Health-Care Consultants Reap Fees From Those They Evaluate
As Insurance, Drug Costs Rise, Employers Seeking Advice Often Discover Conflicts
A Superintendent’s Surprise
By BARBARA MARTINEZ
Wall Street Journal - September 18, 2006; Page A1
When Kevin Grady took over as an employee-benefits consultant for the Columbus Public Schools District in 2001, he signed a contract promising to act “in the best interest” of the schools. The Ohio district agreed to pay him $35,000 a year to help it choose a health insurer. Officials thought that was all Mr. Grady was getting out of the deal.
It wasn’t. After the district switched its health insurance to UnitedHealth Group Inc. on what it says was Mr. Grady’s recommendation, he started getting payments and other compensation from the big Minnetonka, Minn., insurer. “Thank you and United for the steaks,” Mr. Grady wrote in a Dec. 20, 2001, email to a UnitedHealth employee. “We’ll have those on Christmas eve.”
Aetna gives brokers a “retention bonus” for staying loyal. If a broker keeps 90% of his Aetna clients with the insurer for another year, he gets a bonus equal to 0.75% of the clients’ total premiums. If 100% stay, the bonus rises to 1.25% of total premiums. Though employers typically put their health-insurance contracts up for bid every few years, such bonuses are one factor encouraging brokers to keep their clients on the same plan.
A spokeswoman for Aetna said the insurer requires consultants and brokers to disclose such fees to customers. She said Aetna also makes its broker fees public via its Web site and in annual disclosures to clients. Many other insurers don’t detail their contingent commissions on public Web sites.
Consultants also may have financial ties with pharmacy-benefit managers, or PBMs, which administer prescription-drug benefits for employers. Mercer, the big benefits consultant, has done consulting work for a leading PBM, Medco Health Solutions Inc., even as it was advising employers choosing among PBMs including Medco, of Franklin Lakes, N.J. In a proposal for a 1998 job handled by Mercer Management Consulting, Mercer said it could help Medco “refine its pricing to increase its profitability.” Mercer also said it would help Medco “improve relationship with key benefit consultants to better position [Medco] for winning target accounts.”
In 2000, the top Mercer pharmacy-benefits consultant, Nicholas K. Vasilopoulos, gave a written declaration in a lawsuit by Medco clients who accused the PBM of overcharging them for drugs. In it he defended Medco as “forthright” in its business dealings. Mr. Vasilopoulos said he advised employers seeking advice on PBMs — and advised Medco in assessing its competitiveness against other PBMs.
In an email, Mr. Vasilopoulos said “there were no conflicts of interest” when he was a Mercer consultant. He said Mercer had no reason to favor any particular PBM because it provided advice to all the major ones over the years. This advisory role gave Mercer a “more thorough understanding” of each PBM’s offerings, which benefited Mercer’s employer clients, he said.
Lisa Zeitel, a senior consultant at Mercer’s pharmacy-benefits consulting practice, said much of the work for Medco was done by the management-consulting side of Mercer, which is “totally separate” from her unit. She said her own unit occasionally undertakes small assignments for PBMs, but this “in no way interferes with the work that we do for individual clients.”
Joseph Sawicki Jr., the comptroller of Suffolk County on Long Island, N.Y., discovered the ties between consultants and PBMs after the county sought a routine audit of its PBM, Express Scripts Inc., in 2003. The county hired Mercer for the job. Mr. Sawicki says officials didn’t realize at first that Mercer also serves as Express Scripts’s employee-benefits consultant and had other consulting arrangements with the PBM. Mercer says it did disclose the ties.
Mr. Sawicki wasn’t happy with the audit’s results, which initially found that Express Scripts had overbilled the county by more than $1.1 million but later suggested that the overbilling amounted to only $14,000. Mercer charged the county $93,000. Mr. Sawicki withheld half the payment and asked Mercer to return the half it already had received, saying he doesn’t pay for “shoddy” work. A spokeswoman for Mercer, Stephanie Poe, says Mercer made clear its initial estimate was likely to be reduced and it did a good job on the audit although it wasn’t allowed to complete its work. The dispute over the $93,000 is unresolved.
The county didn’t pursue any refunds from Express Scripts in connection with the billing Mercer had audited. It then hired another auditor to review Express Scripts’s billing in subsequent years. That review led to a settlement in which Express Scripts paid the county $865,000. A spokesman for Express Scripts said the company has saved “millions of dollars” for Suffolk County. He declined to comment on the settlement.
Back in Columbus, school-district human-resources chief Craig Bickley wants consultants who aren’t getting money from the same people they are supposed to be evaluating. He was annoyed to discover that under the previous consultant, Kevin Grady, the district switched to UnitedHealth from Anthem (now part of WellPoint) even though UnitedHealth’s administrative fees were $776,000 a year higher. Mr. Grady’s son, Joe, says UnitedHealth offered more coverage for the money.
Mr. Bickley says his first question to consultants nowadays is: “Who are you working in the best interest of, yourself or the client?” The district insisted that the consultant replacing Mr. Grady forgo commissions and bonuses it might otherwise receive from health insurers for bringing in the district’s business. Mercer won the contract and agreed to do so.
—Raymund Flandez contributed to this article.