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Ill begotten 

Sick and uninsured, in the midst of a divorce and without income, Helen Tirpik turned to Wayne County for help one year ago. Suffering from kidney stones, she desperately needed care but had no money to pay for it. With no other options available, she became one of about 27,000 indigent people dependent on the taxpayer-funded PlusCare program for medical coverage.

Things went badly from the start.

Tirpik signed the enrollment forms on March 6, 2003.

The PlusCare program, discontinued at the end of September last year and replaced by a new system, served the poorest of the poor. Only people ineligible for all other programs could participate. Their income had to be less than $250 a month. In health-care-speak, it offered “a managed-care environment.” Coverage was broad. At least in theory.

Two HMOs held contracts, worth about $15 million a year each, to cover everything from hospital stays and doctor visits to prescription drugs and eyeglasses. Enrollees were assigned to one or the other company based on ZIP code. Which is how Tirpik, who lives in Taylor, came to be covered by the for-profit company Ultimed HMO.

She assumed coverage would begin as soon as she filled out the paperwork. She was wrong. Tirpik learned later that coverage didn’t kick in until after her surgery. She wound up owing thousands of dollars.

That was only the start of her troubles.

To remove her kidney stones, drainage tubes called stints were surgically inserted. They were supposed to remain in place three to five days, then removed in a second surgical procedure.

Tirpik’s doctor refused to remove them, telling her for the first time that he didn’t contract with Ultimed.

Because her first operation was an emergency procedure, she couldn’t be turned away. But, apparently, having the stints removed wasn’t an emergency, and the doctor wouldn’t perform the operation without a guarantee he would be paid.

Tirpik says she then tried for six months to find a physician within Ultimed’s network who would perform the procedure. An infection developed as a result of the stints remaining in place, and with each passing week she became sicker.

“I was in so much pain,” she says. “I was losing weight. I was peeing blood.”

Dealing with the HMO only added to her problems.

“They’d keep me waiting on the phone for hours and hours,” she recalls. “It was terrible. It was pathetic. It got to the point where I would be screaming with them, begging with them, because I literally thought I was dying.

“I tried doctor after doctor. None of them would treat me. They all said they didn’t take Ultimed.”

Time and again, said Tirpik, the HMO would direct her to a clinic for treatment and she’d show up only to be turned away.

“They’d tell me that the problem with Ultimed is that they don’t pay,” recalls Tirpik.

Too sick to find work, Tirpik’s bills piled up, heaping on even more stress as she struggled with her health. Tirpik’s mother took out a home loan to help her daughter fend off creditors. That money, too, quickly ran out.

After six months of trying to find someone to remove the stints, the doctor who performed the original surgery agreed to do it if Ultimed would provide a written payment guarantee. The HMO agreed, says Tirpik, but then failed to produce the paperwork. Finally, out of desperation, she phoned the office of Gov. Jennifer Granholm and told her story to an aide. Within the hour, says Tirpik, Ultimed was on the phone, and the guarantee was being faxed to her doctor.

The stints were removed Sept. 30, and her health returned almost immediately. Along with the scars are about $20,000 in medical bills filling a desk drawer.

“I’m going to have to file for bankruptcy,” says Tirpik.

The bare bones of Tirpik’s story are laid out in an affidavit submitted as part of a lawsuit involving more than $20 million and most of the major players providing health care to Wayne County’s indigent.

It is a snake pit of a system, twisted and treacherous.

