Sorin Drache

Tag: Failed

  • why Assad’s army failed to fight in Syria

    By Maya Gebeily, Suleiman Al-Khalidi, Ahmed Rasheed and Timour Azhari

    DAMASCUS/AMMAN/BAGHDAD (Reuters) – Twenty-three-year-old Syrian military conscript Farhan al-Khouli was badly paid and demoralized. His army outpost in scrubland near the rebel-held city of Idlib should have had nine soldiers but it just had three, after some had bribed the commanding officers to escape serving, he said.

    And, of the two conscripts with him, one was regarded by his superiors as mentally unfit and not trusted with a gun, Khouli said.

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    For years, the Islamist rebels of Hayat Tahrir al-Sham (HTS) had sat behind the nearby frontline, with Syria’s long civil war frozen. But on Wednesday, Nov. 27, Khouli’s commanding officer – at another post behind the frontlines – called his mobile phone to tell him a rebel convoy was heading his way.

    The officer said the unit should stand its ground and fight.

    Instead, Khouli put his phone on airplane mode, changed into civilian clothes, dropped his rifle and fled. As he walked along the road back south, other groups of soldiers were abandoning their posts too.

    “I looked back and saw everyone walking behind me. When they saw one person flee, everyone started to toss their weapons and run,” he told Reuters this week in Damascus, where he has found work at a horse stable.

    In a little less than two weeks, the rebels would sweep into the capital Damascus, toppling former president Bashar al-Assad as his army simply melted away. The rout abruptly ended a 13-year conflict that had killed hundreds of thousands of people.

    Reuters spoke to a dozen sources including two Syrian army deserters, three senior Syrian officers, two Iraqi militia commanders working with the Syrian army, a Syrian security source and a source familiar with the thinking of Lebanese group Hezbollah, one of Assad’s main military allies.

    The sources, along with intelligence documents Reuters found in an abandoned military office in the capital, painted a detailed picture of how Assad’s once-feared army had been hollowed out by the demoralization of troops, heavy reliance on foreign allies particularly for the command structure, and growing anger across the ranks at rampant corruption.

    Most of the sources asked not to be named because they were not authorised to talk to media or feared retribution.

    Since the war began in 2011, Assad’s army command had come to depend on allied Iranian and Iran-funded Lebanese and Iraqi forces to provide the best fighting units in Syria, all the senior sources said.

    Crucially, much of the Syrian military’s operational command structure was run by Iranian military advisors and their militia allies, they said.

    But many of the Iranian military advisers had left this spring after Israeli air strikes on Damascus, and the rest departed last week, said the Iraqi militia commanders, who worked alongside them.

    Hezbollah fighters and commanders had already mostly left in October to focus on the escalating war in Lebanon with Israel, the source familiar with Hezbollah thinking said.

    The Syrian army’s own central command and control centre no longer functioned well after the Iranian and Hezbollah officers left and the military lacked a defence strategy, particularly for Syria’s second city of Aleppo, a Syrian colonel, two Syrian security sources and a Lebanese security source familiar with the Syrian military said.

    By contrast, rebels in the northwest, on paper numerically far weaker than the army, had spent years consolidating under a single operations room that coordinated their groups and units in battle, an International Crisis Group report said after the fall of Aleppo.

    Reuters was unable to contact a current representative of the armed forces. Syria’s new most powerful figure, HTS chief Ahmad al-Sharaa told Reuters on Wednesday he would dissolve Syria’s security forces. Iran’s mission to the United Nations, the Iraqi militias and Hezbollah did not respond to requests for comment.

    ALEPPO

    As Aleppo came under attack in late November, army units were not given a clear plan but were told to work it out for themselves or to fall back to the strategic city of Homs to try to regroup, two Syrian security sources said.

    Aleppo fell without a major fight on Nov. 29, just two days after the offensive began, sending shockwaves through the military, three senior Syrian officers said.

    What was left on the ground was a Syrian army severely lacking in cohesion, all the sources said, describing multiple units that were undermanned because officers were accepting bribes to let soldiers off duty, or had told soldiers to go home and were collecting their salaries themselves.

    In 2020, the army had 130,000 personnel, according to think tank IISS’ Military Balance report, describing it as significantly depleted by the long civil war and transformed into an irregularly structured, militia-style organisation focused on internal security.

    In the days ahead of the regime’s collapse on Sunday, the United States had information of broad levels of desertions and military forces changing sides, as well as some elements fleeing to Iraq, a U.S. official, speaking on condition of anonymity, said.

