Cancer clinic severs ties with insurers

Published Feb. 2, 2004

The Parker Hughes Cancer Center is dropping out of Minnesota's two largest health care plans in the face of their investigations of its patient care, insurance officials said Monday.

The Roseville clinic, which is also under investigation by the Minnesota Board of Medical Practice, cut its ties with Medica last week, days after learning of the insurer's "serious concerns" about patient care and business practices at the clinic, according to a Medica official.

Blue Cross and Blue Shield of Minnesota, which is conducting a separate review of the clinic's patient care, is discussing "how to end our relationship in the most compassionate way for patients," said Dr. Bill Gold, the insurer's chief medical officer.

It is unclear what effect the terminations, if finalized, will have on the clinic's finances, but together both insurance companies paid for the care of 750 clinic patients over the past year, according to the health plans.

Health plan officials said they would make provisions for current clinic patients so that their care would not be interrupted. Some members will also be able to use out-of-network benefits if they choose to continue care at the clinic. Such benefits typically carry a higher copayment.

Medica wouldn't reveal the details of the concerns it had with the clinic, but Dr. Charles Fazio, Medica's medical director, said they involved more than the cost of care there.

"This is more extensive and serious than any investigation that we've done in recent memory," Fazio said.

He said Medica began an investigation last year that included an extensive review by independent experts of the care provided by the clinic to 16 Medica members. He said results from eight of the cases were forwarded to state and federal authorities, including the FBI and the state Medical Board, which licenses and disciplines doctors.

Dr. Fatih Uckun, the clinic's founder, gave a different reason for the difficulties with insurers. He said Blue Cross and Medica wanted to put limitations on how patients should be treated. The clinic treats patients with cancer or with inflammatory disorders such as arthritis.

"Parker Hughes and certain insurance companies do have differences regarding what is, or what constitutes, standard of care," he said.

Fazio described Uckun's action as a preemptive move to avoid the possibility of being dropped from the Medica network.

In December, a Star Tribune report disclosed that the clinic wooed desperate patients with inflated promises about their chances of recovery and repeatedly charged insurers for treatments that experts say were unnecessary. The state Medical Board has been investigating billing practices and excessive treatment of terminally-ill patients, and the FBI has made inquiries about allegations that Uckun has solicited financial contributions for the clinic from medical groups in exchange for clinic business.

Blue Cross, which had been reviewing the care of 100 patients, said that it has approached the clinic about its treatment standards but that those talks have broken down. Gold said: "It is unlikely we are able to find common ground."

Uckun declined to characterize discussions with Blue Cross. He defended the clinic's treatment standards.

"Our primary and overriding concern was that patients receive excellent quality of care and treatment," he said. "We don't give up on patients where there is a real chance."

He stressed that the clinic will work financially with any Medica patients if they choose to continue receiving care there.

He said that he had no knowledge regarding Medica's concerns over the clinic's business practices.

Uckun, in his first interview since the newspaper's report, said he does not believe that the clinic's billing practices are out of line.

The newspaper's review of claims filed by the clinic to the Minnesota Medicaid program found that the clinic billed for the most intensive and costliest patient visit 60 percent of the time, while cancer clinics nationwide bill that way 3 to 5 percent of the time.

Uckun said Monday that his billings for intensive patient sessions, which bring higher reimbursements, were below the national average.

He said he believes that the newspaper's three-day series was inaccurate and that he would like to set the record straight about some patients' care but that families will not allow him to release records.

Although Parker Hughes will be leaving the Medica network, the health plan will continue its investigation. It has requested to interview clinic officials, including Uckun, and to review clinic documents.

The move means that 1.1 million members in Medica, the second largest health care plan in Minnesota, won't have access to the Roseville clinic after March 15. However, current clinic patients will be allowed to use their Medica insurance plan there past March 15, and Medica will extend that beyond the 120 days mandated by law, Fazio said.

Medica records indicate that 250 health plan members have been at the clinic since May, with about 130 of them visiting since November. Members will either be called or receive a letter from Medica shortly, he said.

Blue Cross, which has 2.6 million members, is negotiating the details of the clinic's termination from the network, which might happen June 30. Its records show that 500 Blue Cross members have received care at Parker Hughes.

Parker Hughes and Blue Cross "are really committed in doing this in a manner that is compassionate and considerate to the members who are currently seeking treatment," Gold said.

The reporters are at howatt@startribune.com or 612-673-7192

and pmcenroe@startribune.comor 612-673-1745