The Myth of Objective Health Insurance Advice

September 1, 2006

“It may be better to be wrong at the right time than right 
at the wrong time.” 
 
 
 
Recently the Finance Director of a Northeastern city 
contacted us regarding the city’s pension. She had read our 
articles about pension consultant abuses and suspected that 
the consultant her city’s pension had hired was providing 
conflicted advice. “The Board doesn’t care,” she said, “but 
I’m the one who has to sign off on the documents. I’m the 
one who will be held responsible if the harm related to 
these conflicts ever comes to light. What am I suppose to 
do? Can you give me some guidance?”  
 
 
 
Our response is quoted above. We gave her some very 
realistic advice. In many situations, especially politics, 
it may well be better to be wrong at the “right time” and 
receive the support and admiration of those around you, as 
well as any related financial or psychic compensation than 
to be right. To have a correct answer to a question at a 
time when no one wants to hear it can be tragic. We do not 
want to encourage anyone to be a hero, championing 
potentially hopeless causes and angering those around them, 
without being fully aware of the dangers. As children in 
school, we are taught that those who are right, are 
rewarded. It is human nature to want to please others and 
most of us have grown up believing that if we are “right,” 
we will please our teachers and employers, be promoted and 
receive bonus payments, as well as be respected in our 
community. Unfortunately, there is no assurance that having 
the correct answer or doing the right thing will result in 
any consequence, good or bad. If anything, a rigorous 
search for the truth will inevitably place the individual 
in conflict with the community at some point in time. Most 
people, given the choice between being correct and hated 
versus wrong and loved, will choose the latter– even if 
that results in significant harm to his community before 
the error is exposed. Thus, it is the rare individual who 
takes a principled stand and (in the appropriate 
circumstance) finds himself applauded for doing nothing 
more than... the right thing. To do the right thing at a 
point in time when it is difficult is the definition of a 
hero. It also defines failure.  
 
 
 
In summary, we encourage those involved in pension 
decision-making to do the right thing but we are ever 
mindful that anyone who does so must not expect to be 
rewarded in the here-and-now. Over time, those who have 
courage (and most important, staying power), may live to 
see their reward here on earth. That’s the good news we 
have to offer. What’s this got to do with health insurance 
kick-backs? 
 
 
 
The September 18, 2006 Wall Street Journal included a lead 
article regarding healthcare consultant conflicts of 
interest. It seems Journal reporters have discovered that 
parties paid to provide objective advice regarding health 
insurance to companies are, in fact, conflicted. These 
intermediaries are also receiving compensation from the 
health insurers. Some of these intermediaries also provide 
conflicted advice to pensions and that’s how the issue came 
before us. 
 
 
 
When we wrote about health insurance kick-backs in a May 
2005 article entitled, The Next Insurance Scandal: Health 
Insurance Kick-backs, we received a lot of critical 
comments from the health insurance industry. As always, 
companies involved in the matters we are investigating (and 
exposing) advise us: (1) we do not know what we’re talking 
about; (2) we’re exaggerating the extent of the wrongdoing; 
(3) all the conflicts have been adequately disclosed and, 
most importantly, (4) the client is never harmed.  
 
 
 
In hopes of this time being right at the right time, we are 
reprinting the 2005 article below. Judge for yourself our 
ability to predict future regulatory concerns. We can tell 
you that the information included in the 2005 article was 
based upon a preliminary investigation we undertook on 
behalf of a pension sponsor, assisted by an health 
insurance industry insider familiar with law enforcement 
subpoenas received by health insurers at that time. Finally 
it seems the hidden financial dealings are coming to light 
and, we believe, the implications to the health insurance 
industry are profound.  
 
 
 
The Next Insurance Scandal: Health Insurance Kick-backs 
 
 
 
We have endured the research analyst, mutual fund, and 
property and casualty insurance bidding scandals. We are 
awaiting the release of an SEC investigation into conflicts 
of interest involving gatekeepers to the nation’s pensions. 
All of these scandals involve similar business practices: 
companies that purport to be acting in the best interests 
of their clients (for a fee) are secretly profiting from 
ripping them off. Once the industry-wide scamming or 
skimming is revealed, the economics of the industry 
involved are radically altered. What’s this have to do with 
health insurance?  
 
