MVP HEALTH PLAN INSURES 700,000+ PEOPLE. THEY'RE REQUESTING A COURT RULING STATING IT'S OK FOR THEM TO VIOLATE FEDERAL HEALTHCARE RULES (ALLEGEDLY

ARTICLE IN PROGRESS: ACTIONS REQUIRED TO SAFEGUARD AND PROTECT THE WELLBEING OF THE OF OVER 700,000 INDIVIDUALS WHO RELY ON MVP HEALTHCARE TO PROVIDE THEM WITH EQUALITY IN THE DELIVERY OF THEIR HEALTHCARE:

MVP Health Plan Summons and Complaint, INDEX #2021-1300 filed with the Supreme Court in the County of Schenectady NY MVP Health Plan Summons and Complaint, Pg.18?and Pg. 20 of 20

“A non-participating provider is not entitled to any documentation that would be provided to a participating provider”

MVP is under no obligation to communicate in any way with a non-participating provider”…MVP is asking a court of law to rule that a non-participating provider be permanently enjoined from contacting MVP or any of its personnel for any reason

This article is being written to inform the public of the need for judicial intervention to prevent MVP Health Plan, a Medicaid Managed care plan, who we pay with taxpayer money, public funds in return for their promise to deliver quality healthcare to their members, from obtaining a judicial ruling stating that they can continue to operate in violation of strict healthcare rules to avoid penalties.

The fact is that their members, numbering over 700,000 are mostly members of low-income families, the majority of whom are minorities, mostly comprised of racial and ethnic minorities, people with disabilities, and special needs. These members of MVP Health Plan are statistically shown to have suffered the most throughout the public health emergency during which time are documented as having the highest morbidity and morality rates, a fact supporting the need to audit the business practices of this company. They, MVP Health Plan, have provided us with a means to prove that they have, and wish to continue, to operate with complete disregard of attending to the healthcare needs of their members, prioritizing their own interests by requesting this ruling from the Supreme Court of NYS, County of Schenectady.

On September 10, 2021, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced the resolution of its twentieth investigation under its HIPAA Right of Access Initiative. In early 2019, OCR stated that they would create an initiative to enforce patients’ right of access to their own health information in a timely and reasonable manner. This concept is not novel to OCR as it has already been outlined as a stated goal of HIPAA within the Privacy Rule, reinforced in the Security Rule, relating to the sharing of medical information (recorded on paper as well as medical info recorded and shared using electronic means.???This aspect of HIPAA has been enforced at various times in the past, however it has never been enforced with any regularity until the OCR initiative was established. To date, OCR has remained dedicated to ensuring that every patient is afforded access to their health information that HIPAA has long stated such patients deserve.

Dr Kevin Maloney impels the Department Of Health for the State of New York to contact the Supreme Court of Schenectady New York to Intervene In the Matter of a Summons and Complaint entered into this Court by MVP Healthcare Inc., a Privately owned Medicaid Managed Care Plan who has requested that the Court Rule that they do not have to communicate with a covered entity, a healthcare provider “IN ANY WAY”, with complete disregard to the Healthcare Rules which state that they must communicate with a provider who had or has had a relationship with a patient that MVP Healthcare has or had a relationship with if it relates to the treatment of a patient. THE EXACT REQUEST MVPREQUESTS A RULING ON IS PROVIDED BELOW (papers MVP Healthcare Filed INDEX # 2021-1300 Supreme Court Schenectady NY

