{"id":341667,"date":"2021-09-20T02:00:28","date_gmt":"2021-09-19T23:00:28","guid":{"rendered":"https:\/\/en.buradabiliyorum.com\/aetna-sues-nyc-unions-over-tainted-medicare-contract\/"},"modified":"2021-09-20T02:00:28","modified_gmt":"2021-09-19T23:00:28","slug":"aetna-sues-nyc-unions-over-tainted-medicare-contract","status":"publish","type":"post","link":"https:\/\/buradabiliyorum.com\/en\/aetna-sues-nyc-unions-over-tainted-medicare-contract\/","title":{"rendered":"#Aetna sues NYC, unions over &#8216;tainted&#8217; Medicare contract"},"content":{"rendered":"<p>&#8220;<strong>#Aetna sues NYC, unions over &#8216;tainted&#8217; Medicare contract<\/strong>&#8221;<\/p>\n<div>\n<aside class=\"single__inline-module alignleft\">\n        <\/aside>\n<p>New York\u2019s largest private Medicare administrator is suing the Big <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/download-scripts-themes-apps\/\" data-internallinksmanager029f6b8e52c=\"9\" title=\"Download Scripts &amp; Themes &amp; Apps\" target=\"_blank\" rel=\"noopener\">App<\/a>le and its local union leaders for allegedly awarding a $34 billion \u201ctainted\u201d contract to an unqualified rival bidder.<\/p>\n<p>Insurance giant Aetna\u2019s bombshell lawsuit against New York City and the Municipal Labor Committee alleges that the bidding process was fixed to favor Alliance, a consortium that includes Emblem Health and Anthem\/Blue Cross Blue Shield, to operate the Medicare Advantage Plus program, which administers health benefits to 250,000 retired city workers.<\/p>\n<p>\u201cOLR [the city\u2019s Office of Labor Relations] has selected an inexperienced and unqualified bidder through a procurement process that violated New York Procurement law, lacked transparency, and violated principles of public trust and fairness for a procurement that could last up to a minimum of five or as many as eleven years and generate $34 billion dollars in claims revenue,\u201d Aetna alleges in its su<strong>i<\/strong>t filed in Manhattan Supreme Court earlier this month.<\/p>\n<p>Aetna and Alliance were the two finalists that city officials and union leaders considered for the whopping contract, which is anticipated to save the Big Apple about $3 billion over five years, or roughly $600 million a year.<\/p>\n<p>Aetna is asking the court to nix the contract, which takes effect Jan. 1.<\/p>\n<p>Retired city workers are eligible for Medicare, the federally run program that provides health insurance for people who reach 65 \u2014 but their union contract also calls for the Big Apple to pick up the cost of their monthly premiums for Medicare Part B, which covers outpatient care as well as other supplemental services not covered by Medicare.<\/p>\n<div class=\"wp-block-image\">\n<figure class=\"alignright size-nypost-medium-post\"><img decoding=\"async\" loading=\"lazy\" width=\"322\" height=\"483\" src=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all&amp;w=322\" alt=\"Gregory Floyd president of Teamsters Local 237\" class=\"wp-image-19509596\" srcset=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all&amp;w=644 644w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all&amp;w=483 483w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all&amp;w=322 322w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all&amp;w=161 161w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Gregory_Floyd.jpg?quality=90&amp;strip=all 1024w\" sizes=\"auto, (max-width: 322px) 100vw, 322px\"\/><figcaption>Gregory Floyd, president of Teamsters Local 237, is associated with Alliance partner Emblem Health, who was awarded the city\u2019s Medicare program contract over Aetna.<br \/>\n<\/figcaption><\/figure>\n<\/div>\n<p>Aetna is arguing that it has more experience than Alliance in handling such matters. And even city officials have acknowledged that Aetna, the nation\u2019s third largest health-insurance provider, was clearly the more experienced bidder in running Medicare Advantage programs across the country. <\/p>\n<p>One of the criteria in the proposal was that bidders had to have provided service to a client with at least 50,000 subscribers.