 
 
A company uses an insurance agent, broker or benefits 
consultant to locate the best health insurance for its 
employee group. In some instances the company may pay the 
broker a fee for his service; in other cases, the company 
understands the broker will be compensated by the health 
insurer. Regardless of how the broker is compensated, the 
company expects to receive competitive bids from the 
insurers and broker input regarding the best coverage 
available. Consistent with industry practice, the broker 
never discloses to the company the full extent of his 
compensation arrangements with insurers.  
 
 
 
Sound familiar? As we now know, there are large insurance 
brokerages that have for years pretended to serve the best 
interests of clients who hire them, even as they steer 
clients to property and casualty insurers that provide the 
greatest kick-backs or commissions. The hidden financial 
arrangements these insurance brokers have with health 
insurance companies also are pervasive throughout the 
industry, add significantly to the cost of such coverage, 
and are easily concealed from customers. 
 
 
 
In the health insurance arena, the commission paid to the 
broker is built into the premium the insurer quotes. Since 
premiums are based upon numerous factors considered by the 
underwriter related to the composition of the company’s 
employee group, it’s relatively easy to manipulate premiums 
quoted to conceal commissions. And since all the insurers 
pay these commissions, all quotes are inflated to some 
degree. 
 
 
 
How sizable are these commissions? Commissions generally 
range between 3%-5% (but can be higher) and are paid 
monthly to the broker, out of employer/employee premiums. 
These are not one-time finder’s fees but are paid annually 
as the insurance contract is renewed. Additional 
substantial bonus money may be paid to brokers who write 
certain amounts of premium. These are referred to in the 
industry as “broker-bonus program” payments. While 
employers may have limited knowledge regarding the 
commissions brokers are paid by insurers, the “broker-bonus 
program” payments are an industry secret. As a result of 
the bonus payments, many employers may not be made aware of 
more competitive bids from other heath insurers, especially 
the closer the broker is to earning his annual retention 
bonus from the incumbent insurer. (This sounds awfully 
similar to mutual fund marketing where, until recently, the 
investor only knew he was paying the broker a commission 
but didn’t know about additional forms of compensation such 
as shelf-space payments, revenue-sharing arrangements and 
directed brokerage, which may have caused the broker to 
recommend the fund.)  
 
 
 
Back to health insurance. For example, a company with 1,000 
employees paying $1,900 a month each for family coverage 
would earn a broker (assuming a 5% commission) $95,000 a 
month in commissions or over a million yearly ($1,140,000). 
To this amount add the “broker bonus” payments. Still 
believe medical malpractice claims are the cause of 
escalating health insurance coverage?  
 
 
 
For many Americans, their greatest monthly expenses are 
their mortgage and health insurance. Mortgage payments are 
either fixed or adjust within predictable ranges. Health 
insurance costs, however, can increase 30% a year. Family 
coverage can easily cost between $1200 and $1900 a month. 
An employee earning $10 an hour (a rate significantly above 
the minimum wage), working 40 hours a week for a month or 
$20,000 annually, cannot earn enough before taxes and any 
other living expenses, to pay for family health insurance 
coverage—if he can get coverage. We as a nation simply 
cannot afford this massive scamming. 
 
 
 
In Massachusetts and New York law enforcement and 
regulators have been investigating these payments for quite 
some time. The major health insurers have been contacted 
for information. By now industry practices presumably are 
known to these officials. Health insurers are bracing 
themselves for upcoming public disclosure of these 
kick-backs. Some health insurance insiders unhappy about 
being forced to make these payments to brokers over the 
years were eager to blow the whistle and are disappointed 
with the delay in meaningful action. We believe this could 
be the greatest blow ever to the insurance brokers, given 
that health insurance premiums (and related kick-backs) are 
substantially greater than those related to property and 
casualty insurance. 
 
 
 
Expect litigation, settlements and agreements to forego 
receipt of such future payments by the insurance brokers. 
How much will shares of the large insurance brokers be 
worth once they have sworn off all their ill-gotten gains? 
 