Staggering sums

In the early 1990s, in an attempt to rein in the cost of providing health care to the poor, the federal government made a key change in the law. State and local units of government were prohibited from directly receiving federal matching funds for indigent programs. Hospitals such as the former Wayne County General Hospital in Westland were costly and inefficient; better to direct the money to independent hospitals, reasoned the feds. To force the issue, no federal matching funds would be provided to states, cities or counties for direct care to the indigent. But in an area like Wayne County, no single hospital could service all the poor. Likewise, indigent care involves more than hospitals; doctors, pharmacies, optometrists, dentists and others are all part of the system. A loophole provided a way around the problem, and local governments around the country began taking advantage of it. In Wayne County it worked like this:

State, federal and county money would be pooled (last year the sum was $44 million). That money would be placed into an account maintained by one or more hospitals providing a “disproportionate” share of care to poor, uninsured people who required treatment but couldn’t pay for it. But the hospitals only held the funds briefly. The money passed from their hands to a newly created nonprofit organization set up to select providers and administer the funds.

Created by the administration of former Wayne County Executive Ed McNamara, the nonprofit, christened Urban Hospital Care Plus, remained virtually invisible for most of its existence.

According to the nonprofit’s bylaws, its purpose is to “promote, organize, manage and administer programs to create a system for providing or arranging healthcare services in a cost effective manner for persons unable to pay for such care. Additionally, to furnish organizational and operational management and program direction for projects designed to alleviate the cost of uncompensated healthcare to hospitals in the Detroit metropolitan area.”

UHCP was the gatekeeper, if you will. Ultimed and one other HMO had contracts with the nonprofit to establish a provider network of doctors, clinics and hospitals. The HMOs were paid a set amount per person per month (about $100), and were responsible for paying the bills submitted.

Staggering amounts of money were involved.

Over a five-year period beginning in 1997 and lasting until the fall of 2002, UHCP received more than $227 million in government funding, records show. County officials contend the nonprofit, UHCP, received 5 percent of those funds to cover administrative costs. If so, that amounts to more than $11 million over a 5-year period.

A spokesperson for UCHP flatly denies taking such a big cut. According to attorney Lori-Ann Rickard, the nonprofit’s administrative expenses “were less than one-half of one percent … of the total funding of the program.”

What’s not disputed is that an additional sum of about $1.3 million per year was supposed to be paid by UHCP to the county to pay for additional administrative support.

Despite the vast sums moving in and out of its accounts, UHCP kept a low profile. Then a lawsuit hit with all the force of a heart attack.

In June 2003, the Detroit Medical Center filed a lawsuit claiming that it was owed more than $21 million by Ultimed and an affiliated company called Ulticare; both for-profits are owned by Detroit businessman Harley K. Brown. Brown says proudly that his is the only African-American-owned HMO in the country. Because Ultimed operated under a contract issued by UHCP, the nonprofit was also named in DMC’s lawsuit.

The snake pit began to writhe.

The DMC, a group comprising 10 hospitals and institutes, announced that it would stop seeing patients covered by Brown’s companies. UHCP cut off funding to Ultimed. Brown’s Ultimed and Ulticare initiated action against UHCP in an attempt to obtain $5 million he says was owed to his companies. The nonprofit UHCP filed a counter-claim, accusing Ultimed and Ulticare of breach of contract. UHCP also alleged that DMC had submitted more than $12 million in fraudulent claims. Then the county joined in the fray, claiming UHCP owed the county more than $3 million for administrative services performed in 2002 and 2003.

All these disputes remain unsettled.

Mike Duggan, widely credited with playing a significant role in creating the county’s indigent care system, isn’t talking. Duggan resigned as Wayne County prosecutor when he was hired late last year as the DMC’s chief executive officer. In that capacity, he faces the challenge of running a group of hospitals that has lost more than $500 million over the past six years.

Because many of DMC’s financial woes can be traced to the burden of providing care to poor and uninsured patients, there’s no small irony in the fact that Duggan is now in the position of having to deal with the fallout of a system he helped create.

The publication Modern Healthcare lauded him as the “architect” of Wayne County’s program to cover the uninsured in the early 1990s when he served as the chief deputy to McNamara. A key component of that structure was UHCP.