    Reuters could not establish the overall manpower shortage in the military or current force strength.

    The Syrian army sources described officers and troops alike as demoralised by pay that was consistently low even after painful military victories earlier in the war and by reports, which Reuters could not verify, that Assad’s close family were growing immensely rich.

    On Nov. 28, the General Command of the Army and Armed Forces issued a telegram, ordering all troops to be on full combat readiness, according to a military document found by Reuters at an Air Intelligence office in Damascus.

    In a sign the regime was desperate, Syria’s Air Intelligence Directorate, a key agency close to the Assad family, accused its men of “laxity” at checkpoints throughout the country after one was overrun by rebels in the south on Dec. 1, and warned of punishment “without leniency” if they did not fight, the document seen by Reuters shows.

    Despite the orders and threats, increasing numbers of soldiers and officers began to desert, all the sources said.

    Instead of confronting the rebels, or even unarmed protesters, soldiers were seen by residents of Syrian cities, and in many videos that began circulating online, abandoning their posts, changing into civilian clothes and going home.

    Reuters journalists entering Syria on Sunday found army uniforms still strewn across Damascus streets.

    OFFICERS

    The corruption and poor morale went up through the ranks.

    Many midranking officers had been growing increasingly angry in recent years that the army’s sacrifices and successes during the war were not reflected in better pay, conditions and resources, two serving, one recently retired and one defected officer said.

    In 2020, Russia and Turkey agreed a deal that froze the frontlines after Assad retook all major cities and the main highway linking Damascus to Aleppo, further partitioning a country also split by Kurdish-controlled areas.

    But Syria’s economy continued to reel from U.S. sanctions and reduced foreign aid, said Aron Lund, a fellow at Middle East-focused think tank Century International. Rampant inflation ensued.

    “Things just got worse for everyone, except for the oligarchs and elites around Assad. That seems to have been incredibly demoralizing,” Lund said.

    While decrees in 2021 roughly doubled military salaries to keep up with inflation that topped 100% that year, buying power rapidly fell anyway as the Syrian pound crashed against the dollar.

    Col. Makhlouf Makhlouf, who served in an engineering brigade, said that if anybody complained about corruption they were called in for questioning at a military court – something that had happened to him more than once.

    “We were living in a scary society. We were afraid to say a word,” Makhlouf said. He had been stationed in Hama but deserted before the city fell to the rebels on Dec. 5, he said in an interview in Aleppo on Tuesday.

    Anger had been building particularly over the past year or so, a serving senior military intelligence officer said, saying there was “growing resentment against Assad,” including among core high-ranking supporters from his Alawite minority community.

    YEARS OF DECAY

    Khouli’s military experience illustrated the army’s problems – and helps explain his lack of loyalty.

    He was drafted for the obligatory 18-month service at age 19, after having paid-off an officer to delay his service for a year.

    When his service period expired, he was ordered to remain in the army indefinitely. He deserted but was later picked up by a patrol, put in prison for 52 days and then sent to the remote outpost near Idlib.

    He was paid 500,000 Syrian pounds ($40) a month. Army rations were often pillaged before arriving. Sometimes his entire pay went on buying more food, he said.

    Comrades with money would pay officers $100, which he lacked, to get out of service, Khouli said. Khouli’s brigade was supposed to have 80 soldiers, but in fact there were only 60, he said.

    He described bad treatment from officers, including being assigned heavy manual labour digging earth berms in both very hot and very cold weather and during nights.

    Reuters was not able to verify independently the details of his experiences.

    One former major described the use of forced conscripts as a “fatal mistake”.

    A former army logistics serviceman, Zuhair, 28, said in an interview in Damascus on Tuesday he had seen officers steal and sell electricity generators and fuel. “All they cared about was using their positions to enrich themselves,” he said.

    He had fought for Assad for years but he had cousins among the rebels and when they advanced, he cheered, he said. “I don’t know how to describe how happy I am,” he said.

    RELIANCE ON ALLIES

    To fight back the earlier opposition uprising, which began with protests in 2011, Assad relied on allies. Russia sent jets that bombed rebel positions, Iran sent military advisers and fighters from Hezbollah. Iran-backed militias from Iraq and another group it formed from Afghan Shi’ite fighters also came.

    Their fighting skill and well-being contrasted with Syria’s own soldiers. An Iraqi militia commander serving near Aleppo said he knew of a Syrian platoon meant to consist of 30 soldiers that had only eight present.

