It's been a well-kept secret, but since 2017, Blue Cross/Blue Shield of Kansas, through its third-party payer, New Directions Behavioral Health of Kansas, has been illegally withholding their Customers' mental health/substance abuse healthcare treatment benefits.

Were you or those on your healthcare insurance policy denied treatment when it was needed most?

To be compensated for the healthcare benefits stolen from you, report your loss to the FBI at (816) 512-8200.

Your Kansas Insurance Commissioner, Vicki Schmidt, was ineligible to run for the position of Insurance Commissioner. Tens of thousands of Kansans with BCBS-KS insurance have ealthcare benefits stolen from them.

Your Governor, Laura Kelly, and Attorney General, Derek Schmidt, refuse to advocate for Kansans.

Some addicts are fortunate enough to have a healthcare policy that offers benefits for substance abuse treatment. For those individuals, it should simply be a matter of making the decision to regain sobriety by utilizing those benefits. But, sometimes there are complications...

Since 2017, many thousands of Kansans with a healthcare policy through Blue Cross/Blue Shield of Kansas (BCBS-KS) have been illegally denied healthcare benefits through its third-party payer, New Directions Behavioral Health of Kansas (NDBH-KS), for the life-saving addiction/mental health treatment each has been entitled to. Those who could have corrected this mismanagement of policy benefits, our State of Kansas Insurance Commissioners, Mr. Ken Selzer and Ms. Vicki Schmidt, refused to take action.

However -- a quiet, peaceful protest has been waged on behalf of those who have been too ill to fight for themselves.

However, now, it is time for BCBS-KS policyholders to make their own voices heard. Do you have a BCBS-KS policy and have the feeling that healthcare insurance is a "racket"? If so, then maybe it is. You may be one of the thousands of Kansans who have been swindled out of BCBS-KS healthcare benefits for mental health/substance abuse treatment. For years, BCBS-KS, NDBH-KS, and our Kansas Insurance Commissioners have been engaged in an act of collusion that has cheated Kansans out of essential mental health/substance abuse healthcare benefits.

The political corruption supportive of this crime is found within the list of campaign donations accepted by our Kansas Insurance Commissioners Ms. Vicki Schmidt (incumbent), Mr. Ken Selzer, and Ms. Sandy Praeger. The Federal Bureau of Investigation (FBI) acknowledges responsibility to investigate this crime of widespread insurance fraud. However, an investigation can be initiated only after Complaints from victimized policyholders have been received.

Letter from the U.S. Department of Justice, 05/22/19

THE NEXT STEP: After a great deal of back-and-forth correspondence with State and federal officials along with public interests, direction on the next step to bring an end to the practice of healthcare insurance fraud by BCBS-KS/NDBH-KS came from Mr. Ian DeWaal, Senior Counsel, U.S. Department of Justice, Criminal Division, Fraud Section, Washington, D.C. 20530 (letter below). He explained the need for an FBI investigation

"The purpose of insurance commissioners is to maintain fair pricing for insurance products, protect the solvency of insurance companies, prevent unfair practices by insurance companies, and ensure availability of insurance coverage." - Wikipedia

Blue Cross/Blue Shield of Kansas (BCBS-KS)

It's been a well-kept secret, but since 2017, Blue Cross/Blue Shield of Kansas (BCBS-KS), hrough its third-party payer, New Directions Behavioral Health of Kansas (NDBH-KS), have been scamming tens of thousands of its policyholders by illegally withholding healthcare benefits for mental health/substance abuse treatment.

BCBS-KS is the top insurer in the State of Kansas. That is the reason I had daily contact

with BCBS-KS while employed as a Utilization Reviewer at the Valley Hope Association (VHA)

corporate office. One day, without notice, BCBS-KS simply implemented a policy of illegally

withholding healthcare benefits from policyholders. BCBS-KS patients were, without warning,

being denied substance abuse healthcare benefits to treat symptoms that met medical necessity

criteria for the level of care being requested. This practice of illegally withholding healthcare

insurance benefits from policyholders is called "insurance fraud".

"Insurance fraud" is a federal crime.

New Directions Behavioral Health (NDBH-KS)

NDBH‑KS is a profit‑driven third-party payer that BCBS‑KS retains to manage the "behavioral health" (mental health and substance abuse) services of its policyholders. BCBS-KS expects NDBH-KS to authorize the minimal number of healthcare benefits to each policyholder without compromising quality of care. Unfortunately, NDBH-KS took their directive too far, and the phrase maintaining quality of care lost its significance. Financial profit for BCBS-KS shareholders became the top priority. NDBH-KS began authorize fewer healthcare benefits as a way to maximize profit. Policyholders continued to pay their monthly premiums, and BCBS-KS couldn't be more pleased. All the while, the addiction problem in the State of Kansas continued to worsen.

Locating examples of BCBS-KS/NDBH-KS insurance fraud within VHA patient files is very simple. At NDBH-KS, there was only one Care Manager who proved to be consistently difficult to work with. She works, or at least used to, in the at NDBH-KS office located inTopeka, Kansas. Her name is Summer Clinkinbeard. Ms. Clinkinbeard is a Registered Nurse, licensed in the State of Kansas. With less than a handful of exceptions, any VHA patient case that NDBH-KS assigned to Ms. Clinkinbeard will can serve as an example of BCBS-KS insurance fraud. In fact, in 2010 when I first began working as a VHA Utilization Reviewer, Ms. Clinkinbeard was already well established in the practice of swindling substance abuse healthcare benefits away from patients.

-- The FBI wants to hear from YOU! ---

There is only one way the FBI can initiate an investigation into the healthcare insurance scam BCBS-KS has been running, and that is by hearing from you. A phone call or letter is all that is needed. Initiation of a CLASS-ACTION LAWSUIT depends upon Complaints being received from BCBS-KS policyholders who were unjustly deprived of mental health/substance abuse healthcare benefits.

Letters of Complaint can be written by the patient and/or family members of the victim.

If you or a family member were denied necessary treatment for mental health or substance abuse treatment, you are urged to document your experience, then mail it to Special Agent Chars A. Dayoub at the following address:

Mr. Charles A. Dayoub

Special Agent in Charge

1300 Summit Street

Kansas City, Missouri 64105

Phone: (816) 512-8200

COMPOSING A LETTER OF COMPLAINT

Our hard-working State employees, many of them First Responders, deserve better than what Governor Laura Kelly and Insurance Commissioner Vicki Schmidt are willing to give them. The reason Ms. Kelly and Ms. Schmidt are failing to follow-through with their work responsibilities is the same for both women. Neither want to risk losing the campaign funds each receives from the insurance industry. This excuse is inexcusable.

Kansas State employees include occupations listed below:

Administration

Code Enforcement

Firefighting

Economic Development

Finance

Human Resources

Technology

City Attorney

Parks & Recreation

Public Health

Police

Planning

Public Safety

Public Works

Auditor

Engineering

For those who would like assistance with writing a Complaint to the FBI, I would suggest including the following information:

the current date;

your name, address, phone number, and your internet address;

the name and address of the facility you sought treatment at;

date you sought treatment at the facility and the date you discharged from the facility (this could be the same as date of admission);

reason(s) you believe you required more time in treatment than was authorized for payment; and

make the request for a review of your case. For example: I believe I am a victim of insurance fraud by my insurance carrier, BCBS. I would like my case reviewed by a qualified Utilization Reviewer due to BCBS denying treatment benefits before my discharge planning was completed in a way that would permit be to be successful as a clean and sober person.

At the end of your letter include your handwritten signature.

Also ...

In addition to your letter of Complaint to the FBI, three additional courses of action are available.

1. Submit a Complaint to JCAHO.

Submitting a Complaint to JCAHO is a sure-fire way to bring attention to any problem related to the unethical denial of healthcare benefits or any other quality of care issue. JCAHO (Joint Commission on Accreditation of Healthcare Organizations) is an important accreditation that certifies nearly 21,000 health care organizations and programs in the United States. Complaints can be submitted online at: "https://www.jointcommission.org/resources/patient-safety-topics/report-a-patient-safety-event/".

2. Submit a Complaint to Your Employer.

Talk to the person in your Human Resources Department who selects the insurance company your healthcare benefits will be managed by. A supportive call from your employer to the NDBH-KS Care Manager who denied your healthcare benefits could make the difference between an authorization or denial of benefits. Additionally, your employer needs to know if employees are not receiving the healthcare benefits that are being paid for.

3. Submit a letter of Appeal.

Hopefully, you asked someone from the facility you sought treatment at to write a letter of Appeal on your behalf questioning the rationale used to deny benefits for your treatment. There is a timeline for submission of this type of letter. However, timely or not, I urge you to submit a letter of appeal to document your disagreement with the benefit determination your insurer made. Being swindled by your insurer is a big deal! If you decide to write your own Letter of Appeal and would like assistance with this, please submit your contact information in the Contact Form located at the end of this website.

Employment Termination per Demand by NDBH-KS

Facility staff called me routinely, desperate to find away of finding BCBS-KS healthcare benefits for patients who had little chance of being successful twithout treatment. No one is born with the innate ability to live a clean and sober life. The addict requires education that is taught in a treatment setting. VHA leadership had made it very clear to those of us working n the Utilization Review Department that we were not to help patients learn how to contest a denial of benefits made by NDBH-KS. To do so might ruffle the feathers of NDBH-KS. After all, the goal of BCBS-KS/NDBH-KS was to hold on to premiums paid by policyholders. Any outside influence that might create a disruption to that goal woul likely be seen as a threat and would be sqelched. VHA could lose the contract to serve BCBS-KS/NDBH-KS policyholders. The healthcare insurance VHA offered to employees was through BCBS-KS/NDBH-KS. Like others in my Department, I was forced to comply by keeping silent.. All of us Utilization Reviewers needed our jobs, and so we said nothing. The unanswered question was always, "Will this patient survive long enough to participate in future treatment episode?"

Valley Hope Treatment Centers

"Compassion cuts into profits, so it must go!"

In 2014, NDBH‑KS retained Dr. Steven Sehr as its Medical Director. While in this position, Dr. Sehr worked to bring the spirit of compassion into the way benefit determinations made by the Care Managers. Using a more equitable manner of authorizing benefits meant that more patients were receiving treatment services. Patients who met the medical criteria for treatment were no longer being denied those services. Unfortunately, there were those at NDBH-KS who viewed this to be a problem. The primary reason BCBS-KS retained NDBH-KS was to minimize payment of patient benefits as much as possible. This increased profits for BCBS-KS. In the end, it seems the cost of compassion was too costly, and NDBH-KS terminated Dr. Sehr from his position of employment. In 2016, Dr. Deepak Rajpoot was hired as a NDBH-KS Medical Director.

Near the time Dr. Deepak Rajpoot was named as a NDBH-KS Medical Director (Please refer to: https://www.prnewswire.com/news-releases/new-directions-behavioral-health-hires-four-new-medical-directors-300330552.html), Care Managers began to base the authorization of SA benefits using clinical criteria designated for a higher LOC than the one being requested. In other words, if benefits were requested for admission into SA treatment at the Partial Hospitalization LOC, NDBH-KS would require clinical information that met criteria for at the Residential/Subacute Detoxification LOC. (At the end of this Complaint, the NDBH criteria for admission, and continued stay, in treatment at these two levels of care are included.) (A comparison chart of the criteria included within these two levels of care is included at the end of this letter. Please see Attachment #2.) No longer were SA benefit determinations made based on symptoms related to the disease of addiction. Benefit determinations were beginning to be made based on a “medical model,” such as would happen in a hospital setting. This practice was sure to lead to a denial in the vast majority of VHA healthcare benefit requests, as the primary focus of VHA facilities has never been medical care. Rather, VHA facilities were developed to offer substance abuse treatment to those hard-working Americans with healthcare insurance living in rural areas where treatment is so difficult to find.

Practices NDBH-KS use to illegally deny healthcare insurance benefits to BCBS-KS policyholders:

The authorization of Substance Abuse/Mental Health benefits was being based upon the use of clinical criteria designated for a higher level of care than the level of care being requested.

A “fail‑first” policy was being used to authorize benefits, despite the use of such a policy being mandated as illegal per federal law MHPAEA (Mental Health Parity and Addiction Equity Act).*

NDBH annually revises their "medical necessity criteria" guidelines, streamlining standards to enhance profits for BCBS-KS shareholders.

The outcome of any physician review became moot once New Directions Behavioral Health of Kansas (NDBH‑KS) made the patient-assigned Care Manager responsible for the final determination of patient benefits.This, despite the fact that Care Managers never have the professional authority to override the benefit determination of a physician.

The decision was made by NDBH‑KS to stop doing physician reviews for patient cases deemed to be at the “lower level of care.”These lower levels of care included the Partial Hospitalization, Intensive Outpatient, and weekly group session levels of care.

Regardless of the clinical justification to overturn a denial of benefits, treatment benefits continued to be consistently denied once the denial had been issued by NDBH‑KS.

Letters of appeal were routinely, if not always, reviewed, and benefit determinations made, by NDBH‑KS employees who were not professionally qualified to complete this type of work, including those employed as “Care Managers” and even A “Care Manager” is professionally licensed as a Therapist or a Nurse.Employment as a does not even require a GED level of education.

NDBH‑KS refused to speak with Blue Cross/Blue Shield of Kansas (BCBS‑KS) Customers to explain reasons a treatment episode that quite obviously met criteria for benefit authorization was being denied.These BCBS‑KS Customers (patients of VHA) were being denied education on ways to advocate for him/herself per direction of the leadership at NDBH‑KS and VHA.

The Blue Cross and Blue Shield (BCBS) Government-wide Service Benefit Plan is also known as the Federal Employee Program® (FEP®) and offers coverage options the federal workforce and retirees in the Federal Employees Health Benefits (FEHB) Program. Treatment options this Program offered at no charge were still billed if the policy was BCBS-KS/NDBH-KS.

* A very simple explanation of MHPAEA is: The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health and substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical coverage (CMS.gov).

Comparison of medical necessity criteria NDBH-KS Partial LOC versus Residential/Subacute levels of care:

Whether a patient is treated at the Partial or Residential/Subacute levels of care is determined by the symptoms a patient presents with while being assessed by the clinical treatment team. Below is the criteria used by BCBS-KS/NDBH-KS in 2017 when the practice of determining authorization of patient benefits by using criteria of a higher level of care than that being requested was initially implemented. If patient symptomology best suited treatment at the Partial level of care, BCBS-KS/NDBH-KS would use the Residential/Subacute criteria to determine the approval of healthcare benefits. This automatically sabotaged any authorization of treatment benefits for the patient. Use of this practice by an insurer to determine the approval, or disapproval, of healthcare benefits is considered to be illegal and is referred to as "insurance fraud".

This fraudulent manner of authorizing healthcare benefits is what our Kansas Insurance Commissioners have allowed BCBS-KS/NDBH-KS to practice. By not creating problems for the insurance industry, the Commissioner knows donations to their respective campaign funds by the insurance industry is assured. Any additional "gifts" the insurance industry gives to Insurance Commissioners is unknown, as the State of Kansas does not provide oversight on this decisively important matter. For example, if an insurance company offers to give a speedboat to an Insurance Commissioner if the Commissioner overlooks their practice of insurance fraud, there would be no way to track that "gift" because the State of Kansas does not have reporting requirements.

