370K #London #GP patients sold to company owned by #US subprime health insurance profiteer
London’s biggest GP ‘provider’, AT #Medics Ltd, has just been sold to the #UK subsidiary of a US subprime health insurance profiteer with a long record of fraud,

financial dishonesty, health care mismanagement and lack of compliance with #Medicare/Medicaid contracts.
16 Clinical #Commissioning Groups are involved. They’re supposed to carry out due diligence on takeovers. Where is it?

#Operose Health Ltd, owned by #Centene Corporation, is run by the former #NHS England Director of New Care Models, Samantha Jones and the Senior Clinical Advisor for the #NHS England Accountable Care Systems’ Primary Care Development Programme, Nicholas Harding

The #London takeover makes #Operose Health Ltd one of the biggest companies providing #NHS #GP services in England, more than tripling its size to 69 GP Practices. Its patient list now appoaches the size of that of the super partnership Modality –

which was set up in 2009 by Nicholas #Harding, now Operose Health Ltd’s Chief Medical Officer. #Modality was one of the Vanguard schemes overseen by the Operose Health CEO, Samantha #Jones, when she was #NHS England’s Director of New Care Models.

#Medics has 48 practices in 19 #London Boroughs with 370,000 patients on its lists.
34 AT Medics Ltd practices are commissioned with Alternative Provider of Medical Services contracts. This type of contract, introduced in 2006, has opened up GP practices to commercial companies.

Unlike regular #GP contracts which don’t allow sale of the ‘goodwill’ of the Practice if its partners retire or decide to wind it up, an Alternative Provider of Medical Services contract holder can ‘dispose of its rights and duties under the contract…’ –

but first they have to get the Commissioners’ written authorisation. (54.1, APMS Contract)
So where is this prior written #authorisation?
Only two records of Commissioners’ decisions to approve the transfer of control are readily accessible:

North Central London Primary Care Commissioning Committee was presented with a Change of Control Request Report in December 2020. On 9 February, Central London Clinical Commissioning Group was presented with the same Change of Control Request for 1 APMS Practice.

What about the other 14 Clinical Commissioning Groups? There seems to be no record of them authorising this change of control.
North Central London Clinical Commissioning Group Primary Care Commissioning Committee is meeting on 18th Feb

and it needs to answer some questions about its hasty decision in December to approve the Change of Control Request.Questions to North Central London Clinical Commissioning Group
The Change of Control Request Report to the NCL PCCC in Dec 2020 doesn’t identify Operose Health

as wholly owned by Centene Corporation in the #USA. Instead it says “ #Operose Health Ltd is itself owned by MH Services ( #UK) Ltd. which is then owned by #MH Holdings International (UK) inc.” Why?
2. In the due diligence work, solicitors

“carried out searches on financial stability and Good Standing to provide further assurance to commissioners in respect of OperoseHealth Ltd, Operose Health Group; MH Services International and MH Services International Holdings.”

Again no mention of the fact that Operose Health is a wholly owned subsidiary of #Centene Corporation.
Why?

Could it be because of Centene Corporation’s dire record of profiteering; inadequate provision of doctors, specialists, hospitals; massive healthcare fraud;

failure to release accurate financial information related to the acquisition of a healthcare insurance provider; serious mismanagement and non-compliance with federal or state Medicaid contracts or rules; and so on? (Info sources follow):

Dire record of profiteering and demanding taxpayer subsidies. Fines for not providing enough doctors, specialists and hospitals and other key services in its Obamacare insurance programmes,
Committing massive healthcare fraud by selling health insurance plans

without any participating doctors or hospitals and falsifying its lists of providers
Having to pay $7.5 million to resolve a purported class-action lawsuit by investors alleging the company failed to release accurate financial information related to its acquisition of Health Net.

One of its subsidiaries being fined at least $23.6 million in penalties for serious mismanagement and non-compliance with federal or state Medicaid contracts or rules in more than a dozen states
And so on.

3. How is it possible to reasonably claim that the proposed change in control did not constitute a change in contract holder, so there’s no need for a new contract, when all the AT Medics Ltd directors have been replaced by Operose Health Ltd directors?

Despite what the Change of Control Request Report said about “assurances that the current directors of AT Medics Ltd would remain actively involved in the organisation.”
The Change of Control Request Report claims that,

“The proposed change in control did not constitute a change in contract holders and therefore was not a contract novation. A contract novation is whereby a contract holder who holds a GMS or PMS contract wishes to incorporate their contract to a company limited by shares,

then request another company to hold the contract.
The process of novation would be to terminate the incorporated GMS / PMS Company, then issue a new contract.The process of change control under an APMS would not trigger a contract novation,

therefore for this reason the change was not likely to be subject to challenge under the Public Contract Regulations.”
This claim seems to hinge on AT Medics Ltd “assurances” that despite the sale to Operose Health Ltd of the AT Medics Holdings Limited Liability Partnership (LLP)

which wholly owns AT Medics Ltd, “the current directors of AT Medics Ltd would remain actively involved in the organisation.”
What are these assurances worth?
On 11th Feb all 6 AT Medics Ltd directors resigned from AT Medics Ltd –

the day after they had all resigned as “persons with significant control” from AT Medics LLP, where they were replaced by Mh Services International (Uk) Limited and Operose Health Limited.

I look forward with interest to North Central #London Clinical Commissioning Group’s answers to these questions.
Finally, the Change of Control Request Report talks about “the benefits of this collaboration” between AT Medics and Operose Health.

The new Integrated Care Systems Bill that was published last week keeps banging on about collaboration. So I guess this is an example of what the government and NHS England mean by “collaboration”? Stealth takeover by US-owned companies?

The Report also alleges that the

“benefits of this collaboration will include enhanced organisational resilience and accelerated technological capabilities” and “the new collaboration will bring together significant combined expertise in population health management.”

This looks like a nod to Operose Health’s place on the Health Systems Support Framework , which lists NHS England-approved companies that Clinical Commissioning Groups can contract to provide “support” to set up Integrated Care Systems –

formerly known as Accountable Care Organisations. (Just to confuse things, Operose Health Ltd is listed as Centene #UK in the Health Systems Support Framework.)

So it looks as if Operose Health is using the purchase of AT Medics GP practices as a way to embed its Health Systems

Support Framework services in them. Based on the experiences of its parent company Centene Corporation, in Medicare/Medicaid Accountable Care Organisations. Rather than wanting to run the AT Medics GP practices, which it’s not going to do except indirectly by messing

their organisational processes, use of technology, risk stratification of patients, related new care models etc
I have asked North Central London Clinical Commissioning Group if they have contracted with Operose Health for any services through the Health Systems Support Framework

I have also asked AT #Medics Ltd about claims made by its (then) Directors in an “Exciting new partnership” letter sent to “medical colleagues” on 10th February.

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