    The militia often invited those soldiers to eat with them out of pity at the poor condition of their rations, the commander said.

    Hezbollah and allied militias regarded the regular Syrian forces with little more than contempt, the Iraqi militia commanders and a source familiar with Hezbollah thinking said.

    They did not trust them for important operations and often would not fight alongside them, those sources added.

    OCT. 7 HAMAS ATTACKS

    Iran’s presence in Syria was curtailed in the months following the attack on Israel by Tehran-backed Hamas on Oct. 7, 2023, the Iraqi militia commander based near Aleppo and an Iraqi military adviser based in Damascus said.

    Israel’s response to Hamas’ incursion included escalating strikes on Iran-linked targets, including in Syria.

    On April 1, a strike killed top commanders from Iran’s Revolutionary Guards at a building in an Iranian consular compound in Damascus. Israel has not confirmed or denied responsibility for the strike.

    The Iraqi sources both said the number of Revolutionary Guards commanders present in Syria dropped significantly after that. One said Syria’s military operations command became ineffective as a result, a situation exacerbated by the withdrawal of Hezbollah in October.

    Russia conducted air strikes on rebels as they advanced on Hama and Homs, both sides said at the time, but unlike in earlier phases of the war there were no effective ground forces able to benefit.

    By Saturday, Dec. 7, Russia was calling for a political transition. The Kremlin and Russia foreign ministry declined to comment for this story. Russia, the Kremlin said on Tuesday, had “spent a lot of effort” to help Assad during the civil war but the situation had then deteriorated.

    In Aleppo, Syrian forces had relied on Hezbollah to provide operational command, an Alawite Syrian army colonel said. Without Iranian advisers or Hezbollah, the army could not hold onto territory near the city, the colonel, the Iraqi commander and the Iraqi adviser said.

    Iraqi militias sent more fighters to Syria last week, but they found all the contact channels to Iranian military advisors had been cut, the Iraqi commander said.

    On Friday, after rebels had taken the city of Hama, the Iraqi groups were told to leave, he said.

    “The battle for Syria was lost from day one,” the Iraqi military adviser added.

    (Reporting by Maya Gebeily and Timour Azhari in Damascus, Suleiman al-Khalidi in Amman, Ahmed Rasheed in Baghdad, Laila Bassam and Tom Perry in Beirut; Writing by Angus McDowall; Editing by Frank Jack Daniel)

  • Why Health Insurance Regulators Have Failed to Curb Ghost Networks — ProPublica

    Reporting Highlights

    • Extensive Errors: Many states have sought to make insurers clean up their health plans’ provider directories over the past decade. But the errors are still widespread.
    • Paltry Penalties: Most state insurance agencies haven’t issued a fine for provider directory errors since 2019. When companies have been penalized, the fines have been small and sporadic.
    • Ghostbusters: Experts said that stricter regulations and stronger fines are needed to protect insurance customers from these errors, which are at the heart of so-called ghost networks.

    These highlights were written by the reporters and editors who worked on this story.

    To uncover the truth about a pernicious insurance industry practice, staffers with the New York state attorney general’s office decided to tell a series of lies.

    So, over the course of 2022 and 2023, they dialed hundreds of mental health providers in the directories of more than a dozen insurance plans. Some staffers pretended to call on behalf of a depressed relative. Others posed as parents asking about their struggling teenager.

    They wanted to know two key things about the supposedly in-network providers: Do you accept insurance? And are you accepting new patients?

    The more the staffers called, the more they realized that the providers listed either no longer accepted insurance or had stopped seeing new patients. That is, if they heard back from the providers at all.

    In a report published last December, the office described rampant evidence of these “ghost networks,” where health plans list providers who supposedly accept that insurance but who are not actually available to patients. The report found that 86% of the listed mental health providers who staffers had called were “unreachable, not in-network, or not accepting new patients.” Even though insurers are required to publish accurate directories, New York Attorney General Letitia James’ office didn’t find evidence that the state’s own insurance regulators had fined any insurers for their errors.

    Shortly after taking office in 2021, Gov. Kathy Hochul vowed to combat provider directory misinformation, so there seemed to be a clear path to confronting ghost networks.

    Yet nearly a year after the publication of James’ report, nothing has changed. Regulators can’t point to a single penalty levied for ghost networks. And while a spokesperson for New York state’s Department of Financial Services has said that “nation-leading consumer protections” are in the works, provider directories in the state are still rife with errors.