Metro Times asked specifically for information regarding what, if any, role Duggan had in creating the nonprofit. Ginny Seyferth, a spokeswoman for DMC, refuses to answer that question, saying only, “Mr. Duggan has not and does not have any association or involvement with the UHCP/DMC” issues currently being litigated.

The lawsuit, Seyferth notes in an e-mailed response, “was filed well in advance of Mr. Duggan joining the DMC.”

If Duggan did have a hand in creating UHCP while he worked for McNamara, the findings of the Wayne County auditor general could be the reason he won’t talk about it.

Books sealed

In February, Wayne County Auditor General Brendan Dunleavy issued a provocative report on UHCP. By Dunleavy’s own admission, however, it is an incomplete analysis.

“We were unable to perform an audit of UHCP because key documents needed to assess the controls over the financial activity and to evaluate the effectiveness of the overall operations were not provided as requested,” Dunleavy reported.

Despite receiving 100 percent of its funding from government sources — including more than an $8 million from the county, and despite being created under the auspices of the county — UHCP refused to open up its books. The nonprofit’s attorney maintained that because UHCP was not a county agency it “was not an appropriate subject of inquiry by the Office of the Auditor General,” according to Dunleavy’s report.

Given that “unwillingness to cooperate,” Dunleavy relied on the nonprofit’s IRS filings and other publicly available documents.

The county had already cut its ties with UHCP by the time Dunleavy released his report. Another nonprofit, Metro Health Care Services, was established by new Wayne County Executive Robert Ficano to replace it. Dunleavy’s post-mortem was intended to ensure the new system did not repeat problems associated with UHCP, according to the report.

“Based on our examination of these documents and discussions with various individuals, we believe UHCP’s governance structure and operating practices raise many questions and concerns about how well it fulfilled its stated objectives,” reported Dunleavy.


Drawing on interviews conducted while McNamara was still in office, Dunleavy’s department was “consistently led to believe … that all ‘financial matters’ were handled solely by UHCP, along with the related documentation and contracts.”

That proved not to be the case.

Dunleavy concludes that former key members of the county’s patient care management department “may have misrepresented facts or right out lied during previous audits.”

Overseeing distribution of as much as $56 million per year was UHCP’s three-member board of directors. According to Dunleavy’s report, neither the articles of incorporation nor the organization’s bylaws indicate how the directors were selected.

Dunleavy’s report also notes that the directors, who are compensated $150 per meeting attended, seem woefully underqualified.

“… [I]t appears that UHCP’s Board of Directors lacked the knowledge, expertise, and experience to oversee the enormous task of operating a corporation such as UHCP,” Dunleavy reported.

For example, Dunleavy reported that Nancy Roggero, who has served as board president since 1997, is a registered nurse for a school district.

“We question whether serving as a nurse with minimum administrative responsibilities is sufficient experience to serve on a Board that receives and distributes tens of millions annually in what were originally taxpayer dollars,” Dunleavy’s report states.

The nonprofit also lacked the kind of corporate infrastructure one would expect to find in a program of such magnitude.

“… [W]e found that UHCP has no real offices, employees or organization in place to address the significant concerns plaguing indigent healthcare delivery in Wayne County,” reported Dunleavy, adding that “there were no permanent employees with indigent healthcare experience and no physical officers to carry out the many tasks involved in administering over $40 million in healthcare services …”

There was, however, a guy named Edward Forry.

“While Mr. Forry had no clear position or duties with UHCP,” reported Dunleavy, “we noted in our review of Board minutes that Mr. Forry often attended UHCP Board meetings, and often had input on the agenda of items of the Board.”

Furthermore, the nonprofit appeared to rely “heavily” on both Forry and his company, the Berwick Group, to “manage the daily operations of UHCP.”

Nancy Jankowiak, described by Dunleavy as an employee of the Berwick Group, is UHCP’s executive director. And UHCP’s office is located within the Berwick Group’s Livionia office.