Below is a comparison of the medical necessity criteria NDBH-KS used during the year of 2017. Upon evaluation of a patient, healthcare insurance benefits were requested that met criteria of the corresponding level of care. Without any forewarning, NDBH-KS began determining authorization of BCBS-KS benefits by using the criteria of a higher level of care. So, when a treatment facility requested healthcare benefits to treat a patient at the Partial level of care, NDBH-KS would use criteria at the Residential/Subacute Detoxification level of care to make that determination. It goes without saying that the patient would be denied benefits and would then face the dilemma of paying out-of-pocket of discharging without any treatment. NDBH-KS would produce profit for its client, BCBS-KS. Did the Kansas Insurance Commissioner had advance notice when this NDBH-KS "policy change" (aka "practice of insurance fraud") go into effect?

ADMISSION CRITERIA

PARTIAL DAY REHABILITATION

Substance Abuse Patient must meet 1 – 5 and at least one of 6, 7, 8, 9 or 10:

1. A DSM diagnosis of substance use disorder, which is the primary focus of active treatment each program day.

2. There is a reasonable expectation of reduction in behaviors/symptoms with the proposed treatment at this level of care.

3. The treatment is not primarily social, custodial, interpersonal, domiciliary or respite care.

4. The member is able to actively participate in his/her substance use disorder treatment.

5. Active substance abuse/dependency behavior within one week of the current treatment episode unless behavior has been prevented by incarceration or hospitalization.

6. There are acute psychiatric symptoms or cognitive deficits of moderate intensity that require concurrent mental health treatment at the PHP level of care.

7. The member’s environment and support system demonstrate mild to moderate lack of support, but the member can succeed in treatment with the intensity of current treatment services (30 hours/week).

8. There is documentation of ongoing active medical issues secondary to substance use disorder that have the clear potential to precipitate significant medical costs or the member has morbidity from substance use disorder requiring medical evaluation and management.

9. The member has documented symptoms and/or behaviors that are a significant deterioration from baseline functioning and create a significant functional impairment in at least two of the following areas:

a. primary support

b. social/interpersonal

c. occupational/educational

d. health/medical compliance

e. ability to maintain safety for either self of others

10. This level of care is necessary to provide structure for treatment when at least one of the following exists:

a. high likelihood of relapse without near daily treatment support

b. current ongoing intensive outpatient care has failed to improve functioning

c. clear risk for admission to a higher level of care.

ADMISSION CRITERIA

RESIDENTIAL/SUBACUTE DETOXIFICATION

Substance Abuse patient must meet 1-4 and at least one of 5, 6, 7, 8 or 9:

1. A DSM diagnosis of substance induced disorder with withdrawal, which is the primary focus of active daily detoxification treatment.

2. The treatment is not primarily social, custodial, interpersonal, domiciliary or respite care.

3. The identified substance used is known to have a serious potential for morbidity or mortality during the withdrawal period including alcohol, barbiturates, opiates and benzodiazepines

4. Specific documentation of current substances used must include:

a. Substance used

b. Duration of use

c. Frequency of use

d. Last date of use

e. Quantity used per time period

f. UDS or breathalyzer documentation of use

5. There are at least three signs and symptoms of active severe withdrawal or expectation of such with 48 hours or a historical pattern of withdrawal requiring a 24-hour medical and nursing intervention to prevent potential consequences, either behavioral or medical. Withdrawal signs include, but are not limited to:

a. Temperature > 100 degrees

b. Pulse > 100 at rest and BP > 140/90

c. Hyperreflexia

d. Noticeable, paroxysmal diaphoresis at rest

e. Mild to moderate tremor at rest, as observed in outstretched arms

Note: Facilities may substitute a validated scale such as CIWA or COWS in lieu of listing symptoms in the bulleted list above.

6. For Opioid withdrawal, must have at least three of the following symptoms:

a. Muscle aches, nausea, fever, GI cramps (which may progress to vomiting or diarrhea), dilated pupils, piloerection, runny nose, watery eyes, intense dysphoria or insomnia

7. History of seizures or delirium tremens (DT’s)

8. Comorbid medical condition(s) that, in combination with substance dependence/detoxification, presents significant health risks, including but not limited to heart condition, pregnancy, history of seizures, major organ transplant, HIV, diabetes, etc. Medical input suggested.

9. Psychiatric comorbidity that renders the member incapable of cooperating with or tolerating detoxification at a lower level of care.

CONTINUED STAY CRITERIA

PARTIAL DAY REHABILITATION

Substance Abuse Patient must meet 1 – 6 and at least

one of 7, 8, 9 or 10:

1. A DSM diagnosis of substance use disorder, which is the primary focus of active treatment each program day.

2. There is a reasonable expectation of reduction in behaviors/symptoms with the proposed treatment at this level of care.

3. The treatment is not primarily social, custodial, interpersonal, domiciliary or respite care.

4. The member is able to actively participate in his/her substance use disorder treatment.

5. There is compliance with all aspects of the treatment plan, unless clinically precluded.

6. A member’s readiness for change and identified barriers to change are documented and addressed with appropriate therapeutic interventions.

7. There are acute psychiatric symptoms or cognitive deficits of moderate intensity that require concurrent mental health treatment at the PHP level of care (Criteria 4 and 7).

9. There is documentation of member progress towards treatment goals. If the member is not progressing appropriately or if the member’s condition has worsened, evidence of active, timely reevaluation and change of the treatment plan to address the current needs and stabilize the symptoms necessitating the admission.

10. Despite intensive therapeutic efforts, this level of care is necessary to treat the intensity, frequency and duration of current behaviors and symptoms. This includes treatment readiness or lack of recognition of disease effects so that termination of treatment may result in potentially dangerous consequences. Subjective opinions regarding risk of relapse without objective clinical evidence are not sufficient to meet this criterion.

Note: Completing the program structure (fixed number of visits, waiting for family interventions, completion of step work, written autobiography, etc.) is not the sole reason for continued stay in the program.

CONTINUED STAY CRITERIA

RESIDENTIAL/SUBACUTE DETOXIFICATION

Substance Abuse Patient must meet 1 – 3 and at least one of 4, 5, 6, 7 or 8:

1. A DSM diagnosis of substance induced disorder with withdrawal, which is the primary focus of active daily detoxification treatment.

2. The treatment is not primarily1 social, custodial, interpersonal, domiciliar6+52y or respite care.

3. There is documentation that the member has accepted a scheduled follow-up appointment with a licensed behavioral health practitioner within seven days of discharge

4. Must have at least three persistent, medically significant objective withdrawal signs, including:

a. Temperature > 100 degrees

b. Pulse > 100 at rest and BP > 140/90

c. Hyperreflexia

d. Noticeable, paroxysmal diaphoresis at rest

e. Mild to moderate tremor at rest, as observed in outstretched arms

Note: Facilities may substitute a validated scale such as CIWA or COWS in lieu of listing symptoms in bulleted list above.

5. For Opioid withdrawal, must have at least three of the following symptoms:

a. Muscle aches, nausea, fever, GI cramps (which may progress to vomiting or diarrhea), dilated pupils, piloerection, runny nose, watery eyes, intense dysphoria or insomnia.

"These mental health providers are being asked to share notes from patient sessions"

(The following article gives an example of one woman's grief when NDBH-K, using their skewed set of medical criteria, sabotaged the authorization of BCBS-KS healthcare benefits for her son to receive the substance abuse treatment he needed. In this case, the mother was able to find a way to pay for treatment out-of-pocket, but not everyone has the financial recources to do that.

These mental health providers are being asked to share notes from patient sessions

By Andy Marso

KANSAS CITY STAR

January 29, 2018 10:00 AM, Updated January 29, 2018 06:00 PM

Therapists say they’re facing increasingly heavy-handed cost-cutting tactics by Blue Cross Blue Shield Kansas and its mental health subcontractor, Kansas City-based New Directions Behavioral Health. By Andy Marso

Susan Eyman, a psychologist in Lawrence, told a patient last year that the patient’s insurance company had requested her notes from their therapy sessions as part of an audit of her billings.

Eyman said the patient was shocked. The notes included intensely personal things about trauma he had told her in strict confidence. He asked if she could assure the confidentiality of the notes once Blue Cross Blue Shield of Kansas had them.

“And I said ‘No, of course not,’ ” Eyman said. “Of course I can’t. If you send this information out there, it’s out there.”

Eyman said she refused to turn over the notes and was forced to pay back thousands in BCBS Kansas reimbursements.

She’s is one of several mental health professionals who say they feel targeted by heavy-handed tactics that BCBS Kansas and its mental health subcontractor, Kansas City-based New Directions Behavioral Health, are using to limit costs at the expense of patients who need intensive counseling.

Mental health therapists say the audits and payment recoupments are having a chilling effect on their ability to treat people who need counseling either several times a week or for a long period of time.

They’re questioning whether they violate parity laws that require insurers to cover mental and behavioral health care the same way they cover medical care.

“It’s all about cost containment basically and it’s not looking at and really honestly questioning what’s going on in this treatment that it’s taking this amount of time,” said Karen Bellows, a clinical social worker who does mental health counseling in Topeka.

The insurance company says the audits only apply to a small number of high-cost providers, and they’re used to determine whether the services rendered fit what was billed. Therapy notes and other documents provided for the audits are strictly shielded in accordance with medical privacy laws, BCBS Kansas spokeswoman Mary Beth Chambers said.

“We realize that claims analysis does not paint a complete picture, which is why we seek documentation to better understand the diagnostic complexity and why the provider believes a specific patient requires a significantly higher number of visits than the norm,” BCBS Kansas spokeswoman Mary Beth Chambers said via email.

Parity laws are also at the center of a federal lawsuit against Blue Cross and Blue Shield of Kansas City. Blue KC covers the two counties in Kansas, Wyandotte and Johnson, that aren’t in BCBS Kansas territory.

Angela Dailey filed suit against Blue KC and New Directions in a federal court in Missouri in December, alleging that they refused to cover her son’s treatment at a therapeutic wilderness program in Utah in 2015.

According to the suit, her son’s therapist recommended an inpatient program after the teen became “increasingly violent, engaging in self-harm, threatening suicide, drinking alcohol and not attending school.”

New Directions, which referred all questions to BCBS and Blue KC, said her son should receive intensive outpatient therapy instead.

(This is an example of the “fail-first” policy NDBH has used to determine the authorization or denial of healthcare benefits, a policy that precludes a higher level of care without an initial course of treatment at a lower level of care is not in compliance with parity access per the Mental Health Parity and Addiction Equity Act.")

Dailey enrolled him in the wilderness program anyway. He was then discharged to a therapeutic boarding school in Idaho for further treatment. New Directions also denied coverage for that treatment and denied Dailey’s appeal.

Dailey’s attorney, Candace Weatherford, said she would not comment while the legislation is pending.

Blue KC spokeswoman Kelly Cannon said the company takes all complaints seriously.

“Blue KC works with New Directions and our contracted providers to develop and maintain medical policies that are consistent with the latest evidence-based medical literature,” Cannon said in an emailed statement.

Rick Cagan, the executive director of the Kansas branch of the National Alliance on Mental Illness, said those laws are routinely flouted, not only in Kansas but nationally. He said his group has talked to the Kansas Insurance Department about it, but enforcement is still lacking and he’s now talking to legislators about stepping in.

“I feel like until providers and policyholders make some more noise we’re just not going to get the consumer protection we need from our state elected officials,” Cagan said.

But BCBS Kansas said the parity laws themselves are what led to the audits.

The parity laws explicitly prevent insurers from imposing separate co-pays or deductibles for mental health, only covering a certain number of office visits or days of inpatient care, or requiring prior authorizations for mental health services.

Chambers said the audits began after BCBS Kansas moved away from those measures.

“We did make some changes two years ago to some policies and procedures to ensure that behavioral health benefits are administered in the same manner as medical services benefits, which was the goal of the mental health parity law passed in 2009,” Chambers said.

Chambers said the claims reviews and audits are meant to identify “notable differences” between providers and “reduce variations that do not result in better member outcomes.”

But the therapists said the audits don’t account for patients who need more counseling than others.

“They don’t care how disturbed people are,” Eyman said. “They don’t care what the level of distress. They don’t figure that in.”

They’ve brought their concerns to the Kansas Insurance Department.

But Julie Holmes, the director of health and life insurance for the department, said the department reviewed their complaints and found that the audits are in line with parity laws because BCBS Kansas has similar measures for medical and surgical providers.

Still, the therapists say the audits are violating the spirit of the law, if not the letter of it, and their practical effect will be the same as setting the hard limits the law explicitly forbids.

Tom Bartlett, a clinical psychologist in Topeka, said it seems like unless his patients are suicidal, BCBS Kansas doesn’t want him to see them more than once a week. Which might be enough to help them survive, but not enough to help them thrive.

“You’re probably going to find a lot more adult children with mental illness living in their parents’ house,” Bartlett said. “But if you’re the insurance company, that’s not your worry.”

Andy Marso: 816-234-4055, @andymarso

Karen Bellows, a clinical social worker in Topeka, says she and other mental health therapists have been subject to heavy-handed cost-cutting tactics by Blue Cross Blue Shield of Kansas that include auditing therapy session notes and clawing back payments for services already rendered. Andy Marso amarso@kcstar.com

e-mail from Ms. LeAnn Crow, Director, Consumer Assistance Division, Kansas Insurance Department, 04/30/18

From: LeAnn Crow [KID]
Sent: Monday, April 30, 2018 1:42 PM
To: inscommr@outlook.com
Subject: Kansas Insurance Department response file # 72747

Hi Ms. LeClair,

We received the below inquiry and we are glad to research; however, we do need additional information to proceed. Can you provide the exact details of you concerns, including the name of the insurance company? From there, we can investigate your specific complaint directly with the Company.

Also, include your mailing address for correspondence.

1. Who, at the State level, provides oversight of the MHPAEA (Mental Health Parity and Addiction Equity Act)?

2. If an insurer or facility does not follow the mandates of the Mental Health Parity and Addiction Equity Act who should this indiscretion be reported to?

LeAnn M. Crow, PIR, CICSR, AMCM, ACS

Director, Consumer Assistance Division

Kansas Insurance Department

420 SW 9th St., Topeka, KS 66612

Facebook | Twitter | [../../../../../lscott/Desktop/www.ksinsurance.org]www.ksinsurance.org

785.296.7829 | Fax 785.296.5806

leann.crow@ks.gov

(Despite submitting the information Ms. LeAnn Crow requested, a review to confirm BCBS-KS/NDBH-KS complied with guidelilnes set forth in the MHPAEA never happened.)

Kansas Statute 40-109, Qualifications for Commissioner of Insurance

Did you know you have a Kansas Insurance Commissioner who was elected to protect you from any abuse of your healthcare insurance benefits? The political position of Insurance Commissioner is a fairly obscure one. But, it is a post of great importance and influence. Let's take a look at the legally mandated qualifications of the Kansas Commissioner of Insurance ...

