Confronting Health Care 'Demons' Anthony Welters Took an Unlikely Route to Head AmeriChoice, an HMO for the Poor
The Washington Post
May 27, 2002
By Bill Brubaker
Anthony Welters grew up in a one-room tenement in Harlem, sleeping behind a curtain with his three brothers, he says.
Today, he lives in a five-bedroom, seven-bathroom house on five acres in McLean. He has a 75-acre farm in the Blue Ridge Mountains. For a change of pace, there is a 5,000-square-foot house in Aspen, Colo., recently assessed at $3 million.
Welters, 47, made his fortune in health insurance, serving a specialized market.
The market is the poor.
Federal and state audits concluded in the early and mid-1990s that ineffective oversight by Pennsylvania officials had enabled Welters and his partners to make too much money from their taxpayer-supported business.
The audits said the Welters group had paid itself millions of dollars in management fees -- paid to other companies they controlled -- and millions more in bonuses.
Welters's health-insurance business expanded to New York in 1994 and New Jersey in 1996. In both states, the HMO was known as Managed Healthcare Systems (MHS).
In New York, state investigators discovered something was not right about two clinics that MHS retained to serve patients in the borough of Brooklyn.
They determined that from 1995 to 1997 the clinics were being staffed largely by "unsupervised physician assistants or nurse practitioners," New York state Attorney General Eliot Spitzer announced in May 2000.
The investigation also found that patients were "consistently complaining that they were having difficulty getting services or being seen by a doctor."
MHS "failed to take any corrective action or properly oversee" the clinics.
Spitzer announced a settlement in which MHS repaid more than $2 million to the Medicaid program for services the clinics never provided.
In October 2000 MHS changed its name to AmeriChoice of New York.
Anthony Welters, Chairman of AmeriChoice Corp.:
"What [should] a person who takes a $200,000 investment and turns it into a billion-dollar company . . . receive? I don't know. But I know this: I'm not going to apologize for it."
<http://www.washingtonpost.com/wp-dyn/articles/A14254-2002May26.html>http://www.washingtonpost.com/wp-dyn/articles/A14254-2002May26.html
Comment: Medicaid's chronic under-funding threatens access to care for the low-income individuals covered by this program primarily because many providers will not participate at rates that frequently do not even pay overhead expenses. Several state governments have turned over their Medicaid funds to private corporations to administer these programs. Mr. Welters exemplifies how well these plans fulfill their corporate responsibility to their shareholders and executives.
In 2002 we are already spending over $5500 per capita for health care in the United States. Pool that into a single fund, eliminate the middleman thieves, establish a program of public administration, and we would have affordable, comprehensive care for everyone.
Until we do that, those of us that sit back and do nothing must concede the wisdom of the words that William Shakespeare assigned to Puck: "Lord, what fools these mortals be!"
Felix Schwarz, MA, MPH, Executive Director of the Health Care Council of Orange County, comments on Dr. Munoz's article on mental health carve outs:
For years we have been fighting for "parity" for mental health coverage. I am now telling my mental health advocate friends, as forcefully as I can, that we should no longer seek parity in a broken health care system. We should try to fix the system as a whole -- to include mental health coverage in a universal, single payer, fair and rational system that does not try to "carve out" mental health, or carve up the patient population to leave out those whose needs for health care are greatest!