Jill Goodridge was searching for reasonably priced medical health insurance when a good friend instructed her about O’NA HealthCare, a low-cost various to industrial insurance coverage.
The self-described “health care cooperative” promised a defend towards catastrophic claims. Its title urged an affiliation with a Native American tribe — a theme that carried by means of on its web site, the place a feather floats from part to part.
The firm guarantees 24/7 telemedicine and holistic dental care on its web site. It says it supplies extra nontraditional choices than “any other health care plan,” together with protection for essential oils, power medication and naturopathic care. All of that and standard care, too.
It struck Goodridge as progressive. She signed up for a high-deductible plan, paying greater than $9,000 in premiums and costs over 13 months, she stated. Yet she couldn’t get O’NA to cowl her household’s medical payments. For instance, O’NA utilized solely a small portion of greater than $6,000 in hospital-related payments towards her $10,000 deductible.
“It almost seemed like we were just spending the premium money every month for really not much,” stated Goodridge, whose household runs a Rockland, Maine, restaurant that’s quickly shuttered due to the coronavirus pandemic.
A year-long investigation by the state insurance coverage company prompted by her grievance concluded she was proper, uncovering a enterprise scheme working within the grey areas of insurance coverage regulation and tribal legislation to enchantment to sufferers trying to save cash on well being care.
Hers is a cautionary story for anybody on the lookout for cut-rate protection at a time when the price of industrial insurance coverage is rising and a wide range of alternatives are on provide.
Tempting low premiums could imply skimpy protection with large out-of-pocket bills.
“Health insurance is getting so expensive people are looking for other options,” Maine insurance coverage Superintendent Eric A. Cioppa stated. “We tell everybody that if you do business over the internet to call us first and make sure it’s licensed.”
O’NA stood out, with a elegant web site that includes its story of holistic well being and sun-dappled pictures. The gross sales pitch: “We’re here to guide you to a new way for your mind, body, and soul.”
Goodridge felt led astray.
The firm claimed Native American ties that may exempt it from state insurance coverage rules due to tribal sovereignty, which supplies federally acknowledged tribes the authority to self-govern exterior of state or federal legislation. O’NA claimed it didn’t have to stick to federal insurance coverage necessities, similar to guaranteeing normal protection or sustaining a chosen degree of funds in reserve to pay claims.
O’NA HealthCare seems to be the primary insurer to say that Native American standing exempted it from oversight, in keeping with the National Association of Insurance Commissioners.
The firm marketed it was “comfortably nestled under a Native American tribal corporate umbrella” and “protected by the many rights and privileges that Native American Indians enjoy today.”
It despatched its clients a “tribal membership ID & benefits card.” And it stated it derived its standing from an affiliation with the United Cherokee Nation-Aniyvwiya. That tribe will not be one of many three federally acknowledged Cherokee tribes.
But the troubles with O’NA went deeper than that, Cioppa and his workforce found throughout a year-long investigation. Along with critical doubts that anybody concerned with O’NA had legitimate indigenous roots, there have been monetary irregularities, allegations of embezzlement and phony skilled credentials.
“The more we found out,” Cioppa stated, “the more we wanted to keep digging.”
Jill Goodridge took an opportunity on a nonprofit “health care cooperative” bought on-line by a Native American firm referred to as O’NA HealthCare. After paying greater than $9,000 in premiums and costs over 13 months, Goodridge says, she couldn’t get O’NA to cowl her household’s medical payments. (Shelby Knowles for KHN)
For Patients, A Tempting Offer With Red Flags
There was a lot about Goodridge’s new protection that appeared unorthodox to the investigators.
She paid a tribal membership price of $165, which the corporate stated was a tax-deductible contribution to an unspecified Native American tribe. In addition to conventional medication, O’NA stated, its members may search care at “Native American Tribal Healing Centers” nationwide, although it didn’t determine the facilities or their places. Goodridge additionally paid a household premium of $751 a month for 13 months earlier than canceling, in keeping with her testimony earlier than the Maine Bureau of Insurance.
Stranger nonetheless, investigators discovered that O’NA required physicians to pay $485 a yr to affix its community. Her physician declined.
On high of that, Goodridge testified, the plan didn’t pay out when wanted, together with a lot of that $6,000-plus hospital invoice.
It turned out, that was not unusual for an organization that describes its companies as “low cost, high value.” According to a state inspection of O’NA’s unaudited books in fall 2019, the plan spent an “unusually low” quantity of the $2.5 million it collected in premiums to cowl clients’ medical payments — simply 13% or much less. Under federal legislation, most insurers spend 80% or extra on advantages for subscribers.
“However low its prices may be, the value it delivers is even lower,” Cioppa wrote in his December order.
Cioppa instructed KHN that state investigators couldn’t decide the total scope of the operation, partly as a result of O’NA, which boasted an “open provider network across all 50 states,” refused to inform them what number of members it had signed up nationwide. It lined solely 27 folks in Maine.
O’NA’s bookkeeping additionally turned out to be suspect. Maine investigators noticed that in 2019 O’NA paid few medical payments and didn’t hold sufficient money readily available to deal with even a few catastrophic sickness claims, a violation of state insurance coverage rules.
Ultimately, Cioppa dominated that O’NA had illegally operated an insurance coverage firm, falsely marketed its advantages and did not put aside satisfactory reserves to pay claims.
