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  By Brendan BorrellNEW YORK (Reuters Health) - These are heady days for the medical tourism industry. With prices spiraling upward, more and more insurers and individuals are looking abroad fortreatment. By some estimates, 650,000 Americans will check into foreign hospitals from Mexico toThailand this year.The boom has created rich opportunities for entrepreneurs catering to first-time medical travelers, start-upbusinesses and eager hospital managers in developing countries.Enter lawyer couple Jonathan Edelheit and Renée-Marie Stephano.Edelheit and Stephano, both 37, are the founders of the Medical Tourism Association (MTA), a non-profitassociation they created to further quality of care, transparency, communication and education in theindustry. They are also the organizers of the industry's annual top conference, under way this week in LosAngeles.In many ways, Edelheit and Stephano have become the face of medical tourism. That has causedadmiration, envy and unhappiness in the tight-knit industry.Former MTA board members and industry colleagues have stories of how their collaborations with thecouple have become marred by a sense of disillusionment and legal threats since the organization wasfounded in 2007. Their concerns center on three issues:- Edelheit has been accused of selling unauthorized insurance in Washington and Montana. The first probehas been settled. Edelheit dismisses the allegations and says the second investigation will be settled in hisfavor.- Edelheit and Stephano have threatened several critics with legal action and have filed one lawsuit againsta competing non-profit. Edelheit calls it legal diligence to protect themselves and the MTA's members.- The couple set up a thriving annual conference, but critics say the profits go into their private corporationrather than the industry association. Edelheit says the arrangement benefits the MTA.Rudy Rupak of medical tourism facilitator Planet Hospital captured the feelings of many industry playersin December when one slide of his Powerpoint presentation said: The biggest threat to our industry is theMTA. ALLEGATIONS OF BOGUS HEALTH PLANS Edelheit's foray into health insurance started in 2001 after he left the Villanova University School of Lawand moved to Florida to join his father's company, United Group Programs.As vice president of sales for the company's OptiMed Health Plans, Edelheit says he became the first to sellself-funded employee health plans that included medical travel in 2005. OptiMed's Web site listscompanies like Dunkin' Donuts and Chrysler as clients.The Washington State Insurance Commissioner alleged in 2007 that Edelheit and others had sold ormanaged bogus health plans to 4,000 residents and made false, deceptive, and misleadingrepresentations to customers between 2003 and 2007. Edelheit, United Group and OptiMed Health werealso named in a Montana investigation.  I have never been so screwed over in my life, one consumer, Judy Bergin, told an investigator with theWashington State Insurance Commissioner. Bergin had found a plan on the Internet later linked to theUnited Group, made an initial payment of $275 and paid $228 a month thereafter. She said her doctor nevergot paid, leaving her to foot about $3,000 in medical bills.Edelheit and his father bought insurance from underwriters, and were responsible for paying claims filed bycustomers, according to the investigator's report obtained by Reuters Health. The policies were notauthorized in Washington and the Edelheits did not always pay the underwriters' premiums on time, thereport said.The Edelheits have since settled with Washington, agreeing to no longer sell insurance there. Edelheitbrushes off suggestions that he was doing anything wrong, and says he is confident that a pending cease-and-desist order in Montana will be dismissed. Stephano calls the Washington investigation a witch hunt. FROM INSURANCE TO MEDICAL TOURISMThe couple set up the non-profit Medical Tourism Association in May 2007, persuading the industry's bignames to join their advisory board. But former board members say they had little power, and were just partof what one calls the Jonathan and Renée show. By the end of 2008, Karen Timmons of Joint Commission International, Laura Carabello of CPRCommunications, John Bridges of Johns Hopkins University and Ruben Toral of Medeguide had allresigned. Uwe Klein of Germany's Health Care Strategy International resigned this year, saying that theorganization sought to dominate the conversation on medical tourism. The world has more countries than Florida, Klein says. At least a few were upset after the coupleannounced an accreditation program for foreign hospitals and agents who book medical trips. Theycomplained the program was not transparent and did not link its stamp of approval to an operator's qualityof care.Edelheit and Stephano have since backpedaled. A facilitator certification program is in pilot phase.Applicants pay $2,500 and answer an extensive questionnaire.Bethany Van Boxtel of Guam-based Veiovis, who is undergoing the process, says the MTA is filling a gap: We were looking