Anchorage monoclonal antibody clinic under scrutiny for political donation and patient billing

An Anchorage clinic that offered monoclonal antibody treatment at the height of the COVID-19 pandemic in Alaska is under scrutiny for a rent-free deal with the city, campaign contributions to the mayor and its charges to patients.

The clinic run by WEKA — which stands for Wisdom, Experience, Knowledge, Abilities — operated out of a city-owned building, free of charge, from October to March under little governmental oversight. Anchorage Assembly members and others have been questioning how WEKA got the deal with the city and why it charged patients hundreds of dollars per treatment session.

That’s according to reporting by the Anchorage Daily News, which found that WEKA’s owners had been big donors to a political action committee supporting the election of Mayor Dave Bronson.

ADN reporters Michelle Theriault Boots and Emily Goodykoontz wrote the story. Theriault Boots explains how WEKA came to run the clinic and how hundreds of its patients wound up with fairly large bills.

Listen:

Michelle Theriault Boots: WEKA is a small business owned by an Anchorage couple named Todd and Crystal Herring that started about a decade ago, and primarily they were providing transport services for mental health patients around the state, doing some private security. But then in the summer of 2021, both Crystal and her husband got COVID, got very sick, and they themselves were treated with monoclonal antibodies. And they decided to — with some new health care licensing they had — start giving patients monoclonal antibodies. And shortly after they did that, the mayor of Anchorage stopped into their warehouse where they were giving these treatments and made them an offer.

Casey Grove: Do we know why he was interested in talking to them?

MTB: Well, at the time, the city was really just being crushed by this delta variant surge. Hospitals were triaging patients, it was a desperate situation. And the state had gotten some free monoclonal antibody medication from the federal government — each dose is worth thousands and thousands of dollars — and really needed ways to distribute it. And what the mayor has to say about this is that he just wanted to increase the number of people who could get these treatments. So he offered WEKA an unused space at the Golden Lion Hotel, which the city owned, to increase their capacity and ability to give treatments to more people.

CG: So that all seems OK — that the pandemic is going on, people are seeking out monoclonal antibody treatment, it potentially could be a life-saving treatment, and they just needed to expand that operation. So what happened to draw so much scrutiny to this?

MTB: Well, there’s kind of three different elements. It looked like kind of an eyebrow-raising deal for a private, for-profit business to get free rent on a city, publicly-owned building, free utilities. And then people made the connection that the owners of this business, WEKA, had donated about $15,000 to Mayor Bronson’s campaign. So that’s kind of one area of concern.

Another was that after the clinic had been open for several months, patients started reporting being charged upfront $500, sometimes getting bills for $1,200, for these monoclonal antibody treatments that were, again, given free by the federal government and distributed in a free location provided by the city. And the owners of WEKA have an explanation for that. They say that they believed that insurance would cover the the cost of administering these treatments, which is overhead expense, where they have to pay the nurses and pay for some of those costs associated with just getting the medicine in people’s arms. But so far, hundreds, I think, of patients have found themselves on the hook for fairly large bills.

CG: How is this sort of thing even regulated?

MTB: Well, it’s really not. What we found was that the individual providers working in these pop-up infusion clinics are regulated. They’re, you know, paramedics, nurses, EMTs, doctors, and so if there’s a patient complaint or an allegation that the care was substandard, there’s a whole process and a medical board that licensed them. That’s there. But the idea that the pop-up clinics themselves are being regulated, or that some kind of overseeing government entity is coming to inspect them to see if they’re storing the medications properly, or the cleanliness of the clinic — there really isn’t a system in place for that. And part of that probably has to do with the fact that this was an unusual emergency pandemic context, where these pop-up infusion clinics were just springing into being with very little lead up, because it was an emergency situation. But it remains that it doesn’t seem like there’s a huge amount of regulation for these clinics.

CG: Gotcha. Yeah, there isn’t a Health Department inspector coming in and checking things. Let’s go back to the billing part of this. Why would they be charging patients up front for this if they could be billing insurance instead?

MTB: So WEKA says it was operating on what they call a “direct-billing model.” And that basically means you give the service and you send the bill to insurance, and then insurance will reimburse for that. But what happened with WEKA, as they say, they started this whole treatment business so quickly that they weren’t able to get credentialed by insurance. So they were considered out of network by every single private insurer. So that means that if you go to an out-of-network provider, you get a bill and the insurance says, “No, we’re not paying for any of that.” And that’s what’s been happening for people who got these monoclonal antibody treatments who had private insurance. Now, the owners at WEKA, they say they want to help make this right. They want to fight the insurance companies on this. But it remains that people are still dealing with $500, $1,200 bills, even, for getting this treatment.

CG: What was it like for the patients to find out that they were going to have to pay for this upfront?

MTB: Well, we spoke to one patient who said the whole thing seemed weird, but he had had a double lung transplant, and he felt very vulnerable. So, you know, when they asked him to plunk down his credit card and pay that $550, he said, “Well, if death is on one side, and $550 on the other, I’m choosing that $550.” So there are definitely concerned and unhappy patients confused about the billing situation with this clinic.

CG: And that patient in particular, too, there was another issue with just how the drug was administered. And I guess that was a very specific drug. But what was the issue there?

MTB: The issue is that, he says, he was administered a medication by the WEKA clinic that was supposed to be given as two injections but was given to him as an infusion. And when he told his double lung transplant supervising doctor about that, she was mortified, because there is no data on how effective that medicine is when given that way. So there’s still some unresolved questions about why that happened, how that happened. Any other patient care allegations around the WEKA clinic, it’s hard to kind of know where those stand right now, because those allegations against providers would have gone to the Alaska Medical Board. And we don’t know until investigations are complete. Those don’t become public at this stage.

CG: Gotcha. So what happens now? I understand the clinic has shut down, but what happens now with any of those billing issues, or what is currently happening?

MTB: WEKA really wants people to reach out to them to get help, I guess for fighting the insurance companies with the billing issues. It’s fair to say that the Anchorage Assembly, especially Chair Suzanne LaFrance, is really interested in other questions this has raised, both about patient care and about the city’s liability for this all happening in a city-owned space that WEKA was operating out of.

And I should also say that what WEKA says about this whole controversy is that they stepped up at a time of great need to provide a service. It wasn’t seamless. They had issues with the billing and insurance. But they say that, from their perspective, their contributions to the mayor, they don’t believe are what got them the space. They believe that it was an emergency, and they were one of the few operators willing to do this kind of work.

CG: In your story there’s a statement from WEKA, and I just wondered if you could read that for us.

MTB: Yeah, we talked to Crystal Herring, one of the co-owners of WEKA, and she really said that she thinks the public is missing some context about how the clinic at the Golden Lion came to be, how it operated and who benefited from it. And she gave us a statement that: “To view the provision of a large scale, potentially life-saving treatment during the height of the Delta variant surge, and a cooperative agreement between the municipality and private enterprise, which to date has operated at a loss, as a ‘sweetheart deal,’ rather than an attempt to fill an urgent need in the community, requires a very narrow perspective and clearly does not stand up to scrutiny.” So that’s that’s WEKA perspective on all this criticism.

CG: What did they say specifically about their campaign contributions to the mayor?

MTB: They said that campaign contributions are a routine part of our American political system and that shouldn’t be seen as anything other than an expression of political preference. They say they didn’t expect any favors from the mayor. And they say they don’t believe they received any favors from the mayor. That said, you know, some unanswered questions we have are, “How did and why did the mayor show up that day at their warehouse? What was the connection there?”