----------------------------------------------------------------------------------------------------------------------- 
 
Limits on Firms' Donations to California Pension Panel Eyed 
The California teacher fund's board may restrict gifts to 
the governor, treasurer and controller. 
By Evan Halper, Times Staff Writer 
September 8, 2006  
SACRAMENTO — The board that oversees California's teacher 
pension fund is poised to ban financial firms that it does 
business with from making large political contributions to 
its members and the governor.  
 
Implementation of such a ban, which could cost candidates 
for governor and other statewide offices millions of 
dollars in campaign cash, was set in motion Thursday with a 
unanimous vote of the board's corporate governance 
committee. Over the next two months, staff attorneys will 
craft statutes, subject to board approval, that would put 
the new rule into effect. 
 
 
The move, instigated by proxies for Gov. Arnold 
Schwarzenegger, would prohibit companies or their employees 
who are seeking business from the pension fund from 
donating more than $250 to Schwarzenegger, the state 
treasurer or the state controller, all of whom control 
seats on the board.  
 
The development follows revelations in The Times that 
Treasurer Phil Angelides and Controller Steve Westly, 
rivals in the June primary election, steered the pension 
boards they sit on, including the teacher fund panel, to 
invest in firms that contributed to their campaigns. Both 
men have collected millions of dollars from companies 
seeking pension-system cash. But both quickly endorsed the 
new plan. 
 
"The treasurer wholeheartedly supports the proposal," 
Angelides spokesman Nick Papas said. Joy Higa, the 
controller's representative on the board, said Westly also 
backs the measure.  
 
The push comes as pension boards nationwide have been 
tainted by "pay to play" scandals. Investigations into the 
awarding of investment contracts to political patrons of 
pension board members have been launched in several states. 
 
 
"There should not be a perception out there that one pays 
to play, in terms of making campaign contributions to 
officials in California and as a reward you have access to 
the nation's second-largest pension fund," Peter Reinke, a 
campaign finance reform advocate whom Schwarzenegger 
recently appointed to the board of the California State 
Teachers' Retirement System, said at the board's meeting. 
The spirited discussion on political giving stretched 
across 2 1/2 hours. 
 
During President Clinton's years in office, the Securities 
and Exchange Commission launched an effort to put such a 
ban in place. But it unraveled amid intense opposition from 
financial firms. 
 
The same fate still could befall the teacher pension fund 
proposal; opponents have not yet had time to mobilize 
against the plan. Even some of the board members who voted 
to move forward said there could be unintended 
consequences.  
 
Board member Dana Dillon, a teacher from Weed, warned that 
multinational investment firms could lose their contracts 
with the state because a low-level employee made a $500 
contribution to a gubernatorial candidate. Other teachers 
on the board expressed concern that they would not be able 
to attend lunch events held by financial firms.  
 
But supporters praised Thursday's action.  
 
"This move is of tremendous importance to pension funds 
nationwide," said Edward Siedle, a former SEC investigator 
who runs a private firm that helps pension boards root out 
corruption. "Pension plans are under attack. The public 
fund community is trying to defend them. But they are 
realizing that trying to defend their most corrupt 
practices becomes a losing battle."  
 
Westly's support for the measure comes after the 
controller's aggressive pursuit of pension fund cash became 
a focal point of last spring's primary campaign.  
 
Westly intervened at the California Public Employee 
Retirement System on behalf of a politically connected 
venture capital firm that held multiple fundraisers for him 
— and in which CalPERS' outside advisors had opted not to 
invest. After Westly's intervention, the staff at CalPERS 
put $5 million into the fund.  
 
And the controller's desk calendars, obtained through a 
request for public records, are filled with private 
meetings with donors linked to financial firms doing 
business with California pension systems.  
 
The Angelides campaign aired a commercial that accused 
Westly of corruption.  
 
But Angelides' own campaign coffers have received a huge 
boost from companies with business before the pension 
funds, and his advocacy on their behalf was frowned on by 
ethicists.  
 
