Carefirst

Dr. Crystal L. Clark has been named chief medical officer and vice president of medical affairs for Bon Secours Baltimore Health System, where she is the primary liaison between administration and the medical staff. Before joining Bon Secours, Clark was a senior assistant vice president at the New York City Health and Hospitals Corporation, the city's public hospital system. Dr. Dung Le has joined the faculty of the Johns Hopkins Kimmel Cancer Center as an instructor in oncology. Dr. Maria Boradatcheva has joined the internal medicine practice of The Bose Medical Group at Mercy Medical Center's Burk Building.

MARYLAND House OKs 8 ground rent bills The Maryland House of Delegates unanimously approved eight bills yesterday aimed at modernizing the state's system of ground rents and stemming reported abuses of homeowners. pg 1a Tapes of Bromwell made public Former state Sen. Thomas L. Bromwell Sr. boasted to an FBI informant who was posing as a financier of wielding political power to influence some of Maryland's most prominent institutions to benefit himself and friends, according to secretly transcribed recordings made public yesterday.

A computer glitch at the state's largest health insurer recently blew Sharon Nobles' life into disarray, leaving her family with overdue medical bills and, at times, vital prescriptions denied at the pharmacy. And she might not be the only one affected. CareFirst BlueCross BlueShield officials confirm that even as information technology specialists are working to resolve internal system problems, thousands of its members who participate in consumer-directed health plans (CDHP) could be affected, too. "I've spent months trying to fix this problem, but I've gotten nowhere," said Nobles, the mother of twin 11-year-old boys who were diagnosed three years ago with Asperger's syndrome, a neurobiological disorder that can produce autistic-like behavior.

Looking for a leader who could help it navigate an increasingly technology-centered health care world, CareFirst BlueCross BlueShield yesterday tapped the head of an electronic claims-processing firm to be its new president and chief executive officer. Chester "Chet" Burrell, 60, is currently chairman and CEO of Indianapolis-based RealMed Corp., which provides claims services for insurers - including CareFirst - and doctors. He previously founded and led Novalis Corp., a health technology and consulting firm.

The state insurance commissioner yesterday fined CareFirst BlueCross BlueShield $79,000 for improper denials of claims, but said a 15-month study had not established a pattern of arbitrary use of care guidelines to refuse to pay hospital bills.Mid Atlantic Medical Services Inc. (MAMSI), a Rockville health maintenance organization, was fined $10,000 for improperly refusing to pay claims.The ruling by Commissioner Steven B. Larsen stemmed from a complaint last year by the Maryland Hospital Association, charging CareFirst, the state's largest health insurer, and MAMSI with failing to pay millions of dollars in claims.

A state attempt to "reinvent" the way it sets hospital rates will delay efforts by CareFirst BlueCross Blue- Shield to negotiate lower rates on its own, House Speaker Casper R. Taylor Jr. said yesterday.The Health Services Cost Review Commission (HSCRC), which decides what the state's hospitals are permitted to charge, began the reinvention effort in March in response to several years in which the cost of an average case in Maryland increased faster than the national average.CareFirst, the state's largest health insurer, began its effort to drive down rates in June, when it said it wanted to negotiate a new rate system with the hospitals.

Reflecting losses in its Medicare and Medicaid managed care programs, CareFirst BlueCross BlueShield reported yesterday a 5.8 percent drop in second-quarter income to $20.5 million, compared with $21.7 million a year ago.Margins from commercial insurance products were "flat to slightly up," said G. Mark Chaney, executive vice president and chief financial officer for CareFirst, which operates the Maryland and District of Columbia Blue Cross Blue Shield plans.However,...

The Baltimore County Council is expected to award a 10-year, $82 million health care contract tonight without formally checking whether other companies could do the work better or cheaper.On advice from a consultant, the County Council likely will approve a pact with CareFirst BlueCross BlueShield to administer medical claims and provide other services for most of Baltimore County's 22,400 teachers, police officers, public works employees and other workers.The county is bypassing the competitive bidding process designed to ensure that taxpayers get the best deal.

CareFirst BlueCross BlueShield's decision to drop the rural elderly from its Medicare HMO will affect 1,562 Carroll County residents, but county and other officials said the cut should not cause panic.CareFirst BlueCross BlueShield is the latest company to drop the rural elderly from its Medicare HMO, effective Dec. 31.Members of CareFirst's Medicare HMO, called MediCareFirst, may select another HMO, elect to return to their traditional Medicare coverage, or sign up with one of the four Medigap plans offered in Maryland, which will cover services Medicare doesn't.

Downtown Baltimore took a hit yesterday as CareFirst BlueCross BlueShield announced that it will pull 500 administrative employees out of the city and move them to a new site near the health insurer's headquarters in Owings Mills.In addition to shifting workers out of downtown, the company is vacating more than a quarter of the 17-story Bank of America tower at 100 S. Charles St. -- 110,000 square feet of 430,000."It's obviously a significant blow for downtown Baltimore, because they're a major player in the area," said Donald Manekin, senior vice president of Manekin Corp.