for some kind of accreditation or certification to give validity to travel facilitators. Experts agree patients need to check out operators. Most facilitators are operating from a basement and a BlackBerry, says Maria Todd of the Council on theGlobal Integration of Healthcare.But the industry's biggest names have expressed little interest in MTA's certification program. I don't know that they are qualified to certify, says Victor Lazzaro, CEO of BridgeHealth. No one hasasked us if we are certified, and we have a million lives under contract. SEE YOU IN COURTEdelheit has threatened critics with legal action.Keith Pollard, whose company runs medical tourism web sites, says Edelheit told him he was on the verge  of defamation, slander and libel and that he reserved the right to proceed with a legal action in an e-mail late last year.Edelheit also put Dana Taormina at CPR Communications and Planet Hospital's Rupak on notice -- but didnot always get the desired results. So I get one of those famous Cease and Desist mails from our BFFs (best friends forever) at the MTA, Rupak wrote in an email to colleagues in August. The first thing I did was fax them a letter that read:F**K YOU! Edelheit says that he sent the emails to protect the reputation of the MTA, after Pollard and Rupak  distributed false statements about the MTA in writing and in person to advisory board members and(regular MTA) members. Edelheit also filed suit against the International Medical Travel Association for trade name infringementand unfair business practices in September. MTA has the right and is indeed required to protect the interest in its brand against intentional confusionwhich has been developed through the efforts of its membership, Edelheit says.The suit was triggered when the Singapore-based non-profit registered its U.S. arm in Florida in January.Toral, who heads the group, says the lawsuit is baseless but that he may not have money to fight it.A spoof press release now circulating in medical travel circles says that the MTA has sued New York City'sMetropolitan Transportation Authority, also known as the MTA. There are so many people to sue in the world, reads a quote attributed to Edelheit-Stephano in thephony press release. Sometimes when I wake up in the morning, I just don't know where to begin. LUCRATIVE CONFERENCESAnnual industry conferences are the couple's biggest coup. Don't be fooled by the other medical tourism conferences in the industry, their advertising materials say.The MTA conference website says it does not promote the interests of any private corporate orgovernmental interests. Less than a year after the MTA was formed, Stephano set up a for-profit business, WMT & GHC, whichruns the Official Conference of the Medical Tourism Association. The company operates from the sameaddress as the MTA and collects all registration and sponsorship fees.The fees are substantial: The first conference in San Francisco in September 2008 had 850 attendees payingbetween $500 and $2500 each, or between $425,000 and $2.1 million.Sponsors and exhibitors add to the tally. This year, the Council for Korea Medicine Overseas Promotionpaid $100,000 to be the diamond sponsor, according to rate sheets. Malaysia Healthcare paid $75,000 to bea platinum sponsor, and three other organizations paid $40,000 each as gold sponsors. USAID was one of 13 silver sponsors, who paid $15,000 each.While it is not unusual for a non-profit organization to have agreements with for-profit corporations, the  WMT & GHC is not directly paying the MTA for rights to run the conference nor for advertisements on itswebsite.Edelheit says WMT & GHC provides benefits to the MTA by paying for shipping the organization'smagazine, for DVDs, for promotional materials and for staff travel. It also provides a mailing list and fronts$600,000 to run the conference, Edelheit says.The MTA received outside bids for the annual conference but none (could) provide MTA all content andspeakers, and cover the costs, Edelheit says, declining to name bidders. He did not respond to a request foran estimate of WMT & GHC's revenues. It sounds like the non-profit is acting like the marketing arm of the for-profit companies, says LloydMayer, an expert in non-profit tax law at Notre Dame University. If that's true, then it exists primarily togenerate a profit for the companies and not primarily to promote the industry. If they are getting rich, the couple is not showing it: They bought a single family home on 5 acres of land inWest Palm Beach, Florida, for about $445,000 in 2004, property records show.Edelheit and Stephano also own Free Health, which runs the conferences of two other healthcare non-profitassociations they lead. Those conferences are taking place this week alongside the MTA at the Los AngelesHyatt Regency Century Plaza.Organizers expected 2,000 attendees for the MTA conference alone. Rupak is boycotting the event -- butsays he rented three suites at the hotel. I've told everyone if they happen to be in Los Angeles, come to my party, he says.(Editing by Ivan Oransky, Jack Reerink and Martin Langfield)
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