Jankowiak is also director of Affiliated Management Group, a nonprofit that, among other things, supplies pharmaceuticals to people on low incomes. That nonprofit, according to its IRS filings, is connected to another nonprofit, Hegira Programs, which provides alcohol, drug abuse and mental health services. Forry is Hegira’s chief executive officer, a job that pays more than $140,000 per year. Asked for comment, Jankowiak referred all questions to UHCP’s attorney.

Another company linked to Forry, Clinical Resource Management, received a $105,000 contract from UHCP to provide outreach and enrollment services to hospitals for the PlusCare Program, according to the report.

“This arrangement could raise concerns of self-dealings, especially since the company’s relationship with Mr. Forry or the Berwick Group did not appear to be disclosed in Board meeting minutes,” reported Dunleavy.

Forry did not respond to a call seeking comment.

UHCP responded to Dunleavy’s accusations with a press release that said his report “consists of unsubstantiated and factually inaccurate statements.”

In essence, Dunleavy’s report is nothing more than a smokescreen, contends UHCP.

The nonprofit’s spokeswoman, attorney Lori-Ann Rickard, characterizes Dunleavy’s report as politically motivated.

“A critical function of UHCP is to insulate these county, state and federal funds from political meddling, and to ensure that providers of indigent care in Wayne County would be paid without diverting the funds to other uses,” says Rickard.

Rickard contends UHCP operated efficiently for more than a decade. Dunleavy’s criticism about lack of staff misses the point: The nonprofit was intentionally lean to make sure as much money as possible went toward indigent care.

The nonprofit did contract with the Berwick Group, Rickard tells Metro Times. For $4,000 a month, UHCP received office space, a secretary and a part-time executive director. It was, she says, a very good deal.

“We find it ironic that the county’s auditor raised unfounded suspicions about UHCP, when it was the county, as UHCP’s contractor, that was responsible for the day-to-day administration of the program. Clearly this report is an irresponsible attempt to damage the reputation of UHCP, and to justify the politicized decision-making that continues to plague the operation of county health care programs,” says Rickard.

Rickard’s finger points at Harley K. Brown.

“UHCP was organized as an independent nonprofit in order to shield the funding for indigent care from the political process,” explained Rickard. “Now that this funding is controlled by Wayne County, significant abuses have already occurred. Chief among these abuses is the continuation of Harley Brown-controlled entities as managed care providers in the indigent care system.”

There’s no doubt Brown is a serious political player.

In September 2002, when then-Sheriff Robert Ficano was campaigning to win the county executive job being vacated by McNamara, Brown hosted a fundraiser that pulled in more than $24,000. Another Brown fundraiser, this one for Wayne County Commissioner Jewel Ware, who sits on the board of another entity called HealthChoice that contracts with Ulticare, collected more than $23,000 for her campaign.

Rickard says the county cut its ties with UHCP because the nonprofit blew the whistle on Brown.

“Talk to providers,” she says. “He doesn’t pay his bills.”

County officials say the reason it stopped dealing with UHCP was because it refused to open its books for a full audit.

In either case, Rickard is far from alone in raising concerns about the way Ultimed and Ulticare do business. Dr. Michael Marsh, immediate past president of the Wayne County Medical Society, says the organization has been dealing with Brown’s companies for three years in an attempt to address payment problems. Eighty-five physicians have lodged complaints with the Michigan State Medical Society, he says.

It is not uncommon for doctors to experience difficulty obtaining payment, he says, “but this company [Ultimed] is particularly egregious.”

Marsh also noted a report done for the state medical society that analyzes HMOs. According to that report, Ultimed spends more than 38 percent of its premium revenues on administrative expenses. That amount is two to five times higher than the 25 other Michigan HMOs analyzed.

Brown disputes the findings, saying his company’s administrative expenses are comparable to others in the industry.

Marsh believes the report.

“With as much as 38 percent of each dollar going toward administration — that really concerned us,” says Marsh.