Kansas Statute, 40-109. Qualifications for Commissioner of Insurance;

personal attention to duties;
interest in insurance company.

The Commissioner of Insurance

shall be an elector of this state, and
shall be a person well versed and experienced in the business of insurance and matters relating thereto; and he
shall give his personal presence and attention to the duties of his office; but
in no case shall such commissioner of insurance be in the employment of any insurance company or have any official connection with any insurance company, or any financial interest in any insurance company other than as a policyholder.

History: L. 1927, ch. 231, 40-109; June 1.

Source or Prior Law:

L. 1879, ch. 166, § 109; R.S. 1923, 75-905.

Duties and Powers of Insurance Commissioners

The purpose of insurance commissioners is to maintain fair pricing for insurance products, protecting the solvency of insurance companies, preventing unfair practices by insurance companies, and ensuring availability of insurance coverage. In order to accomplish these goals, each state grants several powers to insurance commissioners and their offices, including:

Approval of insurance rates
Periodical financial examinations of insurers
Licensing of companies, agencies, agents, and brokers
Monitoring and regulating claims handling

An insurance commissioner (or commissioner of insurance) is a public official in the executive branch of a state or territory in the United States who, along with his or her office, regulate the insurance industry. The powers granted to the office of an insurance commissioner differ in each state. The office of an insurance commissioner is established either by the state constitution or by statute. While most insurance commissioners are appointed, in some jurisdictions they are elected. The office of the insurance commissioner may be part of a larger regulatory agency, or an autonomous department.

Insurance law and regulation is established individually by each state. In order to better coordinate insurance regulation among the states and territories, insurance commissioners are members of the (NAIC).

(Wikipedia, 08/31/17)

Ms. Vicki Schmidt, Kansas Insurance Commissioner, 2018 - Present

During her campaign, the incumbent Kansas Insurance Commissioner, Ms. Vicki Schmidt nurtured

conflict-of-interest relationships with several insurance companies. As a pharmacist, she had an established network of contacts

within the insurance industry that she put to use during her campaign. You can read more about Ms. Schmidt at her website

vickischmidt.org. The following are campaign donations Ms. Schmidt accepted from insurers,exactly the kind of donations

prohibited by Kansas Statute 40-109. Accepting these donations from the insurance industry made Ms. Schmidt ineligible to run

for the position of Insurance Commissioner. Yet, her name made it on the ballot, and she won the vote.

Below is a partial listing of Ms. Schmidt's campaign donations that are $150 or more. All information about political donations on this website come from followthemoney.org, a website that receives thousands, if not hundreds of thousands, of donation records every day. This list of campaign donations Ms. Schmidt accepted from the insurance industry during her 2018 campaign will be updated as www.followthemoney.org is able to accurately identify and code each donation. Until the remainder of Ms. Schmidt's campaign donations are coded to the business type each represents, they are identified on the www.followthemoney.org website as "Uncoded'. Within Ms. Schmidt's Uncoded list of campaign donations are more donations that are clearly from the insurance industry.

Vicki Schmidt 2018 Insurance Industry Campaign Donors (prohibited donations per Kansas Statute 40-109)

www.followthemoney.org (10/24/20)

If you are one of those who take a closer look at Ms. Schmidt’s list of donors in the "Uncoded" category within the www.followthemoney.org website, you will notice many donors are people working in fields that are professionally connected to the insurance industry such as physicians, pharmacists, hospital staff, etc. These are constituents who depend upon the influence of the Insurance Commissioner to keep insurance money directed at their businesses at the maximum level that is possible.

In the above table of campaign donations Ms. Vicki Schmidt accepted to fund her campaign to be the Kansas Insurance Commissioner, each donation is identified as IND (Individual) or NON-IND (anything that is other than from an individual person). For this campaign, there is a donation limit of $2,000 for both IND and NON-IND donations. Each one of these donations is an illegal one, per Kansas Statute 40-109. Additionally, some donors contributed more than the $2,000 limit, and those are the donations that are highlighted.

Brad Koehn, CPA, served as Ms. Schmidt’s Campaign Treasurer. Included in the Campaign Finance forms Mr. Koehn submitted to the State of Kansas Ethics Committee were all those contributions from insurance companies and all those donations that were above the allowable donation cap. Mr. Koehn, a professional accountant, knew he was reporting the acceptance of unauthorized campaign donations. What he didn't know is that, this time, someone would be reviewing his work.

It's not just Kansas...

Kansas is not the only State with corruption interwoven within its Insurance Department. In 2019, California Insurance Commissioner Ricardo Lara accepted campaign donations from the insurance industry after telling his constituency that he would not. Lara — who suspended all fund-raising last summer after The San Diego Union-Tribune disclosed that he had accepted tens of thousands of dollars from insurers and that his office intervened in proceedings to benefit donors — reported less than $5,000 in donations so far this year. Lara also accepted tens of thousands of dollars in campaign donations from insurers — donations that often listed insurance executives’ spouses, business partners and others as donors.

In early July 2019, the day the Union-Tribune published the first in a series of reports detailing the commissioner’s business practices, Lara called the donations an oversight and promised to return the money. By the end of July 2019, Lara had refunded more than $83,000 in donations. Political corruption does not go away on its own. It needs to be recognized and dealt with for what it is -- a crime. Furthermore, unless legally mandated preventative measures are implemented, this criminal behavior will continue.

https://www.sandiegouniontribune.com/news/watchdog/story/2020-08-10/campaign-fund-raising-all-but-flat-for-state-insurance-commissioner (viewed on 10/04/20

Mr. Nathaniel McLaughlin, 2018 Candidate for Kansas Insurance Commissioner

There was a second candidate running for the position of State Insurance Commissioner in 2018 who deserves mentioning.

His name is Mr. Nathaniel McLaughlin. Mr. McLaughlin did not run the slick race Ms. Schmidt did. But, he did not hold his hand

out to the insurance industry for campaign donations. Rather, he adhered to the law, thereby exhibiting self-respect and an honest

commitment to the people of Kansas. You can learn more about Mr. McLaughlin at his website:

www.douglascountydems.org/nathaniel-mclaughlin/

I have met neither Ms. Schmidt nor Mr. McLaughlin and am not campaigning for either. But, I do get the impression Mr. McLaughlin's experience prepared him to be a competent State Insurance Commissioner. He has gained, through years of experience, the business acumen required to work competently within the healthcare industry. His list of volunteer work tells me he cares about people. I believe he would have started working on the problem of BCBS-KS healthcare insurance fraud as soon as he learned of it. I don't see Mr. McLaughlin as being the kind of person who would expect someone else to do his work, especially a Department such as the FBI.

We know, through followthemoney.org, Ms. Vicki Schmidt raised more than $53,850 in campaign donations from the industry, BCBS-KS being one of her donors. Because the State of Kansas offers no oversight on campaign donations, these illegal, conflict-of-interest donations were never noticed by anyone who would bring them to the public's attention.

We also know, again through followthemoney.org, that Mr. Nathaniel McLaughlin ran an honest race. As would be expected, without the aid of the insurance industry's financial backing, Mr. McLaughlin's monetary campaign resources were significantly less than Ms. Schmidt's. It is of paramount importance that Kansans find a way to prevent self-interest and criminality from continuing to be primary factors leading to the installment of our State's Insurance Commissioner.

The Campaign Treasurer

One person knows of Ms. Schmidt's campaign donations from the insurance industry was her Campaign Treasurer Mr. Brad Koehn, CPA, 3630 SW Burlingame Rd.; Topeka; KS 66611; Business Phone: (785) 234-3427; e-mail address:BKoehn@btandcocpa.com. A summary of the Treasurer's duties can be found at: https://ballotpedia.org/Campaign_finance_requirements_in_Kansas. The Campaign Treasurer's responsibilities sound more tedious than difficult. One of his responsibilities was to obtain the occupation and industry in which the individual works, and recording the occupation and industry of each contributor for any contribution over $150. Even so, these details went unreported for several donors on the Campaign Finance Receipts & Expenditures Reports he submitted.

The highlighted donations above are those that went over the legally mandated annual campaign donation limit. Presently, it is unclear if the contributions were rightfully returned to the donor. Follow-up is needed to determine this and will be posted when the facts are known.

The Kansas Ethics Commission

An account of the Kansas Ethics Commission can be found at: https://governor.kansas.gov/serving-kansans/office-of-appointments/kansas-boards-and-commissions/governmental-ethics-commission/ At this internet address, the Ethics Commission is described as:

Just to reiterate: Of the nine people that make up the Ethics Committee, two are appointed by the Governor. Then, the Governor decides who will chair the Commission. This means those on the Committee will made decisions that the Governor will support. Below are some of the campaign donations made by those in the insurance industry to Governor Laura Kelly's campaign. Any decision the Ethics Committee makes that might disturb the insurance industry is a decision Governor Kelly will not support. And, how does that make you feel?

"The Kansas Governmental Ethics Commission is charged with administering, interpreting, and enforcing the Campaign Finance Act and laws relating to conflict of interests, financial disclosure, and the regulation of lobbying. No member can have a history of holding a party office, elected official, Secretary, lobbyist, or vendor to the state. There are 9 members with two being appointed by the Governor. The Governor selects the chair of the commission."

On 06/06/19, I sent an e-mail to the Kansas Ethics Committee and requested an audit of Ms. Vicki Schmidt's campaign donations for the purpose of identifying illegal donations. Below is the response I received:

RE: Specific Procedures for Administering, Interpreting, and Enforcing ...

Berry, Brett [KGEC] <Brett.Berry@ks.gov>

Thu 6/6/2019 8:43 AM

Good morning,

My legal opinion on this question is inconsequential since the Governmental Ethics Commission is without authority to implement or enforce K.S.A. 40-109. Whether your assessment bears weight and whether authority exists to address Insurance Commissioner qualifications should be determined by the appropriate authority, who ever that may be. Perhaps the Attorney General, the Secretary of State, or Exceptions Board?

Brett Berry, General Counsel

Kansas Governmental Ethics Commission

901 S Kansas Ave; Topeka KS 66612

785-296-4219 (ph), 785-296-2548 (fax)

brett.berry@ks.gov, https://ethics.kansas.gov/

Mr. Berry, General Counsel for the Kansas Governmental Ethics Commission, has determined the Ethics Committee is not responsible for any violation of Statute 40-109. However, the State of Kansas clearly states, "The Kansas Governmental Ethics Commission is charged with administering, interpreting, and enforcing the Campaign Finance Act and laws relating to conflict of interests. https://ethics.kansas.gov" Feeling unsettled by what seems to be an obvious misinterpretation of the facts, I wonder if there is a connection between the Governor and the insurance industry. After checking the list of donors to Governor Kelly's campaign fund, a strong association between the Governor and insurance industry is obvious.

Mr. Berry's unwillingness to follow-through with the mission statement of the Ethics Committee is likely due to a hesitancy to jeopardize his job security. Below is a listing of most of the campaign donations made to Governor Laura Kelly by the insurance industry in 2018. Unlike the Insurance Commissioner, Ms. Kelly's donations from the insurance industry are legitimate. There are no laws prohibiting the Kansas Governor from receiving donations from the insurance industry. Even so, have those donations originating led to a sense of favoritism towards insurance companies?

Ms. Laura Kelly, State of Kansas, Governor , 2018 - Present

Kansas GOVERNER Laura Kelly campaign donations from the insurance industry in 2018

The highlighted donations above are those that went over the $2,000 legally mandated annual campaign donation limit permitted for any individual or business. Presently, it is unclear if Governor Kelly rightfully returned these overpayments to the donor. Follow-up is needed to determine this and will be posted when the facts are known.

www.followthemoney.org (10/24/20)

Mr. Ken Selzer, State of Kansas Insurance Commissioner, 2014 - 2018

When the request was initially made to the State of Kansas for an investigation into the healthcare insurance fraud being

committed by BCBS-KS/NDBH-KS, Mr. Ken Selzer was serving as the Kansas Insurance Commissioner. His disinterest in the

matter was unmistakable. After seeing the many campaign donations he received from the insurance industry, including

BCBS-KS, the reason he wanted me to disappear was obvious. Once his term as Insurance Commissioner was completed, he

made an unsuccessful bid to be Governor of the State of Kansas.

During his campaign, Mr. Selzer had no qualms about nurturing conflict-of-interest relationships with the insurance industry. Below are campaign donations Mr. Selzer accepted from insurers,exactly the kind of donations prohibited by Kansas Statute 40-109. Accepting these donations from the insurance industry made Mr. Selzer ineligible to run for the position of Insurance Commissioner. Yet, his name made it on the ballot, and he won the vote.The State of Kansas does not monitor the list of donors for those campaigning for the position of Insurance Commissioner. .

This list of campaign donations Mr. Selzer accepted from the insurance industry during his 2014 campaign to be the Kansas Insurance Commissioner will be updated as followthemoney.org is able to accurately identify and code each donation. Until the remainder of Mr. Selzer's campaign donations are coded to the business type each represents, they are identified on the followthemoney.org website as "Uncoded'. Within that list of "Uncoded" campaign donations are quite a few donors who clearly represent the insurance industry.

Ken Selzer 2014 Insurance Industry Campaign Donors (prohibited per Kansas Statute 40-109)

www.followthemoney.org

Ms. Sandy Praeger, State of Kansas Insurance Commissioner, 2002 - 2014

Ms. Sandy Praeger served three terms as the State of Kansas Insurance Commissioner. She was first elected in 2002

and was re-elected in 2006 and 2010. During Ms. Praeger's third term as Insurance Commissioner, a business named Brooke

Corp. opened its doors for business in Phillipsburg, Kansas. Brooke Corp. offered insurance services to small-town banks that

the banks then sold sell to customers. Phillipsburg is a small rural community with a has a population of approximately 2,500.

Due to criminal activity of Brooke Corp. owners, it went bankrupt in 2008 amid claims of insurance fraud and financial fraud.

Close to two hundred people lost their jobs. It was a devastating setback for those within the community. Additionally, hundreds

of franchises failed taking with them the ability for investors to make a livelihood.

Ms. Praeger claimed her Insurance Department had no part in the Brooke Corp. financial collapse that devasted the city of

Phillipsburg, Kansas, along with the lives of Insurance Agents who had invested in a Brooke Corp. franchise office. (1) If Ms. Praeger had been proficient in her skills as an Insurance Commissioner, or (2) if the State of Kansas had confirmed her eligibility to run for the Office of Insurance Commissioner, the Brooke Corp. financial disaster may have ever happened.

During the investigation and prosecution of the Brooke's Corp. case, it does not appear Ms. Praeger's crime of accepting campaign donations from the insurance industry was ever disclosed. Would it have made a difference if all involved knew that Ms. Praeger had been ineligible to serve as the Kansas Insurance Commissioner? Considering her conflict-of-interest relationship with several insurance companies, would it have been possible for her to be impartial about any aspect of this case? How forthcoming would Ms. Praeger be with volunteering information that was relevant to this case?

