PODCAST: Athena Health Care systems behind on paying employee health claims, and staff are hurting

Athena Health Care Systems is one of Connecticut’s largest nursing home chains. Its CEO said the company is behind on paying employee health claims — and staff members say they’re struggling.

WSHU’s Ebong Udoma spoke with CT Mirror’s Dave Altimari to discuss his article written with Jenna Carlesso, “Athena nursing home workers say medical bills still going unpaid,” as part of the collaborative podcast Long Story Short. You can read their story here .

WSHU: Hello, Dave. You and fellow Connecticut Mirror reporter Jenna Carlesso have been looking into Athena Health Care’s troubles for a while now and have been able to secure some of the internal email communication. How did that come about?

DA: Well, what’s happened is we’ve been writing — I believe our initial story was almost 18 months ago now — about how Athena was having financial problems. Since then we’ve seen lawsuits filed, we’ve seen them sell some of their nursing homes here in Connecticut. And along the way, people who work in these facilities — they also have facilities in Massachusetts and Rhode Island — have contacted us complaining about their issues with their health insurance.

WSHU: Exactly what are these issues? Because it seems as if you found that Athena was trying to address them in some way.

DA: Basically people there, Athena’s not paying people’s health care bills, and people have racked up thousands and thousands of dollars in debt because of that. And they’re getting hounded by debt collectors or having their appointments canceled because the doctors or the hospital group won’t schedule their appointments because they’re not getting paid by the insurance — Athena is a self-insured company. So I think a lot of people are frustrated, not only with those issues, but the reality is, in some cases, for the company’s quote-unquote “gold plan,” you have to put $140 a paycheck into it.

WSHU: And this has been deducted from the paychecks already, right?

DA: Yes. So you have health insurance, it’s deducted out of your pay, right? And then you go to the doctor, and there’s a copay, and then the rest gets paid by your insurance. Well, that’s not happening on the last part of that for a lot of Athena employees, and they’re wondering, where did that money go? You know, I mean, we’ve been paying in for, in some cases, some of these people have worked 15 and 20 years, certainly since the current owner Lawrence Santilli has owned them, and they can’t get their medical bills paid. Now, Athena has publicly stated previously that they’re, you know, they’re having financial problems and they are behind. They have acknowledged that in emails and some other things that we got when we FOIA’d the state. A bunch of different state agencies’ complaints seem to indicate that those troubles go back a lot farther than what Santilli has said publicly, significantly more than six months.

WSHU: Now, you have a quote from an Athena spokeswoman saying they’re actively working to address the issue. What does that mean?

DA: They are, I believe, trying to basically pay people’s bills. So Athena just sold, a couple of months ago, they sold five nursing homes in Connecticut to another company called National Health Care. Part of that deal called for National to put more than $2 million into the employees’ health care fund. So that tells me that that money was needed to pay back claims that all the people that worked in those nursing homes that Athena had not paid. So that gives you some kind of a sense of how big of a problem this is for people.

WSHU: Yeah, I see that one employee had a $234,000 bill that has not been paid.

DA: I mean, that’s obviously a massive amount, but even people who have $10,000 in unpaid bills, that’s a lot of money. And what’s happening is, they’re getting debt collectors who are calling them or trying to find them because the hospital systems have private debt collectors, so they’re trying to collect since Athena is not paying, they’re trying to collect the money from the patients.

WSHU: So what are the state insurance officials saying?

DA: So we contacted multiple state agencies in Connecticut, the Department of Labor, the Connecticut Department of Labor, Attorney General, DSS. We also contacted the Massachusetts Attorney General. It seems like basically everything has been kind of funneled to the federal department, the U.S. Department of Labor, and their New England office really wouldn’t answer any of our questions about what they are investigating, or what are they doing here to try to help people. Athena, in their own statements, has indicated that they’re working with the U.S. Department of Labor to try to address these issues.

WSHU: But it seems as if Massachusetts was able to get some money from Athena.

DA: They’ve had some success. Rhode Island, the attorney general has been pretty aggressive. The Massachusetts AG has referred complaints, at least from the people that I’ve talked to, to the U.S. Department of Labor. So I think, you know, people are frustrated, this has been going on for a while, and they want to know what happened to their money.

WSHU: So in the meantime, is Athena still the largest provider of nursing home care in Connecticut?

DA: I think now that they sold five, they may not be the largest anymore, but they’re clearly one of the largest, you know, certainly one of the top two or three. State officials have been working with them behind the scenes. There are rumors that they’re going to sell more. I think the state honestly wants to get them out of the business, quite frankly. Things aren’t getting any better. You know, the health insurance thing is the thing that we’ve reported on here, but they still haven’t paid some vendors, there’s still outstanding other bills that show that the financial troubles that have been hounding them for the last 18 months aren’t going away.

WSHU: Well, so, no immediate remedies for these employees.

DA: Now, the people who worked at the five homes that were sold, I do know people there and their bills have been paid. So I do think that’s probably the way forward for some of these places, but Athena owns well over 30 homes in three states, it’s not an insignificant nursing home chain. They own a few of Rhode Island, they own 15 or so at least in Massachusetts, they still own 12 to 14 here in Connecticut. So you know, that’s a lot of nursing homes that are still under their purview.

WSHU: Well, thank you so much, Dave.

DA: Thanks Ebong.