As for the county continuing to contract with Ultimed and Ulticare, Marsh says: “It really doesn’t smell very good.”

More problems

The wrangling over money doesn’t stop with the flap involving UCHP and Ultimed. HealthChoice, a program for low-income workers, has had similar difficulties.

Established by Duggan, the HealthChoice program is supposed to create winners all around. Started in 1995, it was designed to give small businesses and their employees access to low-cost health care. The cost of premiums is divided three ways, with employers, employees and the government each paying a third of the cost — about $150 per month for each person enrolled in the program.

Businesses benefited from the chance to offer employees low-cost health care. That, in turn, helped the county attract and retain small businesses, strengthening the county’s tax base.

As recently as 2002, the program was receiving national praise.

Like indigent funding, money for HealthChoice — $8 million last year — passed through the hands of UHCP. With indigent care, the nonprofit contracted directly with HMOs to provide coverage; another layer was added to HealthChoice, which is administered by an independent board consisting of three Wayne County commissioners and four people appointed by the county executive. Money would come from UHCP, but the HealthChoice board would enter into contracts with companies providing medical coverage. Technically, the companies are neither insurers nor HMOs, a distinction that allows them to provide a narrower range of benefits. Ulticare, owned by Brown, is one such provider.

By 2003, the program was experiencing major problems. Approximately 1,500 complaints were lodged against Ulticare that year, says Ruby Wesley, director of Wayne County’s Patient Care Management System, which administers the HealthChoice program.

A letter from Jackie Victor, co-owner of Avalon bakery in Detroit, summarizes the situation succinctly.

“We have been grateful to Wayne County for this innovative program that has enabled us to offer health insurance to all of our employees,” Victor wrote to Wesley in November. “ We have enthusiastically supported this program, sharing information with other businesses and even traveling to Lansing to testify on behalf of this program when the funding was in jeopardy. In the past year, however, there have been administrative problems that are causing great distress to our employees and ourselves. For example: two former employees ... have been battling collection agencies since last March when their daughter was admitted to Children’s Hospital for procedures that were approved and covered under our contract with Ulticare. Despite the fact that they have made more than a dozen contacts with Ulticare to clear up any errors, their bills have been sent to collection agencies.

“They have been unable to buy a home or obtain credit cards because of the poor credit rating resulting from the outstanding bills unpaid by Ulticare.

“As you can see, when providers fail to meet their obligations it has a domino effect upon people’s lives, leading to consequences that are in some cases irreversible. Up to this point we have had no recourse to solve these problems: messages have gone unreturned, in many cases voice mailboxes are full. I am asking for your assistance in solving these problems immediately, as the health and well-being or our employees and therefore our business is in jeopardy.”

Victor and her employees were far from alone. So many complaints poured into the offices of Wayne County’s Patient Care Management System that a full-time staffer was assigned the task of dealing with Ulticare-related problems.

Among those affected were Bill and Angela Calder of Belleville. Bill, who works as a truck driver for the dairy owned by his family, was rushed to Oakwood Hospital in Dearborn in April 2003 when a blood vessel burst in his head.

He was back to work by June. At about the same time, the bills began rolling in. At first, the Calders assumed that they were being sent the bills in error. After all, they were covered by Ulticare.

Then they learned Ulticare wasn’t paying providers, who turned the bills over to collection agencies that demanded the Calders pay more than $60,000.

“I contacted Ulticare numerous times and they are absolutely of no assistance what so ever,” wrote Angela Calder in a letter to U.S. Rep. John Dingell.

“My credit rating was excellent, now it’s in the dumpster,” she wrote.

She eventually contacted the Michigan Attorney General’s Office, which placed a call to Ulticare on her behalf. Within days, the company sent a $42,500 check to the hospital. But nearly $20,000 in bills remain unpaid. Collection agencies are threatening to garnishee Bill Calder’s pay.

“This is making me sick,” says Angela Calder.