Ms. Praeger's employer, the State of Kansas, is at fault for permitting any ineligible candidate to be named on a voting ballot and then permitting that candidate to serve in the position he/she was unqualified for. The State of Kansas needs to be held accountable for this oversight and the part it played in the devastation created by Brooke Corp.

Those unfortunates who were caught in Brooke Corp.'s web of deceit and greed were victimized twice. Firstly by the owners of Brooke Corp. and secondly by the State of Kansas through the gross negligence of its Insurance Commissioner, Ms. Sandy Praeger. The case of Brooke Corp. has been settled in court. However, there has been no litigation between the victims of the Brooke Corp. Ponzi scheme vs. the State of Kansas. Should there be? Every donation Ms. Praeger accepted from an insurance company was a criminal act. It is the sheer volume of insurance companies that contributed to her campaigns that is so mind-boggling. Ms. Praeger is not someone who would ever take issue with the insurance industry. It was only a matter of time before the public would suffer some catastrophic insurance-related problem. And, that's certainly what happened.

During the time she served as Kansas Insurance Commissioner, a company called Brooke Corp. found huge success in Kansas just before it went bankrupt. At the time, Ms. Praeger was serving her third term as Kansas Insurance Commissioner. She did not seek re-election for a fourth term. Would Kansans have experienced such a devastating financial debacle if a qualified, competent State Insurance Commissioner had filled the position?

Below is a partial listing of Ms. Praeger's campaign donations that are $150 or more. All information about political donations on this website come from followthemoney.org. This list of campaign donations Ms. Praeger accepted from the insurance industry during her three campaigns between 2003 and 2015 will be updated as followthemoney.org is able to accurately identify and code each donation. Until the remainder of Ms. Praeger's campaign donations are coded to the business type each represents, they are identified on the followthemoney.org website as "Uncoded'. Within Ms. Praeger's "Uncoded" list of campaign donations are more donations that are clearly from the insurance industry.

THIRD TERM - Sandy Praeger 2010 Insurance Industry Campaign Donors (prohibited per Kansas Statute 40-109)

SECOND TERM - Sandy Praeger 2006 Insurance Industry Campaign Donors (prohibited per Kansas Statute 40-109)

www.followthemoney.org (10/24/20)

FIRST TERM - Sandy Praeger 2002 Insurance Industry Campaign Donors (prohibited per Kansas Statute 40-109)

www.followthemoney.org (10/24/20)

Any blank spots within the list of campaign donations represents required information that was not submitted by the Campaign Commissioner and Insurance Commissioner. This particular problem happens to be a significant one. It is only through the efforts of the staff from However, the oversight on completion of these forms is minimal, thus making attention to detail a small priority for those who complete them.

Agents Speak Out on ‘Putting Back the Pieces’ after Brooke

The news article below is one that refers to the personal and professional devastation that followed the crash of the Brooke Ponsi scheme.

“Technically, Brooke Franchise owes me $7 million, but who knows if I will ever see it,” said Roger Cunningham, former Brooke franchisee and agent/owner of RKC Financial in the Dallas/Fort Worth Texas, area.

Cunningham, like many Brooke franchise owners, is now involved in a lawsuit with the group. Kansas-based Brooke Corp., Brooke Capital and Aleritas Capital Corp. are part of a financial services lending and franchising enterprise that Robert Orr founded in 1986. The Brooke companies bought independent insurance agencies and other businesses from their owners with Aleritas funds and repackaged them as Brooke agency franchises sold to entrepreneurs using money borrowed from Aleritas.

The Brooke companies also repackaged and resold the loans as securities to Wall Street investors and to groups of mostly small Midwestern banks.

Where once there were almost 800 franchise locations around the country, some sources say only 250 remain. In California there were more than 200 franchises at one time and numerous Brooke agencies in states across the country. But now many former franchisees have hired lawyers, because as Cunningham learned quickly, the contracts written between Brooke and the agent/owners had a specific clause that only allows binding arbitration in any lawsuit. Because Brooke officially filed Chapter 11 on Oct. 25, it could be many years before any arbitration settlements are forthcoming, Cunningham said.

All franchisees have received written notices saying that their contracts with Brooke are now null and void — but financial worries still abound.

Cunningham talks about picking up the “pieces of his life,” and getting his appointments back in place with carriers, and moving on with his agency, but it’s not an easy task.

Many agent/owners say they have lost their life savings. Most claim that Brooke took the premiums paid by clients and then cut commission checks that were not accurate or in some cases just denied that the commissions were owed at all. They say Brooke would put the commissions in question into what was called an “Orphan Fund” — then the monies owed would often never surface. Because most of the agent owners were small to mid-sized agencies, losing commissions, paying rent and other office related fees and struggling to pay back a $165,000 entrance fee to become part of Brooke put most into insurmountable, heavy debt.

Set Up to Fail

“We were set up to fail,” said Harvey Cohen of San Antonio-based Cohen Insurance Inc. Cohen was an experienced agent, spending many years with Allstate and then USAA before deciding to go out on his own. He was confident about Brooke when joined. He then brought his two daughters into the business as well.

But Cohen said that after the initial “wining and dining” to get him to join the franchise, reality set in.

“Within the first few months I noticed I was missing somewhere between $5,300 and $5,800 per month in commissions,” Cohen said. “When I questioned the discrepancy and suggested stealing was going on, Brooke’s regional vice president said that I must be wrong. He himself was such a believer that he had five agencies. Pretty soon I began to doubt myself and my own bookkeeping.”

Cohen added that his daughter, after learning about how he was faltering on the brink of bankruptcy under the Brooke umbrella, tried to commit suicide.

“This horrible situation of mine was just one of several that definitely contributed to her illness,” Cohen said. He added she is fine now, but that he knew of other agents whose marriages were destroyed and others considered filing bankruptcy.

Cohen also has a lawsuit pending. He said that with a Chapter 11 bankruptcy, funds that are still in place could eventually be used to pay former Brooke franchisees the settlements given out during arbitrations — but like Cunningham, he guessed that could be years down the road.

Potential Buyers Back Out

The picture seemed brighter for a while. The Overland Park, Kan.-based Brooke Corp. and Brooke Capital Corp. filed for Chapter 11 bankruptcy protection to prepare for a possible sale to two Kansas businessmen, who later withdrew their interest in purchasing the corporation. Lysle Davidson, an insurance agent from Johnson City, Kan., and Terry Nelson, vice chairman of First State Bank in Norton, withdrew the offer to acquire Brooke’s insurance network, saying there weren’t enough agencies left.

In addition to individual insurance agent franchise lawsuits, additional lawsuits had preceded the Brooke filing of bankruptcy. In September, the Bank of New York Mellon filed a lawsuit seeking more than $5 million from Brooke Corp. Citizens Bank and Trust Co. of Chillicothe, Mo., has also sued to recover a $9 million loan to Brooke Capital for which the bank says the company is in default.

Smoke Signals Trouble

Agents had been calling media outlets, including Insurance Journal, for several years with horror stories about their Brooke affiliations. For these agents, the signals had been loud and clear but they feel watchdogs (referring to the State Insurance Commissioner, among others) dropped the ball. Insurance regulators in general said that the SEC had jurisdiction, not state insurance regulators, because it was a franchise business. However, Kansas Insurance Commissioner and NAIC President Sandy Praeger issued a statement in September saying that Brooke was being monitored, while again pointing out that the insurance department had limited jurisdiction. (Yes, during the Brooke Corp. debacle, Ms. Praeger was elected President of the National Association of Insurance [NAIC]). “Those Brooke lawsuits deal with contractual issues that are not part of the insurance department’s regulatory authority,” Praeger said, “but we continue to monitor any potential problems that could concern Kansas consumers and policyholders.”

Later, the Kansas Department said consumers would be covered in all cases if they could prove or the agency could show premiums had been paid.

Still some agents say insurance regulators (such as the State Insurance Commissioner, among others) should have done more.

Former agency owner in Louisiana, Rhonda Lobell, said the Louisiana Department of Insurance hired an outside auditor in 2007 to look at the books after she and others complained that the Brooke firm was stealing. When the auditor was finished with the exam, the official report said he could not find evidence of any wrongdoing.

The Louisiana Department of Insurance only talked to one side, Lobell said. She and others contend that there were two sets of books and that the department failed to dig deeper.

Insurance Journal contacted the Louisiana Department of Insurance, which provided the market conduct study in full, but a spokesperson said they were unaware of any accusation that two sets of books existed.

“Seven out of the eight Brooke franchises in Louisiana have gone under,” Lobelle said. “What does that tell you?”

In recent days the Missouri Department of Insurance, Financial Institutions and Professional Regulation, as well as the Kansas Insurance Department, said they plan to send market conduct investigators to look at all Brooke’s paperwork. The insurance departments are working with Albert Reiderer, who is the special master appointed to represent Brooke.

But for the agency owners, the struggle to survive is still a reality.

Plano, Texas, former Brooke agent/owner Todd Herron said he is trying to put his life back together.

“I considered myself a pretty smart person when I bought into Brooke,” Herron said. “But with all the trouble going on with this franchise, I kept asking myself, ‘How they were pulling this off? How is it the feds and state regulators weren’t catching what was going on? What had I missed?’ Maybe I wasn’t so smart after all.”

Herron is working to re-establish relations with insurance carriers and plans to keep his agency, but said that many agents he has spoken with won’t have the resources to keep their shops open. Many are small agencies and the larger carriers are reluctant to have a relationship without a big name to go with it.

“Former franchisees are still in debt to local banks with loans they took out to join Brooke,” Herron said. “All are waiting to hear what will happen now that Brooke has filed bankruptcy.”

Other agents and some news outlets now say there is an FBI investigation ongoing with possible RICO charges pending.

Whatever happens to Brooke and its owners, many agents’ lives have forever been changed.

“I wasn’t a rich man coming into this situation, and I definitely am not one now,” said Harvey Cohen, who says he lost his life savings at 59 years of age because of his Brooke affiliation. “All of us are just trying to survive and that is just what I intend to do.”

The Rewards of Knowledge

While still an employee at Valley Hope, my youngest stepson was admitted for substance abuse treatment. His insurer is NDBH‑KS. Prior to his discharge from treatment at VHA, Valley Hope terminated my employment (just a continuation of the boorish behavior VHA's leadership is so well-known for). I received a letter from BCBS-KS/NDBH-KS stating my stepson had been authorized 31 DAYS of treatment! An authorization of days for this length of time from NDBH‑KS was unheard of. After my stepson’s discharge from treatment, he got into trouble and re-admitted within a month. Another 17 days of treatment were authorized. This is so unusual for NDBH‑KS as to be almost unbelievable.

I can say, in all surety, that my stepson is not special. He is no different than other sons, daughters, spouses, et al, who sought substance abuse treatment at VHA and were denied benefits by NDBH‑KS. The ONLY difference between my stepson and other patients was that those working at BCBS-KS/NDBH-KS knew I would not permit them to misdirect the healthcare benefits my stepson was entitled to.

(If anyone reading this would like to hear about simple steps to take that will prevent BCBS-KS/NDBH-KS from illegally withholding your healthcare benefits, send your contact information through the form at the end of this website.)

It Starts with One Person

Benefits & Executive Compensation News

New Directions, Blue Cross Sued Over Mental Health Coverage

Sept. 6, 2019, 11:08 AM

COURT: M.D. Fla.
TRACK DOCKET: No. 6:19-cv-01727 (Bloomberg Law Subscription)
JUDGE: Roy B. Dalton Jr. (Bloomberg Law Subscription)
COMPANY INFO: New Directions Behavioral Health LLC (Bloomberg Law Subscription)

New Directions Behavioral Health LLC wrongly limits coverage for residential mental health treatments by using flawed internal criteria for gauging medical necessity, according to a proposed class action lawsuit filed in the Middle District of Florida.

The Sept. 5 lawsuit was filed by a woman with Blue Cross Blue Shield of Florida health insurance, whose 20-year-old daughter suffers from anorexia. The woman claims Blue Cross and New Directions—which administers mental health benefits for Blue Cross and other insurers—repeatedly denied coverage for residential treatment of behavioral health disorders by using medical necessity criteria that aren’t consistent with generally accepted standards of medical...

To read the full article log in. To learn more about …

https://news.bloomberglaw.com/employee-benefits/new-directions-blue-cross-sued-over-mental-health-coverage (as viewed on 09/02/20)

It only takes one person

to change everything.

Is it Called Criminally Negligent Homicide or Manslaughter?

"Patient neglect is a terrible thing."

NDBH-KS would frequently deny authorization of healthcare benefits when a patient admitted into a VHA facility to Detox from opioids. They would justify this determination by saying, "no one has died from opioid detox symptoms". Nothing could be further from the truth. The detox symptoms from opioid abuse can be extremely uncomfortable. Coming off opioids is so difficult that some opioid abusers will choose suicide over detox as a solution to their problem. When BCBS-KSNDBH-KS denies opioid detox healthcare benefits for a patient who has these healthcare services available, BCBS-KSNDBH-KS needs to be held accountable for any avoidable consequences.

In fact, the State of Kansas may be held accountable for any avoidable tragedy that comes out of a scenario such as that described above. How many years has the State of Kansas KNOWINGLY permitted an ineligible candidate get his/her name on the voting ballot to run for the office of Insurance Commissioner? How many years has the State of Kansas permitted an ineligiblKe candidate not only run for the office of Insurance Commissioner but then let that person actually take office? Ms. Vicki Schmidt, Mr. Ken Selzer, and Ms. Sandy Praeger have all been ineligible to be the Kansas Insurance Commissioner, yet all have served in that office. From what we know, ineligibility equates to dereliction of duty. Mr. Ken Selzer and Ms. Vicki Schmidt have been aware of the scam BCBS-KS/NSBH-KS has been running against its policyholders, yet nothing has been done to

correct it.

(1)

(2)

(3)

(4)

(5)

(6)

Who is responsible for permitting ineligible Candidates run for the office of Kansas Insurance Commissioner?

Who is responsible for letting an ineligible Candidate accept the role as Kansas Insurance Commissioner,

supervise the Insurance Department, and accept the salary of the Insurance Commissioner?

Who bears the responsibility of paying for any corrective measures, including any monetary settlement?

Who is responsible for finding a resolution to this problem?

Do those (such as our Governor) who have known about the insurance fraud and Kansas Insurance

Commissioner problems bear any responsibility to related problems?

Does the facility that offered treatment to a patient despite knowing healthcare benefits would likely be denied have any responsibility to write-off the cost of treatment?

Regulators enjoy cozy relationship with insurance industry

The article below, Regulators Cozy Relationship with Insurance Industry, is relevant to Ms. Praeger, as there is significant information within it about her performance as a Kansas Insurance Commissioner. The article was printed in The Kansas City Star in 2006. As you read the article, I urge you to keep in mind the information about Insurance Commissioners in general is as germane in 2020 as it was in 2006. By keeping politicians happy, the insurance industry is never asked to change, and there is almost no oversight of information related to "insurance". The public can create change by making politicians uncomfortable.