RECENT HEALTHCARE LAWS HAVE EMPHASIZED THE REQUIREMENT THAT HEALTH INSURES SHARE MEDICAL INFORMATION WITH DOCTORS. Patients, by law have a right to access a complete record of all of their health information. Primary Care Physicians are often times not informed of pertinent medical information on their patients by it not being shared with the PCP by other providers, such as Hospitals and Specialists who fail to share info pertaining to the treatment of their patients. Patients believe that their Primary Care Physician (PCP) is being made aware of any changes in their health info when they visit other provider such as a hospital, ER, Urgent Care Center or specialist without informing their PCP. They are given the impression that the facility will notify their PCP of any changes regarding their treatment (new diagnosis, changes in medications, a new allergic reaction to a medication, a surgery.. This is especially true with Hospital Admissions and visits to specialists as when a patient visits these facilities, they request that the patient give them the name of their PCP and the Contact info of the PCP. However, contrary to what a patient believes, the PCP is frequently never once informed by these other providers of visits to them of pertinent medical information relating to the treatment of their patients. Because of this, Laws have now been passed that require hospitals to inform the patient’s PCP of any admission and discharge of any patient of the PCP, regardless of the PCPs affiliation status with that hospital. The Hospitals are now required by law to provide the PP with a summary of what transpired during their patient’s hospitalization (a diagnosis of a new medical illness with medication additions or changes, surgical procedures with pending biopsy reports on discharge… all things the PCP must be aware of to safeguard the health of their patients and ensure that they receive the follow-up care their patients require. Hospitals, for coordination of care purposes and transfer of care purposes without interruption, are by law also required to allow the PCP to participate in the care of their patients throughout a hospitalization should the PCP choose to do and severe penalties will soon be imposed upon those providers and insures of up to one million dollars per violation for those providers (legally named ”covered entities”) who refuse to share medical info when required or requested for treatment purposes. This Caveat has been applid most importantly to Health Care Insurers who are often the only “covered entity” that has the capability of providing a patient’s PCP with more medical information than anyone else on patients enrolled with their plan. They have access to the majority of a patient’s healthcare information through their billing system as a patient’s insurance company is sent billing information from either the healthcare facility a patient visits or patient themselves.

Medicaid managed care plans, such as MVP Health Plan, have access to the majority of their members’ healthcare information. A PCP, as stated, is often not made aware of when a patient has received services, in addition to information stated above, from visits to healthcare facilities a PCP is not informed of. All services that patients receive, such as mammograms, pap smears, colonoscopies, well care visits, hospital admissions, hospital discharges, visits to specialists, etc., are all information that managed care plans such as MVP Health Plan are in possession of, again through their billing system, as all of these other healthcare facilities submit bills for the services they provide to MVP Health Plan. In return for being given public funds, MVP Health Plan promises to ensure that quality healthcare is being delivered to their members by a periodic review of the records their providers maintain on their over 700,000 members. In reviewing these records regularly, MVP Health Plan becomes aware of healthcare information missing and not documented in patient’s records for reasons stated above, when PCP’s are not made aware of such information. MVP Health Plan has the obligation, as promised to the government, to provide the PCP with this missing information that they have but the PCP does not have, and failed to provide the PCP with that information. In doing so, MVP violates their obligation to ensure that a patient has access to a complete record of all of their healthcare information. MVP Health Plan cannot state that they maintain a complete record of their members’ healthcare information as they are aware of the services being provided to their members, but do not view the information specific to the service provided, which often at times, only the provider, be it the PCP, treating physician during a hospital stay, or specialist, have access to and have not shared with MVP. MVP Health Plan does not, for example read reports of radiological services rendered to their members, the actual reports generated by specialists who see their members without informing the PCP, and the same with information generated by hospital admissions. When a PCP receives this information, he reads and addresses the follow-up needed for the patient. For example, if a PCP himself orders a cat scan on a patient, or an x-ray, the report might state that the patient needs additional testing which the PCP addresses and keeps track of the need, often times, to repeat a follow-up test in the future, using as an example, a patient whose cat scan reading might state that there is a small spot that is too small to characterize at present, with a need to follow-up and repeat the test at a future time to determine if that small spot has grown to a size requiring intervention for the early detection of cancer, or by following that with repeated testing over specified periods of time to show that there is no need for worry or intervention on the part of the PCP, there being no growth or need to address that small spot any longer. Again, MVP Health Plan does not read, nor do they have the capability of reading all of these reports, nor do they have in place any method with which to require a PCP to share this information with them. Therefore, in the case of MVP Health Plan and all of their 700,000 plus members, the only way that each and every one of their members has access to a complete record of all of their healthcare information is to provide their PCP’s with the information they, MVP Health Plan, has and are aware that the PCP does not have, which they have repeatedly failed to do for years through the constant record reviews they perform on their PCP’s.

In this summons and complaint presented to the Supreme Court of NYS, County of Schenectady, they have requested a ruling that they be allowed to continue to operate in this manner to avoid being penalized and perhaps being made to return millions, if not billions of dollars of public funds given to them, which they did not use as they promised the government they would in a contractual arrangement they made with the federal government when this private, not-for -profit healthcare company applied for and were given the public funds they requested, funds paid to them to provide much needed healthcare services to low-income families as described, requiring public assistance to ensure the delivery of quality healthcare to these individuals, with equality in terms of delivery of healthcare services to the rest of the general public.