<\/p>\n<p>Aetna currently runs New Jersey\u2019s Medicare Advantage program for 196,577 retirees, the United Auto Workers Retiree Medical Benefits Trust with 140,305 members, the Ohio State Teachers Retirement System with 96,106), the Pennsylvania Employees Benefit Trust Fund with 75,369 members) and Verizon with 73,176 members, according to the lawsuit. <\/p>\n<p>Aetna alleges that Alliance failed to meet even this \u201clow bar.\u201d<\/p>\n<p>Alliance has noted that one of its partners, Indiana-based Anthem, ran the Medicare Advantage program for the Colorado Public Employees Retirement system with 50,000 members. But Aetna claims that Anthem\u2019s contract only covered 43,000 retirees, which should disqualify the Alliance bid for the city work.<\/p>\n<p>Other concerns raised in the lawsuit involved:<\/p>\n<ul>\n<li>Costs: Aetna claimed its prescription-drug plan was at least $30 less expensive per worker monthly than Alliance\u2019s plan and offered free prescriptions for certain generic medications. It also said its plan premium was $366 lower per year for every worker than the advertised Alliance rate.<\/li>\n<li>Breach of confidentiality: The insurer said a city evaluator wrongly disclosed some of its cost proposals at a meeting with union members, which \u201ctainted\u201d the selection process by alerting rival Alliance to its figures.<\/li>\n<li>Arbitrator\/familiarity: The city and labor unions turned to a state arbitrator to help resolve an impasse over the selection of a winning bidder \u2014 a decision that was not mentioned as part of the procurement process.<\/li>\n<\/ul>\n<p>During the early evaluation process<strong>, <\/strong>city officials favored Aetna because of its experience running Medicare Advantage programs, the suit says. But union leaders preferred the Alliance because partners GHI\/Emblem Health<strong> <\/strong>and Blue Cross had more of a history providing medical benefits to city workers, according to the papers.<\/p>\n<p>The parties asked arbitrator Martin Scheinman \u2014 who recently ruled that religious exemptions can be granted from COVID vaccine requirements for public-school teachers \u2014 to be brought in to issue a recommendation on which final bidder the city and the unions should choose. At the time, Scheinman chaired a city panel to find health-care savings. <\/p>\n<p>Scheinman chose Alliance, arguing that its \u201cfamiliarity\u201d with providing benefits to the city workforce trumped Aetna\u2019s superior experience in running Medicare programs, the documents say.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1024\" height=\"682\" src=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Sanitationworkers.jpg?quality=90&amp;strip=all&amp;w=1024\" alt=\"Sanitation Department workers collect garbage near 675 Central Avenue in Brooklyn on March 10, 2021.&#10;\" class=\"wp-image-19509742\" srcset=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Sanitationworkers.jpg?quality=90&amp;strip=all&amp;w=1535 1536w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Sanitationworkers.jpg?quality=90&amp;strip=all 1024w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Sanitationworkers.jpg?quality=90&amp;strip=all&amp;w=512 512w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\"\/><figcaption>Sanitation Department workers collect garbage near 675 Central Avenue in Brooklyn on March 10, 2021.<br \/>\n<\/figcaption><figcaption><span class=\"credit\">James Keivom<\/span><\/figcaption><\/figure>\n<p>His voice helped tip the award to the Alliance, the suit says. <\/p>\n<p>But Aetna argues in the court documents that \u201cthe Solicitation and applicable procurement law did not provide for this action \u2026 and Arbitrator Scheinman\u2019s recommendation was based on a new criterion mentioned nowhere in the procurement documents.\u201d<\/p>\n<p>Aetna also claims that Alliance reps were afforded the opportunity to discuss matters with Scheinman, while its people weren\u2019t.<\/p>\n<p>Aetna received the highest scores during the early phases of the evaluation process, the suit says.