National Provider Network (NPN) Contract
Since the Program’s inception in 2011, the Federal contract to run the National Provider Network (NPN) had been with Logistics Health Incorporated (LHI).
Logistics Health Incorporated had difficulties in delivering services across the country as documented in press reports but there were plans to improve service delivery, with better recruitment of providers, to establish brick and mortar locations in areas with high membership numbers, in addition to other steps to address the problems.
However on November 23, 2021, the Centers for Disease Control (CDC) announced it had awarded the contract to run the Nationwide Provider Network (Contract Number: 75D301-22-C-12935) to a new vendor, Managed Care Advisors (MCA)-Sedgwick.
After several months delay to reportedly better prepare for the changeover, Managed Care Advisors (MCA)-Sedgwick replaced Logistics Health Incorporated (LHI) as the vendor that operates the National Provider Network of the World Trade Center Health Program (NPN) on August 1, 2022.
You can see updated information from the World Trade Center Health Program on this change over in vendors here.
911 Health Watch Inc. was very concerned about the change in vendors since it was announced and how the new vendor might impact the care of members in the NPN. We wanted to make sure that access to the services provided by the NPN was not disrupted. 9/11 Health Watch Inc. raised early concerns with the CDC about the thoroughness of the contracting process that the CDC contracting office undertook. In addition, we hade mounting concerns about the new vendor, Managed Care Advisors Sedgwick , and its new owner Sedgwick, (which has its own history of problems delivering care), which is majority owned by the Carlyle Group.
911 Health Watch Inc. launched a series of letters to the Director of the CDC, Dr. Rochelle Walensky, outlining our concerns about the contracting process and this change in vendors during the pandemic.
Regretfully our concerns regarding the CDC’s contract office management of the contract have proven to be well founded given the abysmal performance of Managed Care Advisors Sedgwick (Sedgwick) since taking over the program on August 1, 2022.
Since Sedgwick took over, World Trade Center Health Program Members in the National Provider Network have experienced increased difficulties and barriers to accessing medical services. From inordinate wait times at the Sedgwick call center, to providers not being in the new network, to incorrect information being provided by the Sedgwick staff.
It is clear that, Sedgwick is not meeting the requirements of their contract with the CDC and not providing the services that are needed to injured 9/11 responders and survivors.
Seeking help with the complex issues regarding federal contracting and oversight of those contracts, 911 Health Watch sought the assistance of the Project On Government Oversight (POGO) and gave it a $10,000 grant to help in the review of the CDC’s contracts. Founded in 1981, POGO is a nationally recognized nonpartisan independent watchdog that investigates and exposes waste, corruption, abuse of power and when the government fails to serve the public or silences those who report wrongdoing.
On September 19th, 2022, consulting with 911 Health Watch, POGO sent a letter to Director of the CDC, Dr. Rochelle Walensky regarding the CDC’s contract office and its management of contracts to assist the World Trade Center Health Program.
The POGO letter asks specific questions and raises concerns over the CDC’s award and administration of the WTCHP’s three recently initiated contracts: the Nationwide Provider Network contract, the Pharmacy Benefits Manager contract, and the Third-Party Administrator contract.
POGO received a response on behalf of CDC Director Walensky on October 13th, 2022.
Given the continued abysmal performance by Sedgwick in managing the National Provider Network for the WTC Health Program 911 Health Watch wrote directly to Sedgwick’s CEO David North on January 6th , 2023 which you can see here.
Here is an excerpt from our letter.
“We’d like to believe that WTCHP members will be spared the horrendous experiences of Amazon employees who get their medical services from Sedgwick. (“Amazon employees are left to suffer after workplace injuries,” The Guardian, April 2, 2019.)
But that does not appear to be the case.
We assume Sedgwick was the low bidder for this contract and you thought you would take your worker compensation business model of spending as little as possible and providing as little assistance as possible on this contract.
Using this model, Sedgwick’s poor performance will continue to impact the care of 9/11 responders and survivors.
Using that model, it appears that instead of “never forgetting” 9/11 and the injured 9/11 responders and survivors whose health is still impacted by it every day, it appears that Sedgwick forgets 911 everyday—by delivering abysmal service to this community.
Mr. North, what is Sedgwick going to do about this?”
We received this response from Sedgwick on January 24th, 2023.
Here is an excerpt from Sedgwick’s response.
“Our client, the WTC Health Program, will follow up with you on additional answers to the questions outlined in your letter.
We continue to partner with the WTC Health Program to find solutions and respond to member needs. With a heightened focus on member experience, Managed Care Advisors works to directly engage with members to ensure they receive the resources needed through these benefits.
Since Managed Care Advisors started supporting the WTC Health Program in August 2022, we have made significant progress and made sure we are doing everything we can to support our members. We have taken steps that include:
• We have expanded member service call center staffing and hours of operation, resulting in increased performance over the last few months. We continue to make improvements.
• We have staff in place and have improved our auditing and monitoring resources to support program members.
• In collaboration with our client, the National Institute for Occupational Safety and Health (NIOSH), we have sent multiple rounds of provider disruption letters to members.
• We have added supplemental support to recruit more providers into the network on a daily basis.
• We have developed onboarding and training programs on the program guidelines, and all of our colleagues who work on the program participate in those activities.
• We continue to communicate with members to ensure they are not billed for WTC-related services and that all WTC-related bills are sent to us for processing.
We are here to support the members of the WTC Health Program and are always open to feedback. The core of our work is taking care of the 9/11 responders and survivors.”