A request is being entered first to the Department of Health to intervene on an emergency basis to prevent this company from operating in such a way that poses a threat to the general public and social?welfare of over 700,000 individuals under their care, again with the realization that many of their members have suffered, having the highest morbidity and mortality rates, and the highest rates of vaccine hesitancy, as many of these members have a natural distrust for a company providing them with insurance who has placed their interests over the interests of delivering quality care to their patients, supported, without question by the request they have made in this summons and complaint for a ruling that they continue to operate with disregard of their members’ civil rights, as defined by rules and regulations stated by the OCR, the Security Act, the Privacy Act, the Affordable Care Act, all in place to protect the civil rights of all of the individuals who the government paid MVP Health Plan to ensure equality in the delivery of their healthcare. This “not-for-profit” has amassed billions of dollars “in profit”, paying their CEO’s millions of dollars in salaries and bonuses and most likely have falsified information they’ve submitted to the government after reviewing and not supplying their providers with information missing in their records and described in order to receive incentives and high marks with regards to the quality of healthcare being delivered to their members, actions which the government must realize they are potentially guilty of?when reviewing their request for this ruling by a court, necessitating a complete audit of the business practices and perhaps shutting them down completely, with transfer and coordination of the care of their members to another publicly funded healthcare company who is operating ?in accordance with healthcare rules and regulations, again which this company is asking for a court ruling that they be allowed to operate with complete disregard of.

To avoid having to object to an appeal MVP intended to enter to the Court requesting that the court grant them an extension Dr Maloney agreed to extend the time limit they have to answer Dr. Maloney's claim allowing him more time to enlist the help of Departments within our Government whose job it is to oversee that these publicly funded not-for-profit companies, operate within the guidelines they promised the government to adhere to when they applied for and were given millions of dollars of taxpayer dollars. Dr. Maloney is trusting that his efforts will not be in vain and that an authoritative body will act quickly to protect those whose healthcare has been entrusted to MVP Health Plan.

UPDATES TO FOLLOW

DISCLAIMER: Relax MVP Execs & all the lawyers you've paid to protect you. All that is written here by or on behalf of Dr. Maloney including all that is written IN ANY ARTICLE OR POST ATTACHED TO HIS NAME, is purely opinion based and is not to to be taken as true or false, without exception. Everyone is entitled to express their opinion about the way you operate especially since we are paying for everything you do. CITIZEN'S WATCHDOG OVERSIGHT COMITTEE ON THE SPENDING OF PUBLIC FUNDS GIVEN TO MVP HEALTH PLAN INC..

