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9/11 Medical Benefits WTC Health Program

LHI Loses Government Contract to Administer 9/11 Medical Benefits

By Hansen & Rosasco

According to a recent report from NBC News, the company that administers WTC Health Program benefits to program members living outside of New York City has lost its contract with the federal government. The company, LHI, will remain at its post until mid-2022, when the new vendor takes over its duties.

The change comes shortly after news reports in September that quoted 9/11 responders and survivors who stated that the company failed to pay medical bills, offered inadequate treatment options, and lacked the compassion and organization needed to treat patients with post-traumatic stress disorder.

Legal teams with experience are addressing the treatment that WTC Health Program members are receiving through LHI. The right 9/11 benefits attorney is here to help those members address their issues with receiving their medical treatment and monitoring benefits outside of New York City.

Who Is LHI?

Logistics Health Incorporated (LHI) was founded in Wisconsin in 1999 as a subsidiary of OptumServe, to address military medical readiness concerning the mass immunization of service members from anthrax. The company has also been involved in other programs to assist the federal government in administering medical services. The company won the first $11 million contract to administer benefits to WTC Health Program members outside New York City in 2008.

LHI describes its services to WTC Health Program participants as case management, noting on its website that case managers have regular contact with program participants to plan and coordinate healthcare services, monitor progress, and ensure that participants receive high-quality and cost-effective care.

LHI’s Caseload Grew 500 Percent in 10 Years

WTC Health Program members living in the New York City metropolitan area, receive medical treatment and monitoring benefits through several area hospitals affiliated with the program. However, for approximately 24,000 responders and survivors who have left the area since 9/11, LHI has acted as a middle man to ensure that they receive the benefits they deserve, coordinating the scheduling of diagnostic tests and appointments with providers.

In 2010, LHI administered services for about 4,000 WTC Health Program participants living outside of New York. As membership in the program skyrocketed over the next decade, the LHI caseload also increased at a rate of about 500 percent.

Worsening the Trauma of Program Participants?

According to a previous news report, current and former employees have stated that program participants have issues because LHI phased out one-on-one relationships between participants and their case managers, choosing instead to provide a call center structure to address patient needs.

The employees noted that the call center is often inappropriate for participants dealing with post-traumatic stress disorder. The staff members working with the 9/11 community through the call center have not obtained mental health training to understand the needs of the patients they serve.

Members also reported having issues when dealing with LHI, such as:

  • Members noted that they had been billed for services that the program was supposed to cover, even having bill collectors attempting to contact them for payment of the services. The WTC Health Program provides free medical treatment and monitoring of 9/11-related conditions, including prescriptions, as long as they access them through a program-affiliated provider or pharmacy.
  • One member suffering from PTSD reported that he was forced to enter an agreement that if he was “disruptive or abusive” to staff, they would suspend his membership in the program.
  • Employees noted that as demand for services increased, the onus was placed more on program members to fight the bureaucracy to access services, with mistakes causing weeks or months of delays.
  • One program participant noted that the program had approved him for treatment of 9/11-related prostate cancer, including surgery to remove his prostate. Everything worked as planned until his husband went to pick up his prescriptions for antibiotics and painkillers after surgery and was told the medications were not approved. It took 48 hours to get the situation resolved, during which time the man was dealing with post-operative pain without the pain medication usually given after such a procedure. The same member reported that he now has difficulty every time he fills his prescriptions, as he is told he needs prior authorization or he will need to pay for the medications out-of-pocket.
  • Several responders entitled to yearly health screenings have noted that they have not received a screening in years because LHI could not find a provider close to home.

Congress Demands Answers

Four days after NBC News published its initial report about the issues that the WTC Health Program participants had accessing services through LHI, the U.S. House of Representatives’ Oversight and Reform and Judiciary committees summoned the company and program administrators to provide a briefing.

“We are alarmed by recent reports detailing problems responders and survivors are having accessing care,” Reps. Carolyn Maloney (D-NY), Jerry Nadler (D-NY), and Andrew Garbarino (R-NY) wrote in a letter to the company. “These allegations are unacceptable.”

What’s Next for WTC Health Program Members Served by LHI?

The government began soliciting bids for a new contract in August. LHI has entered into a bridge contract with the federal government to continue providing services until the new vendor is in place in mid-2022. Following the announcement that the government would replace LHI with a different vendor, one program participant and 9/11 responder noted that he was shocked by the action but had high hopes that the new company at the helm of coordinating program services for participants would do a better job. “I don’t think you can do much worse than LHI has done,” he stated.

The wife of another participant stated, “It’s huge that I don’t have to deal with those people anymore.” She added that she hopes the vendor will do the right thing for program participants.

New Funding Through Build Back Better Act

The WTC Health Program will have a new case management vendor this year and additional funding for the program because of the Build Back Better Act. The law passed in November 2021 and included  $2.86 billion to shore up major funding shortfalls.

About the WTC Health Program

The World Trade Center Health Program was created in 2011 by the James Zadroga 9/11 Health and Compensation Act. The program replaced two earlier programs that provided similar medical treatment and monitoring services to the 9/11 community. The benefits are available to first responders, general responders, survivors, or Shanksville/Pentagon responders exposed to the toxins at the September 11 terrorist attack sites. Applicants must prove that they were present in an exposure area on 9/11 or during the rescue, recovery, and cleanup operations that followed.

The WTC Health Program’s certification of medical conditions linked to 9/11-related toxic exposure is also one qualification for responders and survivors who want compensation from the other federal 9/11 benefits program, the September 11th Victim Compensation Fund (VCF).

More than 100,000 responders and survivors have enrolled in the WTC Health Program. Enrollment numbers are largest for the General Responder group, which includes New York City-area law enforcement personnel and others who worked or volunteered with the rescue, recovery, and cleanup operations. This group accounts for more than half the program’s enrollment, while survivors-including those who lived, worked, or attended school or daycare in Lower Manhattan when the attack occurred-account for slightly more than a quarter of the program’s participants.

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