<\/p>\n<p>Other sources familiar with the negotiations said it appeared that Alliance had an inside track because of its connections to labor leaders. Teamsters Local 237 President Gregory Floyd, for example, sits on the board of Alliance partner Emblem Health.<\/p>\n<p>Some advocates for retirees joined Aetna in questioning the granting of the contract.<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1024\" height=\"682\" src=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/FDNY.jpg?quality=90&amp;strip=all&amp;w=1024\" alt=\"First responders arrive at a construction site in Hudson Street to Vandam Street in Manhattan after a man fell 20 feet into a shaft on September 14, 2021.&#10;\" class=\"wp-image-19509803\" srcset=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/FDNY.jpg?quality=90&amp;strip=all&amp;w=1535 1536w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/FDNY.jpg?quality=90&amp;strip=all 1024w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/FDNY.jpg?quality=90&amp;strip=all&amp;w=512 512w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\"\/><figcaption>First responders arrive at a construction site in Hudson Street to Vandam Street in Manhattan after a man fell 20 feet into a shaft on September 14, 2021.<br \/>\n<\/figcaption><figcaption><span class=\"credit\">William Farrington<\/span><\/figcaption><\/figure>\n<p>\u201cThere\u2019s definitely some fishiness going on. This contract doesn\u2019t make any sense,\u201d said Marianne Pizzitola, president of the FDNY\u2019s EMS Retirees Association and a rep for the New York City Organization of Public Service Retirees, whose groups are affected by the contract.<\/p>\n<p>Pizzitola said retirees were \u201ckept in the dark\u201d on the deliberations and raised the appearance of a conflict with Teamsters\u2019 head Floyd sitting on the board of the winning bidder. <\/p>\n<p>\u201cHow is that not fishy?\u201d she said.<\/p>\n<p>Nicholas Paolucci, a rep with the city Law Department, told The Post in an e-mail, \u201cThe City is committed to selecting providers that are in the best interest of the City and it\u2019s retirees. We\u2019ll review the case.\u201d<\/p>\n<aside class=\"single__inline-module alignright\">\n    <\/aside>\n<p>Meanwhile, union leaders in the Municipal Labor Council dismissed Aetna\u2019s lawsuit as the desperate gambit of a sore loser.<\/p>\n<p>\u201cWe got it done. It was fair and right to the point. I haven\u2019t heard anything wrong with that particular contract, the way it was done. Everything was done to the T,\u201d said Harry Nespoli, chairman of the Municipal Labor Council and president of the Sanitation workers\u2019 union.<\/p>\n<p>\u201cTo me it sounds like sour grapes. Aetna had their shot at it. It does save money for the city of New York. What\u2019s wrong with that?  I thought it was a spectacular deal. I still think it is,\u201d he said.<\/p>\n<p>Teamsters Local 237 President Floyd said his role sitting on the governing board of bidder Emblem Health didn\u2019t pose a conflict. He voted to award to Emblem\/Anthem-Blue Cross.<\/p>\n<p>\u201cIt\u2019s only a conflict if I was the only union leader voting or if I had the most influential vote. It wasn\u2019t the case. I had one vote \u2014 that was it,\u201d Floyd said.<\/p>\n<p>\u201cThis a stupid lawsuit. Aenta put in a bid, and they lost the bid. They\u2019re a sore loser.\u201d<\/p>\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" loading=\"lazy\" width=\"1024\" height=\"682\" src=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Harry-Nespoli.jpg?quality=90&amp;strip=all&amp;w=1024\" alt=\"Harry Nespoli, president of the Sanitation workers' union.\" class=\"wp-image-19509703\" srcset=\"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Harry-Nespoli.jpg?quality=90&amp;strip=all&amp;w=1535 1536w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Harry-Nespoli.jpg?quality=90&amp;strip=all 1024w, https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Harry-Nespoli.jpg?quality=90&amp;strip=all&amp;w=512 512w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\"\/><figcaption>Harry Nespoli, president of the Sanitation workers\u2019 union, argues insurance company Aetna is acting \u201clike sour grapes,\u201d with their city lawsuit.