the lawsuit.
An exchange spokesman said he could not verify the papers’ authenticity or comment on the allegations without seeing the documents.
The documents paint Xerox and exchange officials as failing to take seriously emerging concerns about the viability of Nevada Health Link’s website. According to the letter, when the Centers for Medicare and Medicaid Services would audit the system’s progress before its Oct. 1 launch and spot potential problems, exchange officials told the federal agency the flaws would be fixed later.
The unknown author also wrote that on Nov. 8 and 9, Xerox officials met former exchange Executive Director Jon Hager to discuss enrollment troubles related to calculating federal premium tax credits for buyers. The parties discussed canceling all applications, then numbering at least 20,000, and forcing members to sign up again so the tax credits could be redetermined. The cancellations would even affect people who had already paid.
The cancellations would be needed because the website’s technical problems meant little customer data was accurate, and many customers had multiple system records that could not be reconciled with Social Security numbers. Also, tax credits “were all miscalculated … and not enough money was paid on the premiums,” the letter reads.
That means a 70-year-old smoker would pay less on his richer silver plan than a 25-year-old nonsmoker would pay on a lower-cost bronze plan, for example.
Dropped enrollees would not get an email or phone call telling them of their status. Instead, the documents said, exchange officials would try to pass off the dropped accounts as another in a string of system glitches.
Callister’s partner, Steve Immerman, said if the documents are true, Xerox’s actions could rise to criminal conduct.
“If you’re taking money from people knowing that you can’t give them a product, it’s no different from basic stealing,” Immerman said.
The documents do not clarify whether the exchange intentionally dropped any plans. Some exchange enrollees have been unable to verify plans, but others have successfully bought policies, received cards and used their coverage.
But local insurance broker Tamar Burch, who works with one of the lawsuit’s lead plaintiffs and is now a consultant on the class-action lawsuit, said errors in tax credit calculations seem to have increased since the end of open enrollment on March 31.
“The calculations haven’t been right from Day One, but they’ve gotten worse,” Burch said. “These documents just confirm everything we’ve been dealing with. People are still fighting for coverage and to get their (advance premium tax credit) right. It’s pretty bad.”
Some plaintiffs in Callister’s lawsuit have had issues that would seem to fit the pattern described in the documents. Larry Basich and Lea Swartley, the two original plaintiffs, both paid premiums for two to three months and received no coverage, though Health Plan of Nevada agreed in March to cover Basich after the retired engineer ran up more than $400,000 in bills in January and February following a triple bypass.
Other plaintiffs report similar problems.
One needs surgery for brain cancer, but was told by her doctor that he can’t perform the operation because she has no coverage, Callister said. Two others can’t get treatment for melanoma, and some patients are having trouble getting prescriptions filled for HIV and AIDS medications, he said.
Callister also pointed to an independent audit delivered to the exchange board on Thursday that gave contractor Xerox mostly failing marks in areas ranging from website downtime, call-center hold times and abandoned customer calls. The audit also found that 37.6 percent of 540 files it reviewed had “exception incidents,” or enrollment problems.
“You have folks, many of whom were seniors or of lower socioeconomic status, who now have access to coverage, but they’re being turned away by doctors, by drugstores — you name it,” Callister said. “It’s an appalling problem the state needs to get involved with. Unless there’s some direct intervention, people will get sick, and people could die. This is playing politics with someone’s life, and that’s not acceptable.”
Callister said his firm expects to appear before a District Court judge next week to obtain status as a steering committee to handle the case.
He said he’s also bringing in two powerful national law firms to help. New Orleans-based Gauthier, Houghtaling and Williams, which helped pave the way for a $246 billion tobacco-litigation settlement between cigarette makers and the states, will join the effort. Also signing on is Irpino Law Firm of New Orleans, which is handling claims related to BP’s Deepwater Horizon oil spill in the Gulf Coast in 2010.
Contact reporter Jennifer Robison at email@example.com or 702-380-4512. Follow @J_Robison1 on Twitter.