Angelides' representative at the teacher pension fund, 
Dennis Trujillo, tried Thursday to get the board to adopt 
policies that appeared aimed at embarrassing the governor. 
One would have changed the oath that board members make on 
taking their seats to include a pledge of independence 
underscoring the dangers of "political 'packing' of 
retirement boards."  
 
Trujillo said the pledge was needed because the governor 
removed four board members who opposed his plan last year 
to replace pensions with 401(k)-style retirement plans for 
new government employees.  
 
"We have a governor who terminated four members because 
they didn't walk lockstep with him," Trujillo said. But the 
committee said the treasurer's proposal was incomplete 
because it did not include the actual language that would 
be added to the oath. The measure will be reconsidered at a 
later date.  
 
Angelides also sought to impose a policy that would force 
the governor and his staff to report on the nature of any 
communications he has with his representatives on the 
pension board. 
 
Committee members objected to the proposal, which would not 
have applied to any other state officials who have 
representatives on the pension board. It lost in a 3-6 
vote.  
 
------------------------------------------------------------------------------- 
 
Fighting fraud: Deterring fraud and abuse may be the more 
challenging battle in pension reform 
 
By: Kelley M. Butler 
 
As the debate continues on how to reform the laws governing 
pension plans, two federal lawmakers are calling for an 
investigation of the agencies that oversee the plans, 
claiming the government could do more to ensure pension 
plans operate lawfully. 
 
Last winter, Reps. Edward Markey (D-Mass.) and George 
Miller (D-Calif.) asked the Government Accountability 
Office to investigate whether the government effectively is 
regulating the activities of pension funds and the firms 
that advise them. They also think lawmakers could be more 
vigilant in detecting and deterring fraud, conflicts of 
interest and other unlawful activities in the pension 
industry. 
 
Referencing a May 2005 report from the Securities and 
Exchange Commission that showed "pension consultants may 
steer clients to hire certain money managers and other 
vendors based on the pension consultant's other business 
relationships," Markey said, "More needs to be done to 
ensure that workers' pensions are not put at risk by 
advisors offering conflicted recommendations masquerading 
as objective advice." 
 
Said Miller: "The SEC report raises grave concerns that 
some pension consultants and money managers may be choosing 
investments or other deals to enrich themselves and their 
associates while putting workers' retirement nest eggs in 
jeopardy. That is unacceptable, and it must stop."  
 
The congressmen specifically site the SEC, Department of 
Labor, and the Pension Benefit Guaranty Corporation as 
agencies responsible for taking the necessary steps to root 
out fraud. "Clearly, a thorough, comprehensive examination 
is needed to determine whether the federal government is 
taking the actions necessary to protect workers and their 
pensions from advisors more interested in padding their own 
profit margins than providing impartial advice," Markey 
said.  
 
However, there currently is no such General Accounting 
Office investigation being conducted, nor is one planned.  
 
Catch me if you can 
 
Although Miller and Markey have not yet made headway on 
Capitol Hill, they've got an ally in Edward Siedle, a 
former SEC attorney who now investigates money management 
abuse and fraud with his firm Benchmark Financial Solutions 
in Ocean Ridge, Fla. 
 
Speaking in March at the an annual benefits conference for 
a police union, Siedle recalled meeting former corporate 
thief Frank Abagnale, who chronicled his crimes in the 
book, "Catch Me If You Can." The two men had met at another 
conference while speaking about deterring fraud.  
 
Abagnale's account of how he easily stole millions from 
various companies led Siedle to warn a client, "I could 
steal millions from you, and you'd never know it happened." 
Siedle went on to say that through an investigation, he 
found his client had already "lost tens of millions [the 
client] was utterly unaware of." 
 
Defined benefit plans stand to lose millions from 
kick-backs to corrupt consultants, misrepresented assets 
under management by money managers, and excessive 
commission costs and influence peddling by brokers, just to 
name a few situations, according to Siedle.  
 
"From our investigations, we have observed that corrupt 
practices can easily cost a pension 10% of its value over 
time," Siedle said. "In an environment where market returns 
are limited, the cost of this corruption is unacceptable. 
If funds do not proactively attack pension wrongdoing, 
every instance of wrongdoing that has been neglected will 
be another nail in the coffin" of the DB system. 
 