U.S. insurance companies boast assets of $5.6 trillion. They (insurance companies) benefit from virtually no federal oversight. And the state officials who do regulate insurance companies often are drawn from the industry they police.

That’s how insurance regulation works in America. But too often it may not be working for you.

Insurance companies have far deeper pockets, and far greater political pull, than consumers might ever dream of — and their influence is considerable.

The reason is simple. Big money is at stake. Insurance premiums now equal roughly 10 percent of the U.S. gross domestic product (statistic is from 2006).

“The industry gets what it wants across the country,” said Doug Heller, director of the Foundation for Taxpayer and Consumer Rights, a non-profit California-based consumer advocacy group.

The Kansas City Star found:

Regulators and insurance executives routinely trade jobs through a “revolving door".

More than half of the 35 insurance commissioners who left their jobs in the last three years (from 2003 to 2006) got new jobs with the insurance industry, law firms, or lobbying groups that work for it, according to an informal nationwide survey by the newspaper. One-third of the new commissioners’ replacements came from the insurance field.

Insurance companies invest millions of dollars attempting to influence regulators (Insurance Commissioners) and lawmakers.

Insurers spent $119 million lobbying federal officials in 2005 — more than the auto industry and commercial banking combined. Only pharmaceutical companies spent more money on lobbying than insurance companies. Insurance also regularly ranks in the top 10 of industry campaign contributors, giving candidates more than $230 million since 1999.

Elected state insurance commissioners tend to be more consumer-friendly than appointed ones. (Insurance Commissioners who are appointed by their Governor or a group that reports to the Governor will typically side with the insurance company rather than the consumer. Creating a rift between the Governor and insurance industry campaign donations imay lead to job termination.)

The newspaper’s database analysis showed, for example, that insurance complaints filed in Washington state — where voters choose Commissioners — are twice as likely to be decided in favor of consumers as those in Maryland, where politicians pick commissioners.

Unfortunately, for consumers in 39 states, including Missouri, Insurance Commissioners are appointed. In Kansas and only 10 other states, Commissioners are elected.

Insurance industry spokesmen, lawmakers and regulators all said that lobbying and campaign contributions are just the political reality in America today. They also dispute that the revolving door between state insurance commission offices and corporate boardrooms offers any more influence than that enjoyed by other regulated businesses.

“There are times when I wish they (the industry) would be much more active,” said Marc Racicot, the president of the American Insurance Association, who once served as Montana’s governor and chairman of the Republican National Committee and President Bush’s re-election campaign.

But the influence big money can buy occasionally tempts big-time corruption. In Louisiana, three consecutive insurance commissioners went to prison in recent years.

Yet most of the time, regulators and lawmakers do the industry’s bidding in ways that are perfectly legal (This statement is questionable.).

State Sen. James Seward of New York, chairman of the insurance committee, sponsored bills giving insurers tax credits, easier ways to reorganize their corporate structure, and a proposal that would weaken state oversight of auto insurance rates. Seward has received $500,000 in contributions from insurance interests.

Former California Commissioner Chuck Quackenbush allowed insurers to avoid investigations and fines for underpaying policyholders after a major earthquake. The insurers gave Quackenbush free TV commercials and made donations to charities that included his son’s football camp.

Terri Vaughan, former Iowa insurance commissioner, approved a company’s reorganization, which enabled it to become a public company. The company, Principal Financial, later gave Vaughan a seat on its board of directors. Her old boss, Iowa Gov. Tom Vilsack, took contributions from company insiders, including more than $40,000 from a former chairman.

Seward did not return repeated telephone calls for comment. Quackenbush said he didn’t do anything wrong but his political opponents forced his resignation. Vaughan stood by her decision.

Local politicians also benefit from the close relationships. Insurance interests contributed $1 million to Kansas lawmakers in the past 10 years, and $4 million to Missouri lawmakers (as of 2006).

During that time, Missouri lawmakers passed industry-friendly bills to put new limits on medical malpractice lawsuits and to restrict public access to insurance complaints. They also proposed to shield insurers from having to disclose illegal behavior to regulators and even the courts.

The last bill was defeated after critics said it amounted to a “get-out-of-jail free” card for insurers. But the proposal’s sponsor, state Sen. John Loudon, defended the measure. Loudon, a licensed insurance agent, has received more than $20,000 from insurance interests during his political career. He says his bill was needed to protect insurers from frivolous lawsuits. (This is an excellent example of the "fox guarding the henhouse" behavior.)

“Some people tried to immediately say we’re just trying to hide stuff,” said Loudon, a St. Louis County Republican. “But the plaintiffs’ bar always wants things wide open. They want it wide open so they can go fishing for business.”

Revolving door spins

Even some insurance regulators concede the cozy relationship can lead to lax oversight that hurts consumers.

“You wonder if you get a little bit of the fox guarding the henhouse,” said Georgia’s elected Commissioner, John Oxendine, a politician and attorney who has never worked in the industry.

But insurance companies maintain that hiring former regulators gives them a more consumer-friendly perspective. And Insurance Commissioners maintain that industry experience gives them understanding of the industry’s arcane rules.

Besides, “if you precluded all the people who came from the industry, who would you be left with?” (For example, he would be left with consumer advocates, but that isn't what he wants.) asked former Connecticut Commissioner George Reider, who worked in the industry before becoming a regulator.

However, the way Insurance Commissioners are appointed — usually by governors — worries consumer advocates and some former Commissioners. Critics contend you don’t have to look further than Missouri.

Insurance Director Dale Finke is a former insurance agent and once led the state Association of Insurance Agents. When the director’s seat became vacant last year, Gov. Matt Blunt asked a group of campaign donors and insurance insiders to screen candidates. Finke was their first choice.

Insurers gave Blunt’s campaign $135,000 in 2004. Finke and his wife have contributed $6,300 since 2003.

“In most cases, even when a progressive, pro-consumer governor is elected, the Insurance Commissioner is the insurance industry’s appointment,” said former Missouri Insurance Director Jay Angoff, who served during Mel Carnahan’s administration. “Governor Blunt just asked the industry and made no bones about it: Who do you guys want?”

Blunt’s spokesman at the time, Spence Jackson, said governors commonly consult with stakeholders before filling a position, but denied any link to campaign money.

“This is a governor who does not make policy decisions based on campaign contributions,” Jackson said.

Finke said his background as an independent insurance broker helps him deal with different insurance companies. “I’ve never been considered to be overly friendly to them,” he said.

The revolving door spins both ways for politicians.

Former South Carolina Gov. Jim Hodges is now president of the National Alliance of Life Cos. Ex-Oklahoma Gov. Frank Keating heads the American Council of Life Insurers. Other governors also have gone on to serve on corporate boards.

David Schiff, a former insurance executive who now publishes a trade newsletter, said, “So many Commissioners sit on boards, take jobs with companies they regulated (that) you don’t even notice anymore,” he said.

Lobbying and influence

Lawmakers sometimes get more money from insurance interests than the average American worker makes in a year.

The money isn’t hard to find. In September, Kansas Commissioner Sandy Praeger held a fundraiser in St. Louis during the quarterly conference of the National Association of Insurance Commissioners, where The Star counted industry executives and lobbyists outnumbering commissioners more than 10 to 1.

In her first campaign, Praeger accepted more than $28,000 from Topeka-based American Investors Co., its parent company and subsidiaries, according to Kansas campaign records — more than she received from any other insurer. Executives and their family members contributed another $8,000 to Praeger. (Since 1927, it was been illegal for Kansas Insurance Commissioner to accept campaign funds from the insurance industry, see Kansas Statute 40-109. At the time, Ms. Praeger was WELL aware of this prohibition.)

Since taking office, Praeger hasn’t conducted any investigations of the company’s performance.

Praeger said her office would investigate American Investors if it had a high number of complaints. Yet, The Star found that of the 20 biggest annuity companies doing business in Kansas, American Investors had the worst complaint score.

Mark Heitz, president of AmerUs Annuity Group, has said that the company, which includes American Investors, receives complaints from less than 1 percent of its customers and its goal is to offer “competitive products backed by quality customer service.”

Praeger said there is no connection between her actions and campaign donations. She said that she has pushed tougher rules on how annuities are sold, something she wouldn’t have done if she were doing favors for an annuity company.

“To me it’s not about who’s making the donation, but who the donation is going to,” Praeger said. “It’s about the official’s integrity.” (How's that for justifying the development of conflict-of-interest relationships for personal financial gain?)

Big campaign donors, however, can use money as a weapon, according to California Commissioner John Garamendi. This year, Garamendi asked the FBI to investigate after he said insurers threatened to spend $2.4 million against his campaign for lieutenant governor if he outlawed the use of home ZIP codes in setting auto insurance rates.

“They (the insurance industry) are one of the most powerful lobbying forces in the country,” Garamendi said.

Insurance money seeps through all levels of government. U.S. Sen. Hillary Clinton and outgoing Sen. Rick Santorum each accepted more than $350,000 from insurance interests so far in the 2006 election cycle. Since 2003, California Gov. Arnold Schwarzenegger has accepted more than $2 million from insurance interests.

Blunt awarded contracts to run Department of Motor Vehicle fee offices to four leading contributors in the insurance business. Those offices collectively generate more than $1 million (report from 2006) in business for the contract holders.

The FBI conducted an investigation into the awarding of fee office contracts in Missouri, but ended it without seeking any indictments. But mixing money with politics has led to legal troubles elsewhere:

- ILLINOIS:

Chicago insurance mogul Mickey Segal and his employees gave more than $400,000 to city, state and federal candidates between 1990 and 2002. Segal counted the mayor’s brother and the governor’s son as business partners. Some politicians got free or discounted insurance. Segal’s firm won millions of dollars’ worth of city contracts.

Segal was convicted in 2004 of raiding insurance reserves. Prosecutors also said Segal circumvented campaign finance laws by paying employees to make private donations.

In a letter to The Star from prison, Segal said he was prosecuted by the political allies of an insurance rival.

- LOUISIANA:

Louisiana Insurance Commissioner Sherman Bernard pleaded guilty to taking bribes. His successor, Doug Green, served 12 years in prison for taking $2 million in illegal contributions from an insurer. And his successor, Jim Brown, served six months in 2002 for lying to FBI agents investigating an insurance settlement.

“You get wined and dined, there are golf outings and there is no limit on what is spent,” Brown said. “There are huge industry pressures and a lot of money being thrown around. None of it’s illegal, but …”

- OKLAHOMA:

Former Oklahoma Insurance Commissioner Carroll Fisher is under house arrest after being found guilty this year of campaign corruption. He pocketed a contribution and accepted gifts from an insurance company. Fisher also blamed politics for his downfall.

“I don’t know who I (ticked) off,” Fisher said.

Changes coming?

Regulators may be getting the message. More candidates for Insurance Commissioner are balking at accepting industry contributions (this statement is debatable).

Washington state prohibits commissioner candidates from accepting insurance money. Washington Commissioner Mike Kreidler said a system of elected regulators prohibited from taking insurance money leads to a greater consumer focus.

“There’s accountability,” Kreidler said. “There’s an expectation that the person who holds this office needs to be a consumer advocate.”

www.kansascity.com/newFors/article295078/Regulators-enjoy-cozy-relationship-with-insurance-industry.html , 2006

Letter from Ms. LeAnn Crow, Kansas Insurance Department, 09/29/18

Letter from Mr. Troy Wolf, 12/13/18

NOTE: BCBS-KS has taken no action to rectify the problem of NDBH-KS illegally withholding healthcare benefits despite several face-to-face meetings with VHA leadership. BCBS-KS would listen to the problems VHA leadership had to share about the dishonest manner NDBH-KS was distributing healthcare benefits, but then do nothing. BCBS-KS will never perform a self-audit. It will take definitive action by the FBI before BCBS-KS policyholders will ever recieve all the benefits they pay for.

"Appeals of adverse decisions" have been made countless times by VHA Utilization Reviewers with little success. If you choose to contact BCBS-KS, please keep your expectations low. BCBS-KS will transfer your call, or route your letter, to NDBH-KS, where, more than likely, you will speak with a Representative and nothing will change.

The URAC (Utilization Review Accreditation Commission) and NCQA (National Committee for Quality Assurance) are as ineffective as NAIC (National Association of Insurance). Don't expect BCBS-KS/NDBH-KS to overturn any denial of benefits that have been made. Write your letter to the FBI, and let them take care of things.

Letter from Ms. LeAnn Crow, 12/19/18

American money. Money falling. Dollar si

Write a

letter of Complaint to

the FBI , have your case recognized, and receive updates on any

legal action.

Letter from Ms. LeAnn Crow, Mr. Dennis Jones, and Ms. Vicki Schmidt; 01/29/19

Only Letters of Complaint to the FBI will resolve the problem of BCBS-KS/NDBH-KS insurance fraud and related problems such as unjustly denied healthcare benefits.

Examples of how BCBS‑KS insurance benefits are mishandled per the mandates of the

Mental Health Parity and Addiction Equity Act (MHPAEA), most notably the “fail‑first” policy.

Two more examples of how BCBS‑KS insurance benefits are mishandled per the mandates of the Mental Health Parity and Addiction Equity Act (MHPAEA), most notably the “fail‑first” policy. The MHPAEA a federal law. I will offer to second example of how BCBS‑KS healthcare benefits are being authorized unjustly:

EXAMPLE: For example, you and your marital partner have a child who suffers from mental health problems. Symptoms of this problem include auditory hallucinations and thoughts of suicide. A previous inpatient treatment episode resulted in the diagnosis of Bipolar Disorder. Fortunately, your child responded well to the medications prescribed to treat the disorder. However, after a time, your child decides to stop taking the medication. You come home one day to find your child is nonresponsive due to attempting suicide by overdosing on pills. Once your child is medically stabilized, you are informed that the suicide attempt was precipitated by our child hearing “voices” urging the act of suicide. Your child now requires further treatment to, once again, stabilize the symptoms that led the prior treatment episode. Based upon assessment, it is determined that a treatment plan including one‑hour, weekly counseling sessions will not provide the structure your child needs at this time. Neither will three-hour group sessions occurring three times per week be enough. It is obvious to all your child needs to, once again, be admitted to an inpatient program for treatment to be successful.

If you and your marital partner have a healthcare policy through BCBS‑KS, the authorization or denial of benefits will be completed by their third-party payor, New Directions Behavioral Health of Kansas (NDBH‑KS). And, NDBH‑KS would refuse authorization of benefits for the inpatient treatment your child requires to successfully return to health. NDBH‑KS would initially authorize benefits for treatment that includes either the individual or group counseling option, and it would likely be the weekly individual counseling sessions. This is due to the fact that NDBS‑KS has flagrantly refused to comply with the stipulation within the MHPAEA that healthcare insurance benefits are not to be based on a “fail-first” policy, but on symptoms being presented by the patient. Once it becomes obvious your child will not succeed in treatment at a lower level of care, then authorization of benefits will be considered for treatment at a higher level of care. Of course, the cost of treatment at a lower level of care is less expensive for BCBS‑KS, and keeping treatment costs at a minimum is the reason BCBS‑KS has retained NDBH‑KS to monitor benefits for its Customers.