O’NA’s CEO, L.J. Fay, stated the corporate is working laborious to beat previous errors, noting: “We plan to make everything right. That is the ultimate goal.”
But within the meantime, Cioppa has prohibited O’NA from promoting insurance policies within the state.
The People Behind O’NA
Over the years, Benjamin Zvenia has introduced himself at varied occasions as a physician, a lawyer and a tribal decide. O’NA was described by the United Cherokee Nation-Aniyvwiya as Zvenia’s “brainchild,” in keeping with the Maine insurance coverage bureau order.
He has a paper path of felony and civil infractions relationship to the early 1990s, authorities data present.
In a sworn assertion filed in Maine, Zvenia stated he was a member and “administrative tribal judge” of the Nottoway Tribal Community Meherrin Band of North Carolina. That tribe will not be among the many 573 acknowledged by the federal authorities.
Zvenia additionally instructed Maine officers he served on the board of administrators of Tribal Active Management Services, O’NA HealthCare’s father or mother firm, however had not been paid for his “voluntary” companies and had no duty for day-to-day operations. In a sworn assertion, Zvenia denied enjoying a significant function in O’NA. He didn’t reply to repeated requests for remark for this story.
Zvenia, the truth is, has a felony conviction in Nevada for training medication with no license, which prohibits him from overseeing an insurance coverage firm, in keeping with Maine officers. He was sentenced to 6 years in jail, court docket data present.
In his assertion, Zvenia wrote, “There was a crime, and I did the time. My previous history may be public information, but it is not part of my accomplishments today.”
Zvenia’s authorized work additionally has drawn scrutiny. In March 1999, the Nevada Supreme Court eliminated him from a listing of non-attorney arbitrators, citing his undisclosed felony conviction. A State Bar of Nevada investigation discovered Zvenia had utilized to follow in immigration court docket, claiming to carry a legislation license issued by the Supreme Court of the Federated States of Micronesia. But the state bar checked with Micronesia, and it couldn’t confirm his claims.
Zvenia additionally instructed a state bar investigator that he graduated from the Kensington College “School of Law” in California. The school stated Zvenia had utilized in June 1994 however “never completed enrollment,” in keeping with an exhibit filed with the Nevada Supreme Court order.
A founding father of O’NA HealthCare was Alan Boyer, a Utah musician who stated he was a member of the Cherokee Nation. He was born in West Yorkshire, England, and emigrated to the U.S. in 1998, when he was almost 40 years previous.
Boyer was a founding father of a British-style brass band in Utah but additionally dabbled within the holistic therapeutic arts and naturopathic merchandise earlier than his demise in December 2018 from most cancers at age 59. In one promotional video for O’NA, Boyer, who spoke with a pronounced British accent, stated the phrase O’NA means “new beginnings.”
“One of Alan’s greatest achievements in his later years was acceptance as a sovereign member of the great Cherokee Nation,” reads a web based obituary entered into the file within the Maine continuing.
Maine regulators had their doubts: “It does not appear from the record that any Native Americans have been involved at any time in the establishment, management or operation of O’NA,” reads the state order.
Lisa Hughes, the previous CEO of O’NA and a resident of the Salt Lake City space, additionally raised Maine regulators’ eyebrows. Investigators discovered Hughes’ on-line résumé reveals greater than a decade of expertise in rocket engineering and consulting work in Utah. She lately instructed Maine officers she had been employed at O’NA due to her prior expertise in “systems development and cashflow analysis.”
In an affidavit and different authorized filings filed in January, Hughes asserted she labored for O’NA for a number of years “with no or very reduced salary” earlier than the corporate suspended her in July 2019 amid a company energy battle. The subsequent month, O’NA despatched her a letter from a legislation agency accusing her of embezzling $295,000, filings within the Maine investigation present.
In her affidavit, Hughes stated O’NA concocted the embezzlement accusations “for purposes of smearing me and making me the scapegoat for O’NA’s legal formation and structure.”
Lessons Learned ― Or Not
In his December order, Cioppa gave the insurer till Jan. 21 to create a $100,000 fund to fulfill any excellent medical claims. O’NA failed to take action, and now state officers are searching for a $450,000 penalty, although they aren’t optimistic about gathering it.
Today, O’NA has promised to reinvent itself as a “different type of insurance company,” in keeping with CEO Fay. She stated in an affidavit that it’s anticipating a capital infusion of as a lot as $120 million and has $500,000 in reserves in a cash market account in a Salt Lake City financial institution. She additionally indicated the corporate would file for a license to legally function in Maine. So far, that has not occurred.
Zvenia remains to be energetic on-line, providing skilled and consulting companies by means of Zvenia and Associates in Las Vegas, which says on its web site that it’s a “law firm guided by Benjamin Zvenia, Dr PH, JD.” The web site posts a disclaimer: “All Nevada State legal matters are referred out; our lawyers & advocates are not licensed to practice Nevada State law.”
O’NA presents a brand new wrinkle in an ongoing battle: The states regulate insurance coverage however the web permits for nationwide gross sales, leaving customers mainly on their very own.
Goodridge, the Maine client who sparked the investigation, stated in an interview that she holds little hope of getting any a refund. But she has saved different Mainers from the identical troubles.
Though O’NA well being plans are nonetheless obtainable in lots of states, its web site notes that protection is “not available in Maine.”