Siedle advocates federal forensic investigations of failed 
plans to learn more about rooting out fraud and abuse.  
 
"The PBGC has taken over 4,000 failed pensions and never 
once conducted a forensic investigation," he said. "For 
some reason, when S&Ls fail[ed], we look for wrongdoing, 
but when pensions fail, it's no one's fault - ever."  
 
He holds out hope, however, that "as more plans fail, the 
demand for investigations will grow." - K.M.B. 
 
Copyright 2006 Thomson Financial, All Rights Reserved 
 
----------------------------------------------------------------------- 
 
GAO Investigating Whether Investment-Related Conflicts Are 
Root Cause of Pension Plan Crisis  
 
IM Insight, Sept, 18 2006 
 
Click Here for PDF 
 
------------------------------------------------------------------------ 
 
Investors Pull $120Million From Century City Venture 
Capital Firm 
Harvard and public pension funds in California, Colorado 
and New Mexico are concerned that International Technology 
University sought political contributions from start-ups. 
By Evan Halper and Dan Morain, Times Staff Writers 
September 12, 2006  
 
For a time, the 30-something venture capitalists were 
flying high, backed by tens of millions of dollars from 
Harvard, Boeing and other big-league investors, and 
consulting with such disparate advisors as the Columbia 
University business school dean and KISS singer Gene 
Simmons. 
 
Calling themselves International Technology University, the 
sneaker-clad partners with the Century City address scoured 
top engineering schools, seeking new technologies to turn 
into profitable businesses. 
 
Over the last six years, the duo, friends since their 
student days at Tulane University in the 1990s, persuaded 
investors to entrust them with $250 million to use as seed 
money. 
 
The two funded 36 start-ups, several of which turned 
healthy profits. But last month, their fortunes turned. 
Their most prestigious investors — Harvard University and 
public pension funds in California, Colorado and New Mexico 
— pulled $120 million out of the firm, cutting off much of 
the company's cash supply. 
 
A big reason: The investors were troubled that the two 
partners, Chad Brownstein and Jonah Schnel, solicited 
political contributions from the fledgling firms they 
financed, and several obliged. 
 
Start-ups in Colorado, New Mexico and California gave about 
$68,000 to California Controller Steve Westly, an 
influential member of the state's public pension board who 
was running for governor at the time. 
 
State and federal laws prohibit venture capitalists from 
requiring political giving by the companies they finance. 
Political contributions from fledgling companies to 
politicians in other states raise a red flag, said Edward 
Siedle, an expert on pension malfeasance and a former 
attorney with the U.S. Securities and Exchange Commission. 
 
"When we investigate these things, that is one of the 
telltale signs that there may be a quid pro quo going on," 
Siedle said. 
 
In July, officials in two states took the unusual step of 
calling on ITU to repay the pension funds, or reimburse the 
start-ups the money that was donated — a sign of pension 
boards' increasing sensitivity to perceptions of cronyism. 
Corruption has tarnished several retirement systems in 
recent years, bruising boards in San Diego, Chicago, and 
Philadelphia. 
 
Brownstein and Schnel say the start-up firms' political 
giving has no connection to ITU's business. Although ITU 
suggested that the start-ups make political donations, 
Brownstein and Schnel put no pressure on them to do so, the 
pair said. They feel victimized. 
 
"There is nothing illegal here. There is nothing illicit," 
said Brownstein. "This has been a huge disruption to who we 
are and what we do." 
 
The states asking that the money be returned are Colorado 
and New Mexico, both of which had also made earlier 
investments in ITU. One start-up in Colorado and one in New 
Mexico each donated $20,000 to Westly's failed 
gubernatorial bid. Three ITU-funded start-ups in California 
gave the controller a combined $28,000. 
 
Brownstein and Schnel say they cannot cover the cost of 
donations made by other companies, because doing so would 
mask the true source of the money. Stephen J. Kaufman, an 
attorney hired by the men, said that what Colorado and New 
Mexico are asking them to do "is completely illegal." 
 