With the BCBS‑KS healthcare policy, benefits are the same whether the treatment is for mental health problems or substance abuse problems. Below is an example of a patient seeking treatment for a problem with substance abuse.

EXAMPLE: In this scenario, let’s say you and your marital partner have a child who is addicted to heroin. Symptoms of this problem include your child’s chronic disinterest in school, family and friend relationships, lack of honesty and a problem with stealing money and family heirlooms to get the cash needed to buy more heroin. Your child has been through a 30-day substance abuse treatment program. Your child seems committed to comply with a healthy lifestyle and routinely takes the anti-craving medication that has been prescribed. Five months later, over the period of a four weeks, you notice a deterioration of health behavior choices and notice, once again, the unexplained disappearance of money and valuables from the home. One day, you come home to find your child is nonresponsive and items related to heroin use are clearly visible.

Again, if you and your marital partner have a healthcare policy through BCBS‑KS, the authorization or denial of benefits will be completed by their third-party payor, New Directions Behavioral Health of Kansas (NDBH‑KS). And, NDBH‑KS would refuse authorization of benefits for the inpatient treatment your child requires to successfully return to health. NDBH‑KS would initially authorize benefits for treatment at the lowest level of care possible based on their “fail first” policy. If your child relapses while in treatment at that lower level of care, then authorization of benefits will be considered for treatment at a higher level of care. All you can do is pray your child did not get heroin that is dirty enough to cause permanent brain damage, use a dirty needle and contracts Hepatitis, or conduct sexual relations with someone suffering with AIDS. The use of a “fail first” policy often leads to failure and may even lead to death. That is why it was deemed to be unethical and illegal.

...

Letter from Mr. Derek Schmidt, State of Kansas Attorney General, 02/14/19

Post Office Box 1673

Kearney, Nebraska 68847

Letter from Mr. Derek Schmidt, State of Kansas Attorney General, 03/05/19

Letter to Mr. Derek Schmidt, State of Kansas Attorney General, 10/20/20

Is our Kansas Attorney General, Mr. Derek Schmidt, just one more politician who has fallen under the insurance industry's spell of financial influence? It does appear so. Does the State of Kansas need to throw out the political positions of Insurance Commissioner, Governor, and Attorney General? Why throw taxpayer money at positions filled by people who have no intention of protecting Kansans against any problem that fits between them and their insurance industry campaign dollars?

Date: October 20, 2020

Supplier: Blue Cross & Blue Shield of Kansas

File No: CP-19-000293

Reference: Your letter to me dated March 5, 2019

Dear Attorney General Derek Schmidt:

The information you shared with me in your letter dated March 5, 2019, regarding The State of Kansas File No. CP-19-000293, is greatly appreciated. If I understand correctly, you are saying that, as the State Attorney General, you refuse to take corrective action against neither Ms. Vicki Schmidt nor Mr. Ken Selzer in response to their collusion with BCBS-KS in its insurance fraud scam. As well, you have no recommendation on what Kansans can do to rectify this statewide healthcare crisis stemming from this conflict-of-interest relationship between Blue Cross & Blue Shield of Kansas/New Directions Behavioral Health. Your decision to route my concerns back to the Kansas Insurance Department is terribly lame. You know the Insurance Department will throw my paperwork away. That is the reason I wrote to you and not the Insurance Department.

Your lack of interest in this case of our incumbent (Ms. Vicki Schmidt) and previous Kansas Insurance Commissioner (Mr. Ken Selzer) is concerning. While reviewing other cases of Insurance Commissioner misconduct, I see the State Attorney General is routinely involved in the prosecutorial process. It is inexcusable that not even Mr. Dennis Jones, Director of the Anti-Fraud Division of the Kansas Insurance Department has shown interest.

After reading the State of Kansas 2019 Statute, Chapter 40, Article 1, Section 13, I question even more the rationale behind your lack of involvement. Additionally, Mr. Dennis Jones’ silence on this subject is reprehensible. Mr. Jones may be worried that if he does follow through with the responsibilities entailed within his job description, the insurance industry will begrudge his interference. Offending the insurance industry would offend the Insurance Commissioner and could then have a job-threatening ripple effect for him.

Mr. Schmidt, is it possible your lack of action on this issue is also related to a desire to not upset the insurance industry? During your 2018 push for the position of Kansas Attorney General, the insurance industry donated generously to your campaign fund (please see below). Blue Cross/Blue Shield of Kansas was one of those donors. While it may be awkward for you to identify the criminal activity of one of your primary donors, it does not absolve you from that responsibility. Kansans elected you into office to protect them, and you are not doing that.

Mr. Schmid's Treasurer during his 2018 campaign for the position of State of Kansas Attorney General was Mr. Gary C. Allerheiligen, CPA.

Derek Schmidt 2018 State of Kansas Attorney Insurance Industry Campaign Donors

Patient Neglect

One of the most dreaded outcomes resulting from patient neglect that any treatment facility can face is legal action initiated by the patient. When a treatment facility is held accountable for not providing essential services to a vulnerable patient it has agreed to treat, the outcome can be a costly one for the facility. Yet, patient neglect occurs more often than most people would ever suspect.

Regardless of the level of care a patient is being treated at, there are fundamental goals that the facility is expected to assist the patient with prior to discharge. In turn, the policyholder’s insurer is responsible for authorizing enough benefits for the patient to achieve those goals. The purpose of treatment is to set a patient up for success after discharge. If facility staff fail to develop a viable discharge plan for the patient, and/or if the patient’s insurer fails to authorize the benefits needed for a successful treatment episode, it may constitute a case of patient neglect.

Things became dicey at VHA when all staff became aware that whenever a patient with a BCBS-KS/NBH-KS healthcare policy admitted into a VHA facility for treatment, that patient would likely be the victim of insurance fraud. That likelihood was based on the consistent pattern of insurance fraud inflicted upon thousands of patients, one right after the other, ALL with benefits through BCBS-KS/NDBH-KS. These are the cases of that need to be brought before the FBI for investigation. Somewhere in there is a massive case related to patient neglect.

The Treatment Plan

While no healthcare treatment facility ever wants to be accused of neglecting the needs of their patient(s), it does happen. Even the most ethical healthcare clinicians will, at times, will occasionally overlook routine tasks. While in treatment, regardless whether for mental health or substance abuse problems, a patient will have what is referred to as a Treatment Plan. A Treatment Plan includes the goals to be completed prior to the successful conclusion of a patient’s treatment episode. Patient discharge prior to completion of these goals may be an instance of patient neglect.

The patient will work with his/her Counselor to develop the Treatment Plan and will then receive a copy of it. One of the fundamental treatment goals within any Treatment Plan is the inclusion of the patient's family within the treatment episode. Unless the patient refuses family involvement, the patient's Counselor is responsible for holding counseling session(s) between the family and patient. This may be in-person, via telephone, or through the use of face-to-face computer software. Any excuse, without the patient's agreement, for not having family involvement is an unacceptable one.

After discharge, every patient should review his/her Treatment Plan. If any of the agreed-upon treatment goals were not addressed by the patient's Counselor, this may lead to a decrease in the cost of that treatment episode.

Besides family participation, another essential piece of any Treatment Plan is the Discharge Plan. The point of treatment is to help the patient return to health. To maintain a healthy lifestyle, the changes needed post-discharge are supported within the Discharge Plan.

If a patient is being billed for services he/she did not receive, there is no need to pay for it, and a report to the FBI is warranted.

Contact Your Representative (but don't hold your breath...)

My State Representative is Dr. Roger Marshall. At this time, Dr. Marshall is currently running for the seat of Kansas State Senator. I have reached out to him on more than one occasion wanting to discuss the problem of BCBS-KS/NDBH-KS healthcare insurance fraud. Because he is a physician, I felt sure he would be willing to engage in discussion on the subject. But, that never happened. The threat to public safety that healthcare insurance fraud presents should be a burning issue for Dr. Marshall. So, why isn't it?

As a politician, he will NEVER willingly create trouble for the insurance industry and risk losing that financial backing. See how it works? There is nothing as important to a politician than the insurance industry's financial support.

In 2020, Dr. Roger Marshall is hoping to move from being a Kansas State Representative to being a U.S. Senator representing Kansas. As a U.S. Senator, Dr. Marshall would have a greater influence within the political arena and could bring to light the crime of BCBS-KS/NDBH-KS healthcare insurance fraud. But would he? Absolutely not! Below are some of the contributions Dr. Marshall has garnered from the insurance industry for his campaign to be Senator.

If elected to the Office of US Senator, Dr. Marshall's relationship with the insurance industry will always be his most beloved one. And, keeping his Beloved happy will be his highest priority. Please don't judge him too harshly, because he isn't alone. It would be difficult to find a U.S. Senator who isn't doing the same thing.

The insurance industry has an enormous impact on the lives of every American whether they know it or not. It is legal for Dr. Marshall to accept campaign donations from the insurance industry in his bid to become a Senator for the State of Kansas. Some of those donations he has accepted are listed below.

Let's assume Dr. Marshall wins the race to become a Kansas Senator and a problem is brought before him that requires conflict resolution between the insurance industry and a segment of Kansans. Do you believe Dr. Marshall would support any determination that would pit him against the insurance industry?

Kansas U.S. Senator hopeful Dr. Roger Marshall - campaign donations from the insurance industry in 2020

www.followthemoney.org (10/24/20)

ELECTIONS - 11/08/22

PROTECT YOUR FAMILY

VOTE FOR PUBLIC SAFETY

The 2022 election for the State of Kansas Insurance Commissioner will not be focused on the question, “Who will win the vote?” Rather, the question will be: “Why does Kansas need an Insurance Commissioner at all?” For decades, the position of Kansas Insurance Commissioner has been used as a position of personal opportunity where political corruption is the norm. Our State's Governor, Ms. Laura Kelly; Lieutenant Governor, Lynn Rogers; Attorney General, Mr. Derek Schmit; and Insurance Commissioner, Ms. Vicki Schmidt, have all been derelict in their duty to protect Kansans from being being scammed by unethical businesses, such as the collaborative effort of BCBS-KS/NDBH-KS.

The following political positions will be open for election on November 8, 2022. Each one of these incumbents are aware of the insurance scam run by BCBS-KS/NDBH-KS. Not one of these people took action to save Kansans from that scam. Maybe it is time for a change in every one of these positions:

POSITION INCUMBENT

Governor ...................................... Laura Kelly

Lieutenant Governor...................... Lynn Rogers

Insurance Commissioner................ Vicki Schmidt

Secretary of State.......................... Scott Schwab

Kansas Senator.............................. Jerry Moran

Letter to Mr. Scott Schwab, Kansas Secretary of State, 12/22/20

December 22, 2020

Post Office Box 1673

Kearney, Nebraska 68847  

Mr. Scott Schwab

Kansas Secretary of State

Memorial Hall, First Floor

120 Southwest 10th Avenue

Topeka, Kansas 66612

Dear Mr. Schwab:

SUBJECTS: (1) Blue Cross/Blue Shield of Kansas Healthcare Insurance Fraud

(2) Ineligibility of Ms. Vicky Schmidt to serve as Kansas Insurance Commissioner

(3) Arrest of Ms. Vicky Schmidt for being a Danger to the Public Safety of Kansans

The purpose of this letter is manifold. That is surely apparent by the three reasons listed in the Subject line above. My effort to bring the felonious criminal activities of BCBS healthcare insurance and Kansas State politicians to the public eye began in 2017. Your name is the latest in a long list of contacts I have made seeking the protection of innocent, hard-working Kansans who deserve much better than what our State leadership has given them.

Blue Cross/Blue Shield of Kansas Healthcare Insurance Fraud

Beginning in 2017, Blue Cross/Blue Shield of Kansas (BCBS-KS), in collaboration with their third-party payor New Directions Behavioral Health of Kansas (NDBH-KS), initiated the practice of healthcare insurance fraud in the State of Kansas. Investigation of this criminal activity is the responsibility of Kansas Insurance Department. However, our State’s Insurance Commissioner, Ms. Vicki Schmidt, has refused to investigate this white-collar crime that has harmed thousands of Kansans. In all probability, some Kansans have been harmed to the point of death after being illegally denied healthcare benefits policyholders were entitled to. (Additional information is documented in the website: stolenhealthcarebenefits.com.)

Ineligibility of Ms. Vicky Schmidt to serve as Kansas Insurance Commissioner

Our State’s citizenry has trusted that names on a voting ballot are, at the least, Candidates who are eligible for the Office each is running for. That trust has been misplaced. Examples of three ineligible Candidates who got their names put on the ballot, actually won the election each was running for, and then illegally served in Office include (a) Ms. Sandy Preager, (b) Mr. Ken Selzer, and (c) incumbent Ms. Vicki Schmidt. All served, or are serving, in the position of Kansas Insurance Commissioner.

As might be expected, ruinous consequences have followed in the path of these unqualified political figures. While under Ms. Sandy Praeger’s tenure, our State suffered the Brooke Corp. debacle. If Ms. Praeger had spent as much time working at her job as she did courting insurance companies for campaign donations, the Ponzi scheme of Brooke Corp. may have been discovered in time to prevent the financial ruination of so many people.(1) Mr. Ken Selzer was the Insurance Commissioner initially informed of the insurance fraud BCBS-KS/NDBH-KS was committing. Mr. Selzer decided to ignore the problem and passed it on to his successor, Ms. Vicki Schmidt. Ms. Schmidt has followed suit and now exemplifies the three monkeys who see no evil, hear no evil, speak no evil.

As Kansas Secretary of State, you and your staff have a close association with the State of Kansas Governmental Ethics Commission (GEC). I would like to reiterate the mission of the GEC:

“The Kansas Governmental Ethics Commission is charged with administering, interpreting and enforcing the Campaign Finance Act and laws relating to conflict of interests, financial disclosure and the regulation of lobbying.”

Regrettably, the GEC has, for some reason, exempted the position of Kansas Insurance Commissioner from the mandates of its own Mission Statement. As a result, Kansans have been subjected to a series of Insurance Commissioners who have been (1) ineligible for the Office, (2) inept at the job, and (3) engaged in criminal activity that endangered the public safety of his/her constituency. In the end, who will bear the responsibility of permitting such a travesty to occur?

I would like to share with you an abbreviated e-mail conversation I recently had with Ms. Karina Renna, Campaign Finance Coordinator for the GEC:

QUESTION - A

From: Kristy LeClair <jkleclair2010@hotmail.com>
Sent: Sunday, October 25, 2020 3:44 PM
To: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Subject: Re: State Party Candidate

How can I get a copy of the Kansas Campaign Finance Limits for the years 2004, 2008, 2012, and 2016?
When contributors give more than is permitted to a campaign fund, there’s a form that is sent to the Candidate to inform him/her of the mistake and to say the money needs to be returned. What is the name of that form, and where can I find copies of those forms from the years 2004 until present timer?
How can I get a copy of the paperwork from Candidates confirming the money that was an overpayment was returned to the contributor?

