Some Insurers Checking Provider Lists for Terrorists Joyce Frieden Associate Editor, Practice Trends Insurance plans say they now must cross-reference lists of business partnersincluding providersagainst a federal list of known or suspected terrorists. As a result of an executive order issued shortly after Sept. 11, 2001, many health plans say that they are now required to compare their provider, member, and applicant lists with a list of potential terrorists maintained by the Treasury Department's Office of Foreign Assets Control (OFAC). If we didn't have to do it, we probably wouldn't, said Helen Stojic, spokeswoman for Blue Cross Blue Shield of Michigan, which is matching the names on the OFAC list against its database of 4.8 million members and 20,000 providers. [But] we did not see it as something that was voluntary. Other plans that are checking member and provider databases with the OFAC list include Cigna and Aetna US Healthcare. So far, none of those three plans has found any matches to the list. The executive order states that any transaction or dealing by United States persons or within the United States in property  blocked pursuant to this order is prohibited, including but not limited to the making or receiving  of funds, goods, or services to or for the benefit of those persons listed by the government. Because there was some confusion about whether the order applied to health insurers, the American Association of Health Plans-Health Insurance Association of America sought more information from the Treasury Department. The Treasury Department sent back an informal guidance document explaining that the executive order applies to government agencies and private companies including health plans and insurers and that one method for health plans and insurers to comply is to search their records to see if there are any individuals or businesses that match the names on the OFAC list. If a plan does receive an insurance application from someone on the list, it is obligated not to issue the policy, and if it has inadvertently already issued a policy to a person on the list, plan officials are supposed to contact the Treasury Department. Although the document did not say that comparing lists was the only way to find out if an insurer is doing business with a suspected terrorist, I haven't heard of any other method, Ms. Stojic said. The federal government is not alone in requiring health insurers to comply with the executive order, noted Fred Laberge, spokesman for Aetna US Healthcare, in Hartford, Conn. We've seen similar requests from state departments of insurance saying, We've seen this executive order; demonstrate that you're complying with it. Florida and New York are among the states that have made these requests, he said. Since member and provider lists change constantly, the cross-referencing will be ongoing, plans say. It includes scanning of our databases on a periodic basis to screen new customers and transactions on the OFAC list, said Cigna spokeswoman Amy Turkington. Plans say these checks do not compromise any personal health information or raise any privacy concerns under the Health Insurance Portability and Accountability Act (HIPAA). We're not sharing any information about our members beyond checking the list of names, said Aetna's Mr. Laberge. Private medical information is not even being looked at or asked about. Still, civil libertarians are not happy with the order. We know that databases are filled with errors, said Virginia Rezmierski, Ph.D., of the school of public policy at the University of Michigan, Ann Arbor. If a patient's account is mistakenly frozen because he or she is thought to be on the OFAC list, what does that do to someone getting ready to have a procedure? Checking names against the OFAC list is not as bad as using claims data to do the same thing, Dr. Rezmierski said. However, by approaching terrorism and deterrence of it in this way, we've effectively thrown out the entire notion of innocent till proven guilty. We are now guilty until there's no match. Instead of going from knowledge about the behavior of an individual and having cause to do this violation, we're violating everyone. Jay Stanley, communications director for the technology and liberty program at the American Civil Liberties Union, said he was concerned that this is part of an overall trend of the government enlisting private individuals and companies into its information-gathering and enforcement proceedings. Obviously, it's a good thing if no one does business with true terrorists, Mr. Stanley said. But the problem is that there are no established guidelines for due process in how one gets placed on these lists. Mistakes have been rife, especially when you are talking about Arab names  which have to be translated into a different alphabet. Mr. Stanley noted that such lists are set up primarily to prevent terrorists from laundering money through unsuspecting American corporations. As far as I can tell, nobody uses health insurance to launder money. There are basic questions that need to be asked about the cost and benefit of targeting here. February 2004  Volume 32  Number 2 http://www2.eClinicalPsychiatryNews.com/scripts/om.dll/serve login: cypherpunks/writecode