Brownstein and Schnel say their investors' main concern was 
the departure of several key ITU employees, and questions 
about the political contributions — made before the big 
leaguers put their $120 million into ITU — aggravated 
matters. 
 
"The fact that this political stuff got brought into the 
conversation threw gas on the fire," Schnel said. 
 
Officials at Harvard and in the three states refused to 
discuss their decision, but public records show that they 
began dissolving their partnership with ITU in July. 
Executives at the start-ups that gave to Westly either did 
not return phone calls or declined to discuss the issue for 
the record. 
 
Kaufman, the ITU attorney, said he contacted nearly all the 
companies that gave money and concluded they were "not 
pressured into making any contribution." 
 
The contributions at issue were among many that ITU has 
given to, or solicited for, elected officials connected to 
government pension funds. Many such funds place large 
amounts of cash in venture capital firms in hopes of 
reaping sizable returns. 
 
 
 
ITU's principals and associates have given $19,500 to 
Westly and $20,000 to state Treasurer Phil Angelides, who 
defeated Westly in the June gubernatorial primary. These 
donations are not in dispute. 
 
Westly spokesman Russ Lopez said the controller has met 
with Brownstein privately — including meetings in New York, 
where Brownstein introduced the controller to other 
potential donors — but Westly never intervened on ITU's 
behalf at the California Public Employees' Retirement 
system. 
 
Since founding their firm in 2000, Brownstein and Schnel 
have helped launch several small technology companies from 
the laboratories of UCLA, UC Berkeley and other 
universities. The companies were ultimately bought by such 
corporations as Nokia and Advanced Micro Devices. Such 
sales netted millions of dollars for ITU and its investors. 
 
Along the way, the two struck up relationships with 
Columbia Business School Dean R. Glenn Hubbard, the former 
chairman of President George W. Bush's White House Council 
of Economic Advisors. In addition to relying on Hubbard's 
advice, they hired rocker Simmons to help the start-up 
companies develop marketing plans for entertainment-related 
products. 
 
Brownstein is the son of Denver attorney Norman Brownstein, 
a major donor to pro-Israel political candidates and 
causes. 
 
Another of the early principals at ITU was Adam Winnick, a 
childhood friend of Brownstein's. Winnick's father, Gary, 
founded the now-bankrupt telecommunications network 
provider Global Crossing Ltd. and was once described as the 
richest man in Los Angeles. 
 
Gary Winnick was one of ITU's initial investors, giving 
millions of dollars to help launch the company. 
 
In 2005, ITU proposed that the Los Angeles fire and police 
pension board invest $5 million in the company. The board 
rejected the bid, saying ITU's management fees were too 
high. 
 
In August 2005, Mayor Antonio Villaraigosa appointed United 
Food & Commercial Workers union leader Sean Harrigan to the 
police and fire board. That month, ITU donated $3,000 to a 
political action committee controlled by Harrigan's union. 
In October 2005, Harrigan joined other board members in 
voting to approve the $5 million investment in ITU. 
 
Harrigan did not return phone calls from The Times. 
 
Brownstein, a longtime supporter of Jewish causes, said his 
company gave money to Harrigan and others, mostly because 
they were "strong supporters of the state of Israel." 
 
Westly, Brownstein said, "is a guy who is incredible on the 
state of Israel. And he is a founder of EBay. And if this 
guy were governor, the environment for technology would be 
amazing. That is all we think about." 
 
In July and early August, Brownstein and Schnel tried to 
persuade their big investors not to pull out, meeting with 
them and obtaining letters from several of the companies 
they funded attesting to the pair's business and ethical 
standards. 
 
They also sent investors letters describing political 
giving as normal in the tech world. "Federal and state 
funding is critical to many venture-capital backed 
companies, particularly early stage technology investments, 
and political contributions are a common business 
practice." 
 
Contracts between ITU and its investors do not address 
campaign donations. But they contain a clause that permits 
investors to pull out for "no reason or for any reason," 
and the $120 million was withdrawn despite the men's 
entreaties. 
 
The pullout, they wrote to their investors, "may destroy 
the ITU brand that we have created so carefully."


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