RESPONSE - A

From: Renna, Karina [KGEC], State Campaign Finance Coordinator, Kansas Governmental Ethics Commission, Phone: 785-296-4219, Karina.Renna@ks.gov
Sent: Thursday, October 29, 2020 10:19 AM
To: Kristy LeClair
Subject: RE: State Party Candidate

Campaign information from 2006 to present can be found on our website https://ethics.kansas.gov/campaign-finance/view-submitted-forms-and-reports/. https://ethics.kansas.gov/campaign-finance/contribution-limits/. These limits have not changed.https://ethics.kansas.gov/campaign-finance/notices-sent/ E&O’s are the notices sent.

Excess contributions are returned and shown on Schedule C of the next report due.

QUESTION - B

From: Kristy LeClair <jkleclair2010@hotmail.com>
Sent: Tuesday, November 10, 2020 11:00 AM
To: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Subject: RE: State Party Candidate

Hi Karina,

As I go through the campaign contributions of Kansan politicians, I’m finding there are several Errors or Omissions Notices that should have been sent to Candidates, but weren’t. Is that due to lack of staff, or is it something else?

RESPONSE - B

From: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Sent: Tuesday, November 10, 2020 11:05:18 AM
To: Kristy LeClair <jkleclair2010@hotmail.com>
Subject: RE: State Party Candidate

Hi Kristy,

It is not lack of staff. I do a thorough desk review of all reports for state and statewide candidates. If a candidate amends their report before a desk review is done a notice is not sent.

Do you recognize that a problem exists with the GEC’s practice of not completing timely “desk reviews” to detect the acceptance of prohibited campaign donations? This is a problem that could easily be resolved. So, why hasn’t it?

QUESTION - C

From: Kristy LeClair <jkleclair2010@hotmail.com>
Sent: Tuesday, November 10, 2020 5:01 PM
To: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Subject: : State Party Candidate

There is a Kansas State Statute that forbids candidates who are running for Insurance Commissioner from accepting donations from the insurance industry. Are E&O letters sent out when this kind of transaction takes place?

RESPONSE - C

From: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Sent: Thursday, November 12, 2020 6:24:10 AM
To: Kristy LeClair <jkleclair2010@hotmail.com>
Subject: RE: State Party Candidate

There is no statute in the Campaign Finance Act that forbids Insurance Commissioner candidates from accepting donations from insurance companies.

QUESTION - D

From: Kristy LeClair <jkleclair2010@hotmail.com>
Sent: Thursday, November 12, 2020 12:31 PM
To: Renna, Karina [KGEC] <Karina.Renna@ks.gov>
Subject: Re: State Party Candidate

Yes, there is. Kansas Statute 40-109.

RESPONSE - D

No response was ever received. Neither Ms. Karina Renna nor any other GEC staff member ever responded to my e-mail of November 12, 2020. How the GEC missed such a fundamental law regarding campaign donations as Statute 40-109 does raise serious questions regarding the efficacy of the Kansas Ethics Committee.

It is the many conflict-of-interest relationships Ms. Schmidt has developed within the insurance industry that explains her reticence to “inconvenience” BCBS‑KS with an investigation into claims of insurance fraud. In regards to documentation of campaign donations made to any politician in Kansas, the GEC mandates: “Obtain and record the occupation of each contributor for any contribution over $150. If the individual contributor is not employed, the occupation of the contributor's spouse is to be reported.” Ms. Schmidt and her Campaign Treasurer, Mr. Brad Koehn, neglected to provide identifying information for close to four hundred campaign donations she received. Regrettably, the GEC provides minimal safeguards to protect Kansans against any incomplete reporting of political campaign donations.

Arrest of Ms. Vicky Schmidt for being a Danger to the Public Safety of Kansans

I am appealing to you, as the State of Kansas Secretary of State, to right the wrong perpetuated by the collaboration that has transpired between the State of Kansas Insurance Commissioners, Mr. Selzer and Ms. Schmidt and the insurance company BCBS-KS/NDBH-KS. Every day our Insurance Commissioner permitted BCBS-KS/NDBH-KS to commit insurance fraud, any number of things occurred besides policyholders being scammed out of healthcare benefits. Other possibilities include ER visits, hospital stays, domestic violence, marital separations, burglaries, and death. People don’t recover from addiction or mental illness without on their own.

Even our State Attorney General, Mr. Derek Schmidt, has informed me that he has no responsibility to take any action on this Statewide healthcare crisis. But, Mr. Schmidt was not being truthful when he said that. Likely, there are grounds to officially evaluate Mr. Derek Schmidt’s ability to fulfill the obligations of his position as State Attorney General.

It should be safe to assume that any person wanting to be the Kansas Insurance Commissioner would have a clear understanding of Kansas Statute 40-109. Eligibility requirements for the job include being (1) a person well-versed and experienced in the business of insurance and matters and having (2) a willingness to give personal presence and attention to the duties of his office. The piece of Statute 40-109 regulating the Insurance Commissioner’s acceptance of campaign funding from the insurance industry states:

“In no case shall such Commissioner of Insurance be in the employment of any insurance company or have any official connection with any insurance company, or any financial interest in any insurance company other than as a policyholder.”

Aside from insurance fraud, there are other areas of concern that may deserve investigation such as the possibility of racketeering and insider trading.

RACKETEERING

Kansas Statute 46‑237 outlines boundaries for gifts State politicians can receive. Specifically, Kansas State politicians are not required to report the gifts they accept. So, if on the day after winning an election, the Kansas Insurance Commissioner accepts the gift of a speed boat from an insurance company, neither the Insurance Commissioner nor the insurance company have a responsibility to report the transaction. A conflict-of-interest relationship has now been established. In the end, any “vote” from a Candidate’s constituency is a good thing. But, there is no voter who can compete with the gift-giving power or political influence of the insurance industry. In fact, that is the reason no one has investigated the problems I am reporting to you. Becoming estranged from the goodwill of the insurance industry is always a fear that is paramount in every politician’s mind.

INSIDER TRADING

It would be possible for someone from BCBS/NDBH to whisper into the ear of Insurance Commissioner Schmidt and say, “Our custom of withholding healthcare benefits from eligible policyholders is proving to be successful. Our company profit margin has skyrocketed, and our stocks are in demand. By the way, here are some stocks for you, and purchasing more will make you financially independent the rest of your life.” If that happened, it would be considered “insider trading”. But, no one would know about it, because there is no responsibility for the Insurance Commissioner to report.

Mr. Schwab, what legacy will you leave behind after completion of your four-year term? Should you decide to further your career in politics, what will be the public’s perception of your political competence? Do you deserve public confidence? My endeavor to bring all the referenced criminality to light, I have donated my time and expertise. I have paid out-of-pocket for all paper, postage, printer ink, envelopes, and the monthly payments for my electronic bulletin board. Being unemployed, I take money out of my very small retirement fund to pay for all this. What are you willing to do?

Sincerely yours,

Kristy LeClair, MSEd, LMHP

Despite repeated efforts encouraging our (1) Kansas Insurance Commissioner, (2) Attorney General, (3) Secretary of State, and (4) Governor to protect addicts and the mentally ill in our State from being defrauded of healthcare benefits by BCBS-Kansas/NDBH-Kansas, none would fulfill the responsibilities of his/her post.

I concluded the only way to gain their attention was to appeal to the source what every politician considers to be most important – their campaign donors. It took me months of work, but, on March 31, 2021, I sent off a letter to every campaign donor who contributed to Ms. Schmidt’s, Mr. Schmidt’s, and Mr. Schwab’s 2018 campaign. Examples of those letters are below:

Letter to Kansas Insurance Commissioner 2018 Campaign Donors, sent 03/31/21

March 31, 2021

Post Office Box 1673

Kearney, Nebraska 68847

_______________________
_______________________

_______________________

Dear __________________:

SUBJECT: Refund of your 2018 Campaign Donations to Kansas Insurance Commissioner, Ms. Vicky Schmidt

The purpose of this letter is to share information with you in regards to the campaign donations you made in 2018 to then-political Candidate Ms. Vicky Schmidt in the amount of $100. She was running for the position Kansas Insurance Commissioner. Considering her credentials, it was not surprising when she won the election. However, there was, and still is, a problem. Ms. Vicky Schmidt did not meet eligibility requirements to run for the post of Insurance Commissioner. Her name should never have been on the voting ballot.

Ms. Schmidt’s Campaign Treasurer, Mr. Brad Koehn, CPA, overlooked a fundamental exclusion regarding campaign donations made to Kansas Insurance Commissioner Candidates. On June 1, 1927, Kansas enacted Statute 40-109 which prohibited Kansas Insurance Commissioners from accepting campaign donations from the insurance industry.

The rationale behind establishing Statute 40-109 is self-evident. Any Insurance Commissioner who is financially connected to the industry he or she oversees is engaged in what is referred to as a “conflict-of-interest relationship. Let’s say an Insurance Commissioner has accepted campaign donations from the insurance industry and is then asked to resolve an ongoing problem between the insurance industry and the people of Kansas. Only Statute 40-109 prevents the Insurance Commissioner from neglecting his/her civic duties and favoring the insurance industry.

Unfortunately, the above scenario is exactly where Ms. Vicki Schmidt finds herself today, potentially placing hundreds of thousands of Blue Cross/Blue Shield of Kansas policyholders at risk of being illegally denied healthcare benefits each may have been qualified for. None of this is news to Ms. Schmidt. This is all information she had from the day she took Office as our Kansas Insurance Commissioner. It was her predecessor, Mr. Ken Selzer, who initially learned of Blue Cross/Blue Shield of Kansas’ practice of healthcare insurance fraud.

The website www.stolenhealthcarebenefits.com elaborates on the information that has been reported within this letter. Should you have questions, please contact the State of Kansas Insurance Department or an attorney. No one should be expected to contribute to an ineligible Candidate.

Sincerely yours,

Kristy LeClair, MSEd, LMHP

Article 1. - INSURANCE DEPARTMENT

40-109. Qualifications; personal attention to duties; interest in insurance company. The commissioner of insurance shall be an elector of this state, and shall be a person well versed and experienced in the business of insurance and matters relating thereto; and he shall give his personal presence and attention to the duties of his office; but in no case shall such commissioner of insurance be in the employment of any insurance company or have any official connection with any insurance company, or any financial interest in any insurance company other than as a policyholder.

History: L. 1927, ch. 231, 40-109; June 1.

Letter to Kansas Secretary of State 2018 Campaign Donors, sent 03/31/21

March 31, 2021

Post Office Box 1673

Kearney, Nebraska 68847

_______________________
_______________________

_______________________

Dear __________________:

SUBJECT: Ruinous Failure Within Kansas Secretary of State’s Department

As a Contributor to the political campaign of Mr. Scott Schwab, now serving as our State of Kansas Secretary of State, you are receiving this letter. It is the responsibility of our Secretary of State to enforce State mandates that have been implemented to (1) thwart ineligible Candidates from seeking Office and (2) to stop any Candidate from accepting conflict-of-interest campaign donations. Yet, the ineligible Candidate, Ms. Vicki Schmidt, our State’s incumbent Insurance Commissioner, was able to sidestep those mandates and slip past any review for Office eligibility. This has left Kansans with an unqualified Insurance Commissioner who has a stronger commitment to the insurance industry than to the health and safety of Kansans.

When it was reported to Ms. Schmidt that BCBC‑KS was committing insurance fraud through its third‑party payor New Directions Behavioral Health of Kansas (NDBH‑KS) by illegally withholding mental health and substance abuse healthcare benefits from policyholders, it was her duty to investigate. Yet, she refused to look into the matter. Mr. Ken Selzer, the Kansas Insurance Commissioner prior to Ms. Schmidt, had been advised of the BCBS‑KS/NDBH‑KS healthcare insurance scam. Mr. Selzer, also an ineligible Candidate for the position of Kansas Insurance Commissioner, clearly stated he would not look into the matter. He was focused on protecting the insurance industry rather than his constituency.

There is a motherlode of potential locked within patients who suffer from mental health/substance abuse problems. Once these patients receive the treatment each needs, our State becomes stronger, and we all win. What responsibility will the State of Kansas have to BCBC‑KS policyholders when they learn their State leadership did not place importance on the thousands of vulnerable Kansans who have been defrauded out of healthcare services? Kansas is not a State flush with financial resources. Is it possible the neglect of those responsible for the welfare of Kansans will have a fiscal blowback on citizenry who had no connection to this white-collar crime? The money will have to come from somewhere.

One more thing… Before Mr. Selzer took office, Ms. Sandy Praeger was the Kansas Insurance Commissioner. Ms. Praeger served three terms. She may have run for a fourth term if it was not for her involvement in the Brooke Corp. scandal. (https://www.sec.gov/news/press/2011/2011-104.htm). Thousands of people across the Country were financially ruined after falling victim to the greed of some very clever insurance grifters. Per Kansas Statute 40‑109, Ms. Praeger was also ineligible for the position of Insurance Commissioner. Her many conflict‑of‑interest relationships with the insurance industry had not been detected by the person who was serving as the Kansas Secretary of the State. Apparently, Ms. Praeger’s ineligibility to serve as the Kansas Insurance Commissioner was never presented as evidence during the Brooke Corp. trial. If I was one of the thousands of people harmed by the Brooke Corp. debacle, I would surely now contact an attorney and sue the State of Kansas.

In conclusion, your campaign donations help all Kansans when it brings competent politicians into office. Without question, our State is sorely lacking in ethical political leadership, and you deserve to know this prior to the 2022 elections. We need a Secretary of State who will prevent ineligible Candidates from getting their names on Kansas voting ballots. The website www.stolenhealthcarebenefits.com offers more information on this subject.

Sincerely yours,

Kristy LeClair, MSEd, LMHP

Letter to Attorney General 2018 Campaign Donors, sent 03/31/21

March 31, 2021

Post Office Box 1673

Kearney, Nebraska 68847

_______________________
_______________________

_______________________

Dear __________________:

As a Contributor to the political campaign of Mr. Derek Schmidt, now serving as our State of Kansas Attorney General, you are receiving this letter regarding a state-wide problem with healthcare insurance. We should all be able to assume our insurer will provide the healthcare benefits listed on the insurance policy we pay monthly premiums for. On January 24, 2019, information was sent to Mr. Schmidt regarding an alleged healthcare insurance scam being run against Kansans by Blue Cross/Blue Shield of Kansas (BCBS-KS) through its third-party payor, New Directions Behavioral Health of Kansas (NDBH-KS). I shared that during the time I was employed at Valley Hope Association, helping those with addiction problems, I witnessed thousands of patients with an insurance policy through BCBS-KS/NDBH-KS being swindled out of healthcare benefits each was eligible for. When an insurer illegally withholds benefits from a policyholder, it is called “insurance fraud”, and it is a federal crime.