<br \/>\n<\/figcaption><figcaption><span class=\"credit\">William Farrington<\/span><\/figcaption><\/figure>\n<p>Noting that Aetna is one of the country\u2019s largest private health-insurance companies, Floyd said, \u201cHow greedy can you get?\u201d<\/p>\n<p>Floyd said contracts expire and that there will be opportunities for future business \u2014 but he added that Aetna is burning its bridges.<\/p>\n<p>\u201cI have a long memory,\u201d Floyd said.<\/p>\n<p>He said Aetna currently administers prescription-drug benefits to his members, who work as security officers in schools, homeless shelters and NYCHA complexes. <\/p>\n<p>In that case, Aetna replaced HIP\/Emblem Health because the union didn\u2019t like the latter\u2019s performance, and Aetna is doing a \u201cgood job,\u201d the Teamsters boss said.\n                        <\/p><\/div>\n<blockquote><p><strong><span style=\"color: #ff6600;\">If you liked the article, do not forget to share it with your friends. Follow us on\u00a0<span style=\"color: #ff0000;\"><a style=\"color: #ff0000;\" href=\"https:\/\/news.google.com\/publications\/CAAqBwgKMLG0nwswvr63Aw\" target=\"_blank\" rel=\"nofollow noopener noreferrer\">Google News<\/a><\/span>\u00a0too, click on the star and choose us from your favorites.<\/span><\/strong><\/p><\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\">For forums sites go to <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/forum.buradabiliyorum.com\/\" target=\"_blank\" rel=\"noopener\">Forum.BuradaBiliyorum.Com<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<blockquote>\n<p style=\"text-align: center;\"><strong>If you want to read more <a href=\"https:\/\/buradabiliyorum.com\/en\/category\/news\/\" data-internallinksmanager029f6b8e52c=\"2\" title=\"News\" target=\"_blank\" rel=\"noopener\">News<\/a> articles, you can visit our <span style=\"color: #ff9900;\"><a style=\"color: #ff9900;\" href=\"https:\/\/en.buradabiliyorum.com\/news\/\" target=\"_blank\" rel=\"noopener\">News category.<\/a><\/span><\/strong><\/p>\n<\/blockquote>\n<p><span style=\"color: black;\"><a style=\"color: #ff9900;\" href=\"https:\/\/nypost.com\/2021\/09\/19\/aetna-sues-nyc-unions-over-tainted-medicare-contract\/\" target=\"_blank\" rel=\"noopener\">Source<\/a><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&#8220;#Aetna sues NYC, unions over &#8216;tainted&#8217; Medicare contract&#8221; New York\u2019s largest private Medicare administrator is suing the Big Apple and its local union leaders for allegedly awarding a $34 billion \u201ctainted\u201d contract to an unqualified rival bidder. Insurance giant Aetna\u2019s bombshell lawsuit against New York City and the Municipal Labor Committee alleges that the bidding&#8230;<\/p>\n","protected":false},"author":1,"featured_media":341668,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"fifu_image_url":"https:\/\/nypost.com\/wp-content\/uploads\/sites\/2\/2021\/09\/Earns_Aetna.jpg?quality=90&strip=all&w=1024","fifu_image_alt":"","footnotes":""},"categories":[70897],"tags":[7309,116211,75699,61184,73139,71579,100275,90651,104365],"class_list":["post-341667","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-unions","tag-9-19-21","tag-contracts","tag-fdny","tag-manhattan-supreme-court","tag-mayor-bill-de-blasio","tag-medicare","tag-teamsters","tag-teamsters-local-237"],"_links":{"self":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/341667","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/comments?post=341667"}],"version-history":[{"count":0,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/posts\/341667\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media\/341668"}],"wp:attachment":[{"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/media?parent=341667"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/categories?post=341667"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/buradabiliyorum.com\/en\/wp-json\/wp\/v2\/tags?post=341667"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}