Addendum, to article in progress

This company (MVP Health Plan Inc.) uses intimidation and retaliation tactics against doctors like Dr Maloney who dare to challenge them. Their members are afraid to speak up for the same reasons often for fear that their insurance will be taken away from them if they dare complain to this company. Dr Maloney is not afraid to speak up and demand that a healthcare company comply with their responsibilities. He is an advocate for his patients and their well being. Dr. Maloney was not afraid when he submitted complaints to MVP Health Plan informing them for years that they were not sharing information with him, information that they told him he was required to maintain in the records he kept on his patients, information that MVP informed Dr. Maloney he was responsible to maintain, with knowledge that it was impossible for Dr. Maloney to do so because MVP refused to share the information with him. When Dr. Maloney and his staff demanded that MVP share information with him for a good part of 2019, informing MVP that it was their responsibility according to the rules and regulations they had to follow in return for receiving public funds, Dr. Maloney was aware of the fact that MVP was not happy about the requests and demands that Dr. Maloney and his staff made to MVP and was prepared to be the recipient of retaliation by MVP who might try to discredit him, accuse him of poor work, malign his reputation, etc., so it came as no surprise to him when they did just that. Dr. Maloney was prepared because he experienced the same 30 years ago when he reported auditors within the Medicaid system which at that time had no oversight whatsoever. They fined Dr. Maloney after he refused to withdraw his complaints against them. They had audited Dr. Maloney's records and returned them to him with 100% approval without a single deficiency noted. The NY Times, at the time, described Medicaid's audit practices as " nazi-like raids". One of Dr. Maloney's staff members, his phlebotomist at his practice, can tell you that during this audit, raid, when Medicaid auditors came in and randomly took records to review which Dr. Maloney freely handed over, she, a young woman was forcibly shoved against a wall by one of these auditors. Nonetheless, after returning Dr. Maloney's records and telling him that they were in order, Dr. Maloney proceeded to report the auditors to the Attorney General's office, etc., only to learn that the Medicaid department at that time subsisted without any oversight nor ability by any government agency to investigate or reprimand their activities. Therefore, after learning that Dr. Maloney reported them, they returned to Dr. Maloney and stated to him that if he did not stop reporting them they were going to re-audit his records. They stated as an alternative to performing another review of his records, because of reporting them, they were nonetheless going to exclude him from the Medicaid system, without further retaliation. Dr. Maloney refused their demands, fought them at a hearing conducted within their department that was fixed, at which Dr. Maloney showed that they did perform a second review stating that Dr. Maloney submitted "false claims", a term they created and used against doctors who dared to stand up to them, to imply that a doctor had not seen or provided services to a patient. The fact is that in re-auditing records that they already approved on Dr. Maloney, they hired a doctor to lie and state that Dr. Maloney did not provide enough documentation in the record to justify payment for services he provided or ordered. Dr. Maloney later had the decision overturned by submitting proof to the Dept. of Health that he did nothing wrong, showing that a doctor had lied about simple medical facts, for example that you look at the white blood cells and not the blood count to determine anemia, stating that Dr. Maloney should not have ordered an iron level on a patient because their white blood cell count was normal. The patient had a low hemoglobin and hematocrit, was anemic, and it was appropriate for Dr. Maloney to order an iron level, as one example that's easy to understand how the doctor lied. The doctor stated that you don't look at hemoglobin or hematocrits, you look at white blood cell counts to determine anemia. At that time Dr. Maloney was in a situation one would describe as "You can't fight City hall". Things changed however when Diane Sawyer aired an investigative report on a television show called "Prime Time Live" entitled "Audit the auditors" exposing the corruption that Dr. Maloney had reported. Dr. Maloney subsequently submitted proof to the Medicaid Inspector general that he had done nothing wrong and had been the victim of retaliation, requesting only that the department reinstate him, requesting only ordering privileges and participation with managed care plans knowing that these Medicaid managed care plans were to follow strict rules and because they were privately funded companies, they had oversight and were in a position to be punished by other authoritative figures. Not only was Dr. Maloney's request for reinstatement honored, but without asking, his Medicaid privileges were back dated to the date of his original enrollment, negating any time period of any restrictions. Therefore, Dr. Maloney was thoroughly prepared for and not surprised that MVP Health Plan proceeded to use the same tactics against him to scare him, harass him, over burden him,... in efforts to discredit him and shut him up, using whatever means and connections they had to do so, believing that Dr. Maloney would back down and stop demanding that they adhere to healthcare rules with regards to the sharing of information, believing that they did not want to do so as the sharing of information that Dr. Maloney requested, translated into MVP spending money given to them on services for their members with a decrease in their profit to loss ratio, as I believe this company has a net worth of over a billion dollars accumulated using public funds given to them primarily to focus on delivering an increased amount of services to their members, especially preventive care services which in the long run proves to keep people healthy at a dramatically decreased expenditure of public funds over the course of an individual's lifetime. Dr. Maloney will continue to fight this company and do whatever it takes to ensure that they comply with their responsibility to adhere to rules and regulations they promised the government they would follow in return for the money given to them, as Dr. Maloney is and has always been an advocate to ensure to the best of his ability his patients receive comprehensive quality care with special attention to needed follow-up care.

?For years Dr Maloney informed MVP that it was their responsibility to help him obtain and provide him with medical information on his patients so that Dr. Maloney could be in possession of and maintain a complete record of all of his patients’ health information in his patients’ records. He informed MVP that he needed MVP to share medical information with him and they refused to do so. MVP refused to help Dr. Maloney obtain medical information on his patients informing MVP that he needed this information to be sure that his patients received follow-up treatment stated in visits to specialists and hospital admissions etc., informing MVP that he had no way of obtaining this information without the help of MVP. He informed MVP that they had in their possession, information Dr Maloney requested that MVP provide him with information, information that they were able to provide Dr. Maloney with. MVP refused to share this information with him. Dr Maloney was unable to obtain notes from Specialists and Hospitals Visits on his patients informing MVP that he was frequently not informed of these visits, while MVP was, and MVP refused to share this information with Dr Maloney which Dr Maloney needed both for treatment purposes (to ensure that his patients received needed followup care stated in Specialists’ notes and Discharge Summaries from Hospitals. Dr Maloney informed MVP that as MVP refused to share this information with Dr Maloney that MVP made it impossible for Dr Maloney to maintain a compleat record of all medical information on his patients and that MVP was preventing Dr Maloney and MVP’s members in many instances from obtaining followup services stated in Summaries after visits to these other Healthcare Providers that MVP refused to provide Dr Maloney with means in which Dr Maloney could obtain this medical information on his patients. Dr Maloney informed MVP that they knew of every visit his patients made to Specialists, ERs,Urgent Care Centers, every service that his patients received (surgeries, any biopsy, x-ray, pathology report, colonoscopy, pap smear, colonoscopy, blood result…and explained to MVP that Dr Maloney was not aware of this services his patients received from other providers, explaining to MVP that some of his patients would tell Dr Maloney that they believed that this information was always shared with Dr Maloney as the Hospital or Specialist.. had asked the patient who their PCP was and when they they gave Dr Maloney’s name the facility recorded Dr Maloney’s name and contact. Dr Maloney stated that he and his staff would do the work and contact these other providers to obtain info he needed to treat his patients, requesting that MVP provide Dr Maloney with the facility who treated his patient by simply sharing with him MVP could provide him with from billing records MVP maintained on all their members. Dr Maloney requested that MVP provide him with the names of and dates of services where his patients were treated, stating to MVP that Dr Maloney and his staff would contact those facilities themselves to obtain needed medical info on his patients and MVP refused to share this info with Dr Maloney that he requested for the protection and safety of the 600+ patients of Dr Maloney’s who had signed up with MVP to provide them medical insurance and had assigned Dr Maloney to them as their PCP (also called medical home).