Mr. Schmidt’s letter of response, dated March 5, 2019, is printed on opposite side of this letter to you. Mr. Schmidt states his Office is “only authorized to take action in instances where a violation of the KCPA (Kansas Consumer Protection Act) is violated.” He defines “consumer transaction” as the sale or solicitation of goods or services to a Consumer by a Supplier. When a Consumer selects a Supplier to provide healthcare insurance and then purchases a policy from a Supplier, that is a “consumer transaction”. As Attorney General, Mr. Derek Schmidt is responsible for tackling any violation of trust between a Kansan Consumer who has been bilked by an insurance Supplier. This problem should actually be addressed by our State’s Insurance Commissioner, Ms. Vicki Schmidt. However, Ms. Schmidt has refused to consider the welfare of her constituency, thus leaving Kansans with healthcare services through a BCBS-KS/NDBH-KS Supplier vulnerable to continued criminality.

So, what could possibly lead Mr. Derek Schmidt and Ms. Vicki Schmidt to ignore allegations of insurance fraud that was harming so many within their constituency? (1) Could it be nothing more than the fear of losing campaign contributions from the insurance industry? The support of the insurance industry can spell political success for almost any Official. (2) Could it be the fear of losing favor with the State Governor? A good relationship with the Governor spells political opportunity. Investigating an insurer could create conflict and have an adverse affect on the amount of campaign donations the insurance industry gives to the Governor’s next campaign.. THEN, it was discovered Ms. Vicki Schmidt had not been a qualified Candidate when running for the office of Kansas Insurance Commissioner in 2018. According to the eligibility requirements clearly stated in Kansas Statute 40-109, Ms. Schmidt’s name should never have been on the voting ballot. Even with this information, Mr. Derek Schmidt made the decision to do nothing, leaving Kansans with healthcare insurance through BCBS-KS/NDBH-KS prey for further victimization.

Due to HIPAA regulations, only treating facilities such as Valley Hope Association are capable of notifying patients who have been conned while receiving services at their facilities, but that will never happen without a legal mandate. The FBI is willing to investigate the allegations of insurance, but first need written accounts from patients who have been unjustly denied the BCBS-KS/NDBH-KS healthcare benefits each has paid for. I do not have the financial resources to fund a public service announcement to advise victims to contact the FBI, or a competent class-action attorney, for assistance and possible monetary recompense by the State of Kansas, their insurance carrier, or both. The website www.stolenhealthcarebenefits.com offers additional information on this subject. In conclusion, your campaign donations help all Kansans when it helps to bring competent politicians into Office.

Sincerely yours,

Kristy LeClair, MSEd, LMHP

Letter to Kansas AA/NA meeting sites, sent 04/09/21

April 7, 2021

Post Office Box 1673

Kearney, Nebraska 68847

AA/NA Group

_______________________

Dear AA/NA Members:

This letter is being sent with grave concern for those of you who have a healthcare policy through Blue Cross/Blue Shield of Kansas (BCBS-KS) with substance abuse/mental health benefits handled through New Directions Behavioral Health of Kansas (NDBH-KS). If you participated in substance abuse treatment since 2017, there is a strong probability you are one of the victims included in a healthcare insurance scam executed by NDBH-KS in collusion with BCBS-KS. Since at least 2017, BCBS-KS has permitted its third-party payor, NDBH-KS, to illegally withhold treatment benefits from patients who met criteria for an extended treatment stay. This white-collar crime came to my attention during the eleven years I was employed at Valley Hope Association (VHA) as a Substance Abuse Counselor and Utilization Reviewer.

While in treatment, every patient is assigned a Utilization Reviewer. This is the person who shares your overall presentation with your insurer and then requests benefits for days in treatment. When NDBH-KS began to criminally deny benefits, BCBS-KS refused to intervene. It was extremely disturbing for VHA staff to see how patients were being mistreated. However, the leadership of VHA made it clear that any employee who educated patients and family members on their insurance rights would be terminated from employment (despite the information being available to the public). This approach to patient education means those who were defrauded by BCBS-KS/NDBH-KS may also be a victim of patient neglect by the treating facility. If even half of the policyholders who were scammed by BCBS-KS/NDBH-KS submitted a Letter of Complaint to the FBI, there would be adequate grounds for a class-action lawsuit.

Every time NDBH-KS denied benefits to patients, it translated into higher profits for BCBS-KS shareholders. Pulling in profits is the only reason BCBS-KS retains NDBH-KS. Several thousands of Kansans have been swindled out of their healthcare benefits. Potential consequences related to the unlawful denial of benefits to those with mental health/substance abuse problems may have endured dire consequences, even death.

Typically, those who have been deceived by an insurance carrier would turn to their State Insurance Commissioner for assistance. However, our Kansas Insurance Commissioner, Ms. Vicki Schmidt, secured her position despite being ineligible for it due to her many conflict-of-interest relationships with insurers. It was our Kansas Secretary of State, Mr. Scott Schwab, who overlooked Ms. Schmidt’s ineligibility for the post and permitted her name to be placed on the 2018 Kansas voting ballot. Ms. Schmidt’s refusal to investigate allegations of insurance fraud means the investigation has now been assigned to the Federal Bureau of Investigation (FBI). Prior to initiating that investigation, the FBI needs a Letter of Complaint from policyholders who have been cheated out of healthcare benefits.

In conclusion, if you believe you are a victim of healthcare insurance fraud and/or patient neglect, you are encouraged to submit a Letter of Complaint to: Special Agent Timothy Langan; Federal Bureau of Investigation; 1300 Summit Street; Kansas City, Missouri 64105. Assistance with writing a Letter of Complaint can be found on the website www.stolenhealthcarebenefits.com. All that is needed is (1) your contact information, (2) a copy of your insurance card, and (3) a written explanation of the reason(s) you believe you were cheated out of insurance benefits. I want to share with you all the kindness I have to offer for those of you who have suffered needlessly and are now working toward a better future.

Sincerely yours,

Kristy LeClair, MSEd, LMHP

Letter to Mr. Timothy Langan, FBI, 08/13/21

August 13, 2021

110 West Waverly Street

Norton, Kansas 67654

Mr. Timothy Langan

Special Agent in Charge

Federal Bureau of Investigation

1300 Summit Street

Kansas City, Missouri 64105

Dear Mr. Langan:

SUBJECT: State of Kansas Insurance Industry Criminal Activity

This letter is being sent for the purpose of appealing to your sense of duty to protect Americans who are under your care. As shared with you in prior correspondence, thousands of Kansans with a healthcare insurance policy through Blue Cross/Blue Shield of Kansas (BCBS-KS) have been illegally denied healthcare benefits for addiction/mental health treatment. This white-collar crime has been successfully concealed from BCBS-KS policyholders by (1) their third-party provider, New Directions Behavioral Health, (NDBH-KS), (2) incumbent Kansan Legislators, and (3) the leadership of treatment facilities.

Kansas Insurance Commissioner

Few are aware that Ms. Vicki Schmidt has always been ineligible for the post of Kansas Insurance Commissioner due to her many conflict-of-interest relationships with the insurance industry. This is exhibited by her acceptance of campaign donations from insurers. Her efforts to nurture those prohibited relationships have kept Ms. Schmidt from investigating the reported wrongdoing of BCBS-KS/NDBH-KS. Ms. Schmidt’s illegal inaction places the responsibility of investigating insurers upon the shoulders of the FBI.

Kansas Secretary of State

Kansas Secretary of State, Mr. Scott Schwab, improperly permitted Ms. Schmidt’s name to be included on the State’s ballot during the 2018 voting cycle. There was no one to protect voters from this illicit oversight. For some, the consequences have likely been deadly.

The Kansas STATE Workforce

It is the responsibility of Mr. John Eichkorn, Director of Compliance, Enforcement and Anti-Fraud Division, to monitor alleged wrongdoing by the Kansas Insurance Commissioner. Despite this, Mr. John Eichkorn has taken no action to initiate an investigation. Kansas Attorney General, Mr. Derek Schmidt, has said he will not investigate any problems within the Kansas Insurance Department. Despite BCBS-KS being the primary healthcare insurer for State employees, Kansas Governor Laura Kelly has shown no interest in protecting neither her employees nor her constituency from being swindled by this sweeping BCBS-KS healthcare insurance fraud scam.

The Kansas FEDERAL Workforce

The BCBS-KS/NDBH-KS healthcare insurance problem that Kansas State workers face is one that is shared with the Kansas Federal workforce. On paper, Federal employees have excellent healthcare insurance possible under the Federal Employee Program® (FEP®). This gives federal employees and their Dependents who experience mental health/addiction problems the opportunity to receive the level of intensive treatment each needs before returning to work as a productive employee, returning to school as a focused student, returning home as a loving spouse and parent, and so forth. But those opportunities have been denied to Federal employees and Dependents who live within the State of Kansas. BCBS-KS/NDBH-KS corporate greed has taken precedence over the welfare of its policyholders.

During a telephone conversation with one of your Agents, I was informed that the FBI will initiate an investigation into the BCBS-KS/NDBH-KS insurance scam only when enough policyholders submit Complaints to the FBI about being swindled out of healthcare benefits by the insurer, BCBS-KS/NDBH-KS. There are two roadblocks that prevent policyholders from submitting those Complaints: (1) The wholesale secrecy surrounding this scam that keeps policyholders in the dark, and (2) the difficulty of getting this information out to the policyholders. No newspaper or periodical will print anything that might be construed as negative information about a politician or an insurance company. Without an objective Insurance Commissioner to safeguard Kansans, BCBS-KS/NDBH-KS policyholders are sunk.

The U.S. Department of Justice relies upon the FBI to investigate allegations of federal crimes. The insurance fraud I have reported is a crime at the federal level. The hope is that you will value Federal employees working in the State of Kansas enough to accept the responsibility of your position and take appropriate action on this white-collar crime perpetrated by BCBS-KS/NDBH-KS.

In Conclusion…

In conclusion, please accept my congratulations on your new assignment as Assistant Director of the FBI’s Counterterrorism Division. Prior to formally leaving office as the Special Agent in charge of the Kansas City Field Office in Missouri, I beseech you to protect your staff and all other Kansans who are impacted by the catastrophe Ms. Vicki Schmidt has brought into their lives. If I can assist in any way, please feel free to contact me at telephone number (785) 874-4409. I look forward to your response in regards to this enduring offense that has targeted hard-working middle-class Americans who responsibly pay overpriced monthly deductibles for healthcare insurance benefits that were never available to them.

Sincerely,

Kristy LaNeva LeClair, MSEd, LMHP

www.stolenhealthcarebenefits.com

cc: Mr. Christopher Wray Mr. Ian DeWaal, Senior Counsel

Director of the FBI U.S. Department of Justice

FBI Headquarters Criminal Division, Fraud Section
935 Pennsylvania Avenue Northwest Washington, DC 20530
Washington, D.C. 20535-0001

Letter to Ms. Vicki Schmidt's 2021 Campaign Contributors, 03/31/21

March 31, 2021

Post Office Box 1673

Kearney, Nebraska 68847

Caremark Rx Inc
P O Box 287
Lincoln, Rhode Island 02865

Dear Caremark Rx Representative:

SUBJECT: Refund of your 2018 Campaign Donations to Kansas Insurance Commissioner, Ms. Vicky Schmidt

The purpose of this letter is to share information with you in regards to the campaign donations you made in 2018 to then-political Candidate Ms. Vicky Schmidt in the amounts of $2,000 and $1,000. She was running for the position Kansas Insurance Commissioner. Considering her credentials, it was not surprising when she won the election. However, there was, and still is, a problem. Ms. Vicky Schmidt did not meet eligibility requirements to run for the post of Insurance Commissioner. Her name should never have been on the voting ballot.

Article 1. - INSURANCE DEPARTMENT

History: L. 1927, ch. 231, 40-109; June 1.

The website www.stolenhealthcarebenefits.org elaborates on the information that has been reported within this letter. Should you have questions, please contact the State of Kansas Insurance Department or an attorney. No one should be expected to contribute to an ineligible Candidate.

Sincerely yours,

Kristy LeClair, MSEd, LMHP

EXAMPLE

Letter to Mr. Derek Schmidt's 2021 Campaign Contributors, 03/31/21

March 31, 2021

Post Office Box 1673

Kearney, Nebraska 68847

Union Pacific Railroad Company
600 Broadway Boulevard
Kansas City MO 64105

Dear Union Pacific Railroad Company Representative:

SUBJECT: Dereliction of Duty by State of Kansas Attorney General, Derek Schmidt

As a Contributor to the political campaign of Mr. Derek Schmidt, our State of Kansas Attorney General, you are being contacted in regards to his failure to safeguard Kansans against a widespread healthcare insurance scam that thousands of Kansans have fallen prey to. On January 24, 2019, Mr. Schmidt was advised of the alleged scam being instigated by Blue Cross/Blue Shield of Kansas (BCBS-KS) through its third-party payor, New Directions Behavioral Health of Kansas (NDBH-KS). BCBS-KS was withholding mental health/addiction benefits from policyholders who met criteria for those benefits. When an insurer illegally withholds benefits from a policyholder, it is called “insurance fraud”, and it is a federal crime.

Mr. Schmidt’s letter of response, dated March 5, 2019, is enclosed. Mr. Schmidt states his Office is “only authorized to take action in instances where a violation of the KCPA (Kansas Consumer Protection Act) is violated.” However, the justification he presents for refusing acceptance of his responsibility to protect Kansans from the unscrupulous white-collar crime of insurance fraud is groundless. As Attorney General, Mr. Derek Schmidt is accountable for tackling any violation of trust between a Kansan Consumer who has been bilked by a healthcare insurance Supplier. However, he refuses to do so.

In his letter, Mr. Schmidt points out that any complaint of healthcare insurance fraud “falls under the jurisdiction of the Kansas Insurance Department”. Mr. Schmidt is aware that neither our State’s incumbent nor prior Kansas Insurance Commissioner met eligibility requirements for the position. Due to the oversight of Kansas Secretaries of State Mr. Kris Kobach and Mr. Scott Schwab of Kansas Statute 40-109, both Ms. Vicki Schmidt (our incumbent Kansas Insurance Commissioner) and her predecessor, Mr. Ken Selzer, found their way into office. Mr. Schmidt has taken no action to correct this mistake despite the fact that both Candidates have been appallingly incompetent during their service as Kansas Insurance Commissioner.

It is not only the private sector that has been injured by Mr. Derek Schmidt’s inactivity. BCBS-KS is the preferred insurer for our State of Kansas employees. The FBI is willing to investigate these allegations of insurance fraud, but first need written accounts from patients who have been unjustly denied healthcare benefits each was eligible for. Due to HIPAA regulations, only treating facilities are capable of notifying patients who have been swindled while receiving services at their facilities. Without a legal mandate, no facility will ever do that. Yet, somehow victims must be advised to contact either the FBI or an attorney.

In conclusion, your campaign donations help all Kansans when it brings competent politicians into Office. Currently, our State is sorely lacking in competent political leadership, and you deserve to know this prior to the 2022 elections. The website www.stolenhealthcarebenefits.com offers additional information on this subject.

Sincerely,

Kristy LeClair, MSEd, LMHP

EXAMPLE

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Duties and Powers of Insurance Commissioners

“Technically, Brooke Franchise owes me $7 million, but who knows if I will ever see it,” said Roger Cunningham, former Brooke franchisee and agent/owner of RKC Financial in the Dallas/Fort Worth Texas, area.

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