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 (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. 911 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 had 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 was 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.
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.
On February 17th, 2023, New York State Comptroller Thomas DiNapoli, wrote to Harvey Schwartz, CEO of the Carlyle Group to express concerns about the job that Sedgwick, which Carlyle Group is a majority owner, is doing in performing its contract as the National Provider Network for the World Trade Center Health Program. Here is his letter.
On March 8th, 2023, Sedgwick CEO Michael Arbour responded on behalf of the Carlyle Group to the Comptroller. Here is his letter.
On May 19th, 2023, 911 Health Watch Executive Director Benjamin Chevat wrote to the Carlyle Group regarding the troubling issues raised by Sedgwick’s response.
Our letter can be found here.
While service for 911 responders and survivors in the National Provider Network has improved with more providers being available to program members and better services from Sedgwick, 911 Health Watch continues to be concerned regarding the performance of the CDC contract office and its management of the contracts for the World Trade Center Health Program and what that means for the health care of 911 responders and survivors.
On February 6, 2024, 911 Health Watch wrote to the Director of the Centers for Disease Control regarding the CDC Contract Office poor performance in administering the contract for National Provider Network and the impact that has had on services to the program members along with specific suggestions for the Contract Office to follow in any future RFP’s when the NPN contract expires.
On March 29th, 2024, the CDC responded with saying that the contract office will take our suggestions into consideration.
Following up our letter to the CDC Contract office, 911 Health Watch wrote additional letters regarding the contract office performance regarding contracts for services for the WTC Health Program.
We wrote on March 20, 2024, to the Director of the CDC regarding the World Trade Center Health Programs Third Party Administrator Contract (TPA) and the extensive problems that the CDC contract office has had in issuing that contract.
On April 11, 2024, 911Health again wrote to the CDC Director regarding the CDC’s contract office this time regarding the Pharmacy Benefit Manager (PBM) contract and the problems that the program has experienced each time the CDC has changed PBM managers and the impact that that has had on the WTC Health Program members.
On April 25, 2024, Senators, Kirstien Gillibrand and Charles Schumer along with Members of Congress Andrew Garbarino, Jerrold Nadler, Anthony D’Esposito, Dan Goldman wrote to Health and Human Services Secretary Xaiver Becerra urging that New York area Clinical Centers of Excellence be allowed to provide services to NPN members to help increase NPN capacity and give members greater flexibility and choice.
On July 10th, 2024, Senators Kirsten Gillibrand (D-NY), Charles Schumer (D-NY), Mike Braun (R-IN) along with Members of the House Andrew Garbarino (R-NY), Jerrold Nadler (D-NY), Anthony D’Esposito (R-NY) and Dan Goldman (D-NY) wrote a letter to Dr. Mandy Cohen, Director of the Centers for Disease Control about the continuing problems that members of the World Trade Center Health Program National Provide Network (NPN) were having in getting services from MCA Sedgwick.
The letter stated:
While there have been improvements in service, such as the wait time to get the call centers to answer and the expansion of the number of providers in the Network we are concerned that there are still serious deficiencies in MCA Sedgwick’s ability to deliver services.
While your staff have been providing regular updates to our offices on a continuing basis, we would like to have the Centers for Disease Control (CDC) provide us with additional information:” and then asked a series of detailed questions.
On August 23, 2024, Senators Kirsten Gillibrand (D-NY), Charles Schumer (D-NY), Mike Braun (R-IN) along with Members of the House Andrew Garbarino (R-NY), Jerrold Nadler (D-NY), Anthony D’Esposito (R-NY) and Dan Goldman (D-NY) wrote another letter to Dr. Mandy Cohen, Director of the Centers for Disease Control (CDC), this letter regarding the CDC’s contracting office and its administration of contracts for the World Trade Center Health Program.
Their letter suggested that any future contracts for the program have enforceable termination provisions allowing the program to fire a vendor for non performance, Financial penalties allowing for action short of termination for non performance and provide for public contract performance statistics in any future contract so that the details of performance were available to the public.
On October 18, 2024, the CDC responded to the Members of Congress letter of July 10th, 2024, asking about problems in service delivery by MCA Sedgwick, here is some of that response.
The WTC Health Program (the Program) takes any barrier to the prompt delivery of effective healthcare to members very seriously. The Program transitioned the vendor that administers the NPN to MCASedgwick on August 1, 2022. The months following this complex transition saw three key challenges in accessing care: (1) call center wait times and customer service, (2) access to network providers, and (3) claims processing. The Program has made major progress in addressing these challenges, including slashing call center wait times, tripling the number of network providers, recruiting and enrolling new providers in underserved regions, providing a direct line of communication between members and MCASedgwick to connect them to pre-screened in-network providers, and dedicating significant resources to improve NPN claims processing. Work is ongoing in these areas, and we will strive to continually improve the level of care and service we provide to Program members. Below, I describe these issues and the steps we’ve taken to date to address them.
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)
LETTERS
October 18, 2024, CDC Response to Gillibrand, Schumer, Garbarino July 10, 2024, Letter on Sedgwick
April 25, 2024, Garbarino, Gillibrand Letter to HHS Sec. regarding allowing Clinics to NPN Providers
April 11, 2024, 911Health to CDC regarding PBM Contract
March 29, 2024, CDC Response to NPN Letter
March 20, 2024, 911 Health to CDC regarding TPA Contract
February 6, 2024, 911 Health to CDC regarding NPN Contract
May 19th, 2023, 911 Health Watch letter to Carlyle Group
March 8th, 2023, Sedgwick CEO Michael Arbour response to Comptroller
February 17th, 2023, NYS Comptroller Letter to Carlyle Group
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
NEWS ARTICLES
‘Serious issues’: Flaws at 9/11 health program draw lawmakers’ attention
The Chief-Leader | August 6, 2024
Lawmakers noted that some program members could not secure the annual monitoring exam to which they are entitled. There also appear to be “serious problems” with program providers getting paid.
RETIRED OREGON INCIDENT COMMANDER NEEDS DOUBLE LUNG TRANSPLANT 2 DECADES AFTER RESPONDING TO GROUND ZERO
KGW8 Portland | March 7, 2024
“I wasn’t diagnosed with it until fairly later, and then it went boom.”
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.
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.
7 takeaways from our investigation of Tennessee’s workers’ compensation system
Memphis Commercial Appeal | July 16, 2022
The Commercial Appeal spent months speaking with injured workers and reviewing hundreds of documents related to workers’ compensation cases in Tennessee.
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.
Revealed: Amazon touts high wages while ignoring issues in its warehouses
The Guardian | August 7, 2019
The company has responded to criticism over its working conditions by claiming it is an industry leader in compensation, but a Guardian investigation has revealed many workers take issue with this messaging, as serious workplace issues remain that they say are still not being addressed.