HMO chief accuses doctors of lying

Wednesday, Oct. 16, 2002 | 11:08 a.m.

Sierra Health Services Chairman Tony Marlon lashed out at local obstetricians who have complained about Medicaid health maintenance organizations, accusing them of spreading lies about the state-funded program.

Marlon made his remarks Tuesday on "Face to Face With Jon Ralston" on Las Vegas ONE, a partnership of the Las Vegas Sun, Cox Communications and KLAS-TV. Marlon's company is one of two in Clark County -- the other is Nevada Care Inc. -- that run Medicaid HMOs.

"The fabrication, the lies, the belligerence by these doctors is absurd," Marlon told Ralston.

The Sierra chief was referring to complaints that executives of the Clark County OB/GYN Society have made about Medicaid HMOs, much of it to do with perceived red tape and slow reimbursements. Medicaid, which includes matching federal funds, is designed to provide health care for low-income patients.

Marlon said the state launched the Medicaid HMO program in the county in 1997 in part because Medicaid patients had difficulty getting doctors appointments.

"In today's program we've got 87 obstetricians who are willing to care for Medicaid patients," Marlon said. "There are no issues with access and no issues with quality care for those patients. The state is happy. We're happy and we do it less costly than the state did it.

"The biggest problem we're having with the physicians is that they're putting the patients in the middle of a dispute with us. They don't like anybody that gets in the way of their access to patients and to money."

But Dr. John Nowins, president of the society, said Marlon defends the Medicaid HMO concept because it makes money for his company.

"Tony Marlon has never been a physician who took care of Medicaid HMO patients," Nowins said. "He's a physician who runs an insurance company for profit and the Medicaid HMO is extremely profitable for his company."

Marlon said his company has terminated individual contracts with seven local obstetricians. Nowins said he knows that five of those terminations -- including himself -- involved executives of the OB/GYN society who met on Sept. 18 in Las Vegas with Gov. Kenny Guinn to discuss their concerns about Medicaid HMOs.

Nowins said the terminations and Sierra's unwillingness to work with those doctors "left a bad taste in my mouth." But Marlon had a different take.

"These doctors, all the screamers and yellers that you're talking about, actually between 2001 and 2002 in our program delivered three babies," Marlon told Ralston.

Marlon had particularly harsh comments about Dr. Robert Comeau, the society's communications officer who had exchanged heated correspondence with Sierra earlier this year and was also terminated by the insurer. Ralston read Marlon a quotation from Comeau that expressed reasons why the doctor thought Medicaid HMOs didn't work.

"Dr. Comeau is a loudmouth who shoots from the hip, doesn't know his facts," Marlon said.

Comeau told the Sun later Tuesday that he opposed Medicaid HMOs for a number of reasons.

"They decrease access of patients to physicians because physicians are dropping out of Medicaid HMOs," Comeau. "They're dropping out because of delays in payments in some plans. There is increased paperwork and there is unfair authorizations."

Comeau said that when physicians dealt directly with Medicaid patients there was no need to get authorization for each treatment, leading to more efficient care.

"My statements are based on facts that were in a survey that was sent to 40 or 50 doctors in the OB/GYN society," he said.

But Marlon defended the quality of Medicaid HMO care and said that reimbursement to doctors usually occurs within 30 days provided the bills are for legitimate medical services.

Marlon said he sympathized with the plight of obstetricians who have been hit with skyrocketing medical malpractice insurance premiums. But he said doctors who seek reimbursement increases from health care insurers in response to malpractice insurance increases should be directing their ire at attorneys.

"Instead of lashing out at some of the lawyers and the problems with tort reform, they want people to pay them more in order to pay their malpractice premiums," Marlon said.

"There is no question they have an issue," he said of the obstetricians. But he said, "They demagogue the issue. They want to blame everybody but themselves."

Obstetricians aren't unhappy only about Medicaid HMOs. They believe that Sierra and other insurers reimburse less than they should for non-Medicaid patients as well. Marlin said -- and Nowins concurred -- that Sierra reimburses doctors about 30 percent less under non-Medicaid health plans than under Medicaid HMOs.

"That's pathetic," Nowins said. "That's one-fourth of our charges. How are we supposed to cope with that?"

Obstetricians have complained that Nevada ranks 49th in prenatal care among Medicaid patients and that patients often don't see a doctor until their seventh month of pregnancy, if at all. But Marlon said the problem is that it is hard to become eligible for Medicaid, something Guinn and Charles Duarte, Nevada's administrator of health care financing, have both acknowledged.