She means that literally, saying she has developed a bleeding ulcer as a result of all the stress caused by the hounding of creditors and the damage to the couple’s credit rating.


The system for delivering health care to Wayne County’s indigent and working poor began changing drastically last year.

In September, Wayne County canceled its contract with UHCP. The nonprofit claims that Ficano, the successor to McNamara elected in November 2002, prompted the move as a way to gain control of tens of millions of dollars in annual funding.

A new nonprofit, Metro Health Care, was created to replace it. However, because of a waiver obtained by the state, most of the roughly $44 million that once flowed through UHCP now goes directly to the county. Only a small portion — about $4 million — is directed into the new nonprofit, which in turn hands the money over to the HealthChoice board to fund its program.

UHCP says Ficano has politicized the process.

The Ficano administration provides another take on the situation. It says it is regaining control of taxpayer money that previously flowed into a nonprofit corporation that was shielded from public accountability. The fact that UHCP could turn away county auditors is evidence of just how little oversight could be applied.

In either event, Brown continues doing millions of dollars in business with the county.

This is occurring despite significant protest.

Last December, as new contracts with Ultimed and Ulticare were being considered, the Michigan Health & Hospital Association wrote to Ficano urging that county ties to Brown’s two companies be cut. In addition to the DMC litigation, a number of other providers were reporting that they couldn’t collect payments. The continued use of Ulticare and Ultimed, asserted the Health & Hospital Association, “will cause other health plans and providers to abandon these programs and to actively oppose their continuation.”

David Spivey, president and CEO of St. Mary Mercy Hospital in Livonia, wrote a similar letter. Stating that hospital officials had “spent many frustrating hours over the last year, writing letters, making phone calls, reprinting claims, documenting problems and meeting with Ultimed/Ulticare officials.”

Nonetheless, wrote Spivey, problems with the two companies remained “significant and ongoing.”

Chief among them was “non payment of reasonable and appropriate hospital and professional charges despite numerous attempts to collect.”

“As such we believe that contracts with Ultimed and Ulticare should not be renewed and should be discontinued,” urged Spivey.

Harley K. Brown says he’s the real victim in all this. Part of the problem, he says, is that the funding being provided him is inadequate for the task at hand. He points to the fact that a number of companies associated with top-tier providers such as Blue Cross/Blue Shield have stopped participation in HealthChoice. In addition, he claims new requirements regarding the provision of treatment for pre-existing conditions were foisted upon him without any added funding to cover the costs. An evaluation by an independent consultant found that Brown’s complaints had some merit and recommend that the county make a retroactive increase to settle the dispute. However, the same consultant found insufficient evidence to justify Ulticare’s denial of most claims.

The two contracts up for renewal had to follow different tracks for approval.

Decisions regarding HealthChoice contracts to provide coverage for low-income workers lie in the hands of the HealthChoice Board. Normally composed of seven members, one of the four seats reserved for appointees of the county executive was vacant, leaving a 3-3 split between commissioners and Ficano’s people.

Four different providers originally bid on the contract. Of those four, a team of evaluators gave Ulticare the lowest rating. One of the top-rated bidders, Total Health Care, was selected. Concerns about the financial structure of another top bidder prompted the board to put the contract out to bid again. The second time around, Ulticare submitted a bid as part of a newly formed partnership with a company called Pro Care Helath Plan. Ficano’s appointees originally blocked awarding a contract to the Ulticare partnership. At a subsequent meeting, when only two Ficano appointees were present, the contract was awarded to the partnership, with Commissioner Kwame Kenyatta, who serves as chair of the HealthChoice Board, shepherding the process. When Total Health Care dropped out of the program, all enrollees were transferred to the partnership involving Ulticare.

Asked why a company with such a history of complaints would be allowed to continue participating in the program, Kenyatta tells Metro Times that conversations he had with Brown led him to believe that at least part of the company’s problems could be traced to it “not getting the money it was supposed to be getting from UCHP.” Had the money been turned over, he reasons, Brown would have been able to settle claims against his companies.