Dr. Maloney also showed MVP that he often was unable to obtain information on his patients from specialists at times when Dr Maloney was aware of a visit to a specialist by one of his patients, physically showing MVP often multiple documented faxed requests and phone calls Dr Maloney had sent and made to request notes from specialists who took care of his patients and would not provide Dr Maloney with a note. At times Dr Maloney and specialists at tomes would communicate with each-other by text or phone call that was sufficient for Dr Maloney and the information he needed to coordinate the care of his patients, make sure that they received the followup services a specialist communicated to Dr Maloney but MVP insisted that Dr Maloney had and was required to have a written consult note from the specialist in the patient’s record. Dr. Maloney in showing MVP the multiple requests he and his staff had sent to specialists requesting notes without success, including phone calls made requesting a notes from specialists. Regardless Each time MVP performed a review of the records, which was frequent, MVP informed Dr Maloney that it was his responsibility to maintain a note from every specialist a patient of Dr Maloney had visited. MVP knew that Dr Maloney had exhausted all means of obtaining specialists notes on MVP’s members and and MVP refused to share information with him that would enable Dr Maloney to contact specialists to obtain notes from, visits to specialists Dr Maloney was not aware of SO Dr Maloney, informed MVP that if MVP wanted Dr Maloney to have and maintain a note from all Specialists who treated Dr Maloney’s patients, it would help if MVP required the Specialist to provide Dr Maloney with a consult note. For years Dr. Maloney requested that MVP do this and MVP informed Dr Maloney each time every year. that they would consider his recommendation, without ever implementing it nor any of the many suggestions Dr Maloney communicated to MVP, methods MVP had the capability of using to ensure that their provides were able to maintain a complete record of their member’s health information. MVP prevented Dr Maloney from maintaining a complete record of all medical information on over 600 members MVP had assigned to Dr Maloney. MVP recommended Dr Maloney to many of their members assigning Dr Maloney to them as their PCP, or adding a patient to Dr Maloney’s list of MVP patients (Dr Maloney’s patient roster or panel of patients) at the request of patients as well. MVP Health Plan personally handed Dr Maloney with an award given to his practice from the NYS Board of Health for the quality of care Dr Maloney provided to his patients. MVP Health Plan had recommended that the Board of Health commend Dr Maloney for the care he provided to MVP’s members based on multiple reviews MVP performed on the records Dr Maloney maintained on his patients. The quality of care award named Dr Maloney’s practice but MVP Health Plan personally handed this award to Dr Maloney, stating that it belonged to Dr Maloney and was bases on the care Dr Maloney alone provided to his patients, noting it was not intended to commend any one else affiliated with his practice. MVP was thoroughly aware of and understood that there existed a number of corrupt auditors within the Medicaid System over 30 years when Doctor Maloney chose to practice in the South Bronx, in an area close to where he spent his last two years of medical school completing his education at the Albert Einstein College of Medicine in conjunction with the University of Guadalajara. Dr Maloney speaks Spanish, fluently adding to his desire to practice in that area as there was a need for a doctor who spoke Spanish in this area where the majority of people spoke Spanish with little or no access for this population to obtain care from a Spanish speaking physician.

TO CONTINUE