On January 20th, 2023, Senators Gillibrand and Schumer wrote to the CEO of Sedgwick David North directly raising to Sedgwick their concerns over their performance so far in delivering services to 9/11 responders and survivors in the National Provider Network that Sedgwick is managing.
On February 10th, 2023, Lisa Firestone, President of Managed Care Advisors, the subsidiary of Sedgwick responded to the Senators by denying the scope and severity of the problems World Trade Center Health Program Members in the National Program have been experiencing.
Here is the Sedgwick response.
ARE YOU A WTC HEALTH PROGRAM MEMBER HAVING PROBLEMS WITH GETTING SERVICES FROM THE NATIONAL PROGRAM?
If you are a 911 responder or survivor in the National Program getting services from Sedgwick and you experience any disruptions with your care, have concerns about your care and/or questions you can contact 911 Health Watch by going to our web respond portal and we will get back to you.
Here is our 911 Health Watch Contact Us Portal.
WTC HEALTH PROGRAM WEBSITE ON NATIONWIDE PROVIDER NETWORK TRANSITION
Nationwide Provider Network Transition Information (cdc.gov)
February 10th 2023, Sedgwick Response to Senators
January 24th 2023, Response from Sedgwick to 911 Health Watch Letter
January 20th, 2023, Gillibrand, Schumer letter to Sedgwick
January 6th 2023, Letter to Sedgwick CEO
November 16th, 2022, CDC response to 911 Health Watch letter.
November 10th, 2022, 911 Health Watch letter to CDC Director Rochelle Walensky
October 13th 2022, Response to Project on Government Oversight from CDC
September 19th, 2022, Project on Government Oversight Letter to CDC Director Rochelle Walensky
April 5th 2022 CDC Letter in Response
February 16th, 2022, 911 Health Watch Letter to CDC Director
January 24th, 2022, CDC Letter in Response to 911 Health Watch Letter
December 7th, 2021, 911 Health Letter to CDC Director
9/11 ‘vampire’ Christine LaSala blasted over service to ailing responders
NY Post | April 4, 2023
The “vampire” of 9/11 – a woman infamous for fighting illness claims by Ground Zero workers – is now overseeing a healthcare firm that is making their lives a “nightmare.”
Health company for 9/11 first responders still falling short: advocates
NY Daily News | January 23, 2023
The company that took over the contract to treat thousands of ill 9/11 responders around the country is still failing to do the job, advocates charge in a new letter to the firm’s parent company.
Macon man who worked during 9/11 struggles to get therapist
13 WMAZ | December 16, 2022
The 9/11 health providers have not found a counselor for him, but he’s not the only one.
CDC keeps contract with Managed Care Advisors-Sedgwick as it struggles to provide medical services to 9/11 responders
NY Daily News | November 22, 2022
The CDC has no plans to terminate a contract with a company that is struggling to provide medical services for 9/11 responders, and the agency is declining to say what penalties the firm could face.
9/11 advocacy group asks CDC to reconsider contract with Sedgwick for health services due to ‘nonperformance’
NY Daily News | November 16, 2022
The letter identifies numerous instances where Sedgwick still needs to live up to the contract’s requirements, which called for a system of providers to be in place and ready to go in May.
9/11 health program users plagued with problems using new medical providers
NY Daily News | November 7, 2022
A change in the companies managing health care for more than 118,000 people sickened by the 9/11 attacks has proven a nightmare for many enrolled in the program.
Health care problems persist for Tampa Bay 9/11 survivors enrolled in troubled government program
WFLA News Channel 8 Tampa Bay | September 12, 2022
The multi-billion-dollar government program set up to provide healthcare for more than 100,000 9/11 survivors continues to frustrate Floridians and others across the country.
Jacksonville 9/11 first responder battling cancer dropped from WTC health program after insurance provider switch
News4 Jacksonville | September 1, 2022
Jeffrey Brown helped recover and remove bodies at the Pentagon. He said the WTC program paid for his cancer treatments up until last week.
House members from New York want info on federal contract to manage health care for some 9/11 survivors
NBC News | March 22, 2022
A federal spokesperson said handing management of the program over to a new firm would be delayed “to allow more time for a smooth transition.”
Maloney, Nadler, Garbarino Request Information About New Federal Contract for 9/11 Survivors’ and Responders’ Medical Care
House Committee on Oversight and Reform | March 22, 2022
Following reports that some responders and survivors of the September 11, 2001, terrorist attack were not receiving the medical care they deserve, the Members have been conducting rigorous oversight of the program.
FIRM THAT ADMINISTERS MEDICAL BENEFITS FOR SOME 9/11 SURVIVORS LOSES FEDERAL CONTRACT
NBC News | November 29, 2021
Survivors said the program was failing to pay medical bills, providing inadequate treatment options and neglecting to address the needs of a population with significant rates of post-traumatic stress disorder.
MALONEY, NADLER, GARBARINO SEEK INFORMATION ON SERVICES PROVIDED BY CONTRACTOR TO 9/11 SURVIVORS AND RESPONDERS
House Committee on Oversight and Reform | September 14, 2021
We must ensure the World Trade Center Health Program not only has the necessary resources, but that the program is properly administered so that members receive the high-quality care that they need and deserve.
‘I FEEL BETRAYED’: SOME 9/11 RESPONDERS STILL FACE MAJOR HEALTH CARE OBSTACLES
NBC News | September 9, 2021
A company tasked with helping responders and survivors get free medical care has failed to achieve some of its basic aims, patients and staffers say.
GAO Report World Trade Center Health Program Quality Assurance Program Should Include Monitoring of Access to Health Services July 29, 2022