In addition, with other insurers opting out, the Ulticare partnership at least provided the opportunity to keep the program going.

“They have shown a commitment to serve,” Kenyatta says of Ulticare. “How do you throw out a group that is willing to try and stay in there?”

However, Kenyatta says he harbors concerns about the viability of the HealthChoice program, and will evaluate it closely to determine whether it should be continued.

Paul Stevenson, the attorney representing Avalon bakery and its employees, has a different take on the situation.

“To renew Ulticare’s contract without resolving the existing issues constitutes political malpractice,” he says.

As for Ultimed’s participation in the indigent program, with UHCP out of the picture, the decision on that contract was placed in the hands of the county. It has been operating under temporary contracts since October. The commission is expected to vote on awarding a new contract soon.

Given the lawsuits and other complaints about Ultimed, why is it still providing coverage to thousands of Wayne County’s indigent?

“Ultimed received a scoring that allowed for their continued participation in the program,” says Wesley, a Ficano appointee who directs the county’s patient care management system.


Harley K. Brown sat in a Wayne County courtroom last week and pumped his clenched fist, barely able to contain his glee.

Brown has been trying to shake $5 million from UHCP since last year. The nonprofit cut off his supply of funds beginning in July, citing concerns that providers weren’t being paid.

A month before, the Detroit Medical Center filed a suit claiming Ultimed, Ulticare and UHCP owed it $21 million. The DMC alleged that it hadn’t been paid for care provided to indigent patients since 2000. At the time, Brown called the DMC’s claim grossly inflated.

In canceling its contracts with Ultimed and Ulticare, the DMC announced it would stop seeing patients in the PlusCare indigent program seeking non-emergency care.

That left only St. John’s contracting with Ultimed, putting a serious crimp in the network that’s supposed to guarantee treatment of thousands of indigent residents. That is another reason UHCP decided to “blow the whistle” on Ultimed, says attorney Rickard.

It appears DMC and Brown have worked out their differences. After reaching a settlement agreement, the two sides were in court Friday, March 26, asking for the release of funds being held by UHCP.

Rickard argued in court that the nonprofit needed to hold onto the money because more than 70 providers had just stepped forward claiming they were owed $22 million by Brown’s companies. Rickard contended that it was UHCP’s role to make certain that the money be distributed fairly.

Brown’s attorney and a lawyer for DMC stood shoulder to shoulder as they asked Wayne County Circuit Court Judge William Giovan to order that the $5 million be released so that the DMC’s claim could be settled and the two sides could again start working together.

DMC’s attorney noted that further delay would only hurt poor people. He estimated that upward of a million dollars had already been spent on attorney fees by all the parties involved. That is money that should be going to pay for indigent health care.

Giovan agreed. He ordered UHCP to release the money, and sent lawyers representing everyone with a claim on it to figure out how it should be divvied up.

Asked about the $22 million in new claims, Brown said they posed no problem. It is his contention that the majority of providers on the list aren’t part of his company’s network, that they shouldn’t have been providing care to enrollees without entering into an agreement with Ultimed, and therefore aren’t owed anything.

As for Helen Tirpik, she was finally able to have those stints removed six months after they were put in. It only took the power of the governor of Michigan to make it happen. Within a week she felt well enough to return to work. She found employment cleaning tour buses — a job that provides her with health insurance, so she no longer depends upon Wayne County for coverage. A mountain of medical bills still sits in a drawer, and bankruptcy looms. But the six months of what she describes as “hell, pure hell” are behind her. And should she fall ill again, this time it will be a private insurer, not the county, providing coverage.

“It is,” she says, “like finding the pot of gold at the end of the rainbow.”

View a chart of the players.

Curt Guyette is the news editor of Metro Times. E-mail

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