Politicians and regulators are swarming CareFirst BlueCross BlueShield again, this time in Washington. By the end of the month, the D.C. insurance commissioner could order CareFirst to spend hundreds of millions of dollars on unspecified "community health reinvestment" instead of medical care for its insurance customers. It's an unprecedented attack on reserves paid for by subscribers in Maryland, Virginia and the district, says CareFirst. District officials see "a pot of money" to fill budget holes, says company CEO Chet Burrell.

William L. Jews, the former chief executive officer of CareFirst BlueCross BlueShield, has sued Maryland's top insurance regulator over its decision to deny him about $9 million in severance and other pay, calling the regulatory move unconstitutional. The lawsuit, filed in U.S. District Court in Baltimore this week, takes issue with a ruling last month by state Insurance Commissioner Ralph S. Tyler that cut Jews' $18 million severance package in half. Tyler found that CareFirst's board violated a 2003 state law requiring executive pay for the nonprofit to meet a "fair and reasonable" standard.

Former CareFirst BlueCross BlueShield Chief Executive Officer William L. Jews may be two years gone from his old job, but he's clearly not been forgotten, at least not by Maryland Insurance Commissioner Ralph S. Tyler. This week, Mr. Tyler ruled that Mr. Jews' nearly $18 million retirement package violated state law and ordered it reduced by about half. Mr. Jews has had his difficulties with insurance regulators before. Five years ago, it was then-Commissioner Steven B. Larsen who thwarted Mr. Jews' attempt to convert CareFirst to a for-profit entity, sell it to a California company and reap a much larger windfall for himself and other senior executives.

William L. Jews is entitled to only half of his $18 million severance package from CareFirst BlueCross BlueShield, Maryland's top insurance regulator said yesterday in a ruling that accuses the former chief executive of abandoning the insurer's nonprofit mission. In a 65-page order, state Insurance Commissioner Ralph S. Tyler wrote that CareFirst's board had violated a 2003 state law requiring executive pay for the nonprofit to meet a "fair and reasonable" standard. The decision marks the first test of the law, which was passed by legislators furious with Jews for trying to convert CareFirst to a for-profit entity and sell it to a California company.

June E. Fisher, a retired CareFirst BlueCross BlueShield worker and a homemaker, died Sunday of cancer at Carroll Hospice's Dove House in Westminster. The longtime Woodlawn resident was 76. June E. Healey was born and raised in Baltimore. She was a 1950 graduate of Western High School. Mrs. Fisher worked for a decade before retiring in 1998 from CareFirst, where she had been a credentialing specialist. Mrs. Fisher, who had lived in Woodlawn for more than 50 years, enjoyed cooking, entertaining and watching soap operas.

CareFirst BlueCross Blue- Shield's former chief executive defended his $17.65 million retirement and severance pay yesterday, and denied accusations by regulators that his sole focus as CEO was boosting profits. William L. Jews, who became a lightning rod for criticism after he tried to convert the state's largest health insurer to a for-profit company and sell it, made his comments on the last day of hearings in Hunt Valley into whether his pay deal is out of sync with the Blues plan's nonprofit mission.

William L. Jews, who was fiercely criticized by legislators when he tried to engineer the sale of CareFirst BlueCross BlueShield, is expected to appear before insurance regulators tomorrow to defend a $17.65 million severance and retirement package that state officials say is excessive for a nonprofit health insurer. Maryland's insurance commissioner ordered the inquiry after Jews stepped down as chief executive in a 2006 management shake-up, which triggered salary and bonus payments spelled out in his employment contract.

The Maryland Better Business Bureau says it continues to hear identity theft concerns from customers of CareFirst's The Dental Network HMO, which last month accidentally posted the personal data of 75,000 subscribers on a public Web site. It offers these tips: Check your insurance plan. You are only at risk if you have The Dental Network through CareFirst. Simply being a CareFirst member does not put you at risk. The Dental Network is offering a free year of identity protection service.

A CareFirst BlueCross BlueShield dental HMO accidentally exposed personal information, including Social Security numbers, of about 75,000 members on a public Web site last month and didn't notify them until about three weeks later. The Dental Network, which is owned by CareFirst, informed the members - mostly Maryland and District of Columbia residents - that their names, addresses, dates of birth and Social Security numbers had been posted on its Web site for two weeks in February because of a technical error.

Chester Burrell, chief executive of CareFirst BlueCross BlueShield, stood between Gov. Martin O'Malley and a phalanx of Maryland officials yesterday as they touted the company's contribution to help seniors pay for prescription drugs. After two months as CareFirst's CEO, Burrell is forging a relationship with state leaders that is in stark contrast to the rocky relations between state officials and his predecessor, William L. Jews. Before stepping down in 2006, Jews drew fire from lawmakers and regulators when he attempted to convert CareFirst to a for-profit operation and sell it several years ago. Burrell says he is committed to CareFirst's status as a not-for-profit entity.