    A similar pattern of errors and lax enforcement is happening in other states as well.

    In Arizona, regulators called hundreds of mental health providers listed in the networks of the state’s most popular individual health plans. They couldn’t schedule visits with nearly 2 out of every 5 providers they called. None of those companies have been fined for their errors.

    In Massachusetts, the state attorney general investigated alleged efforts by insurers to restrict their customers’ mental health benefits. The insurers agreed to audit their mental health provider listings but were largely allowed to police themselves. Insurance regulators have not fined the companies for their errors.

    In California, regulators received hundreds of complaints about provider listings after one of the nation’s first ghost network regulations took effect in 2016. But under the new law, they have actually scaled back on fining insurers. Since 2016, just one plan was fined — a $7,500 penalty — for posting inaccurate listings for mental health providers.

    ProPublica reached out to every state insurance commission to see what they have done to curb rampant directory errors. As part of the country’s complex patchwork of regulations, these agencies oversee plans that employers purchase from an insurer and that individuals buy on exchanges. (Federal agencies typically oversee plans that employers self-fund or that are funded by Medicare.)

    Spokespeople for the state agencies told ProPublica that their “many actions” resulted in “significant accountability.” But ProPublica found that the actual actions taken so far do not match the regulators’ rhetoric.

    “One of the primary reasons insurance commissions exist is to hold companies accountable for what they are advertising in their contracts,” said Dr. Robert Trestman, a leading American Psychiatric Association expert who has testified about ghost networks to the U.S. Senate Committee on Finance. “They’re not doing their job. If they were, we would not have an ongoing problem.”

    Most states haven’t fined a single company for publishing directory errors since 2019. When they do, the penalties have been small and sporadic. In an average year, fewer than a dozen fines are issued by insurance regulators for directory errors, according to information obtained by ProPublica from almost every one of those agencies. All those fines together represent a fraction of 1% of the billions of dollars in profits made by the industry’s largest companies. Health insurance experts told ProPublica that the companies treat the fines as a “cost of doing business.”

    They’re not doing their job. If they were, we would not have an ongoing problem.

    —Dr. Robert Trestman, an American Psychiatric Association expert, speaking about insurance regulators

    Insurers acknowledge that errors happen. Providers move. They retire. Their open appointments get booked by other patients. The industry’s top trade group, AHIP, has told lawmakers that companies contact providers to verify that their listings are accurate. The trade group also has stated that errors could be corrected faster if the providers did a better job updating their listings.

    But providers have told us that’s bogus. Even when they formally drop out of a network, they’re not always removed from the insurer’s lists.

    The harms from ghost networks are real. ProPublica reported on how Ravi Coutinho, a 36-year-old entrepreneur from Arizona, had struggled for months to access the mental health and addiction treatment that was covered by his health plan. After nearly two dozen calls to the insurer and multiple hospitalizations, he couldn’t find a therapist. Last spring, he died, likely due to complications from excessive drinking.

    Health insurance experts said that, unless agencies can crack down and issue bigger fines, insurers will keep selling error-ridden plans.

    “You can have all the strong laws on the books,” said David Lloyd, chief policy officer with the mental health advocacy group Inseparable. “But if they’re not being enforced, then it’s kind of all for nothing.”

    The problem with ghost networks isn’t one of awareness. States, federal agencies, researchers and advocates have documented them time and again for years. But regulators have resisted penalizing insurers for not fixing them.

    Two years ago, the Arizona Department of Insurance and Financial Institutions began to probe the directories used by five large insurers for plans that they sold on the individual market. Regulators wanted to find out if they could schedule an appointment with mental health providers listed as accepting new patients, so their staff called 580 providers in those companies’ directories.

    Thirty-seven percent of the calls did not lead to an appointment getting scheduled.

    Even though this secret-shopper survey found errors at a lower rate than what had been found in New York, health insurance experts who reviewed Arizona’s published findings said that the results were still concerning.

    Ghost network regulations are intended to keep provider listings as close to error-free as possible. While the experts don’t expect any insurer to have a perfect directory, they said that double-digit error rates can be harmful to customers.

    Arizona’s regulators seemed to agree. In a January 2023 report, they wrote that a patient could be clinging to the “last few threads of hope, which could erode if they receive no response from a provider (or cannot easily make an appointment).”

    Secret-shopper surveys are considered one of the best ways to unmask errors. But states have limited funding, which restricts how often they can conduct that sort of investigation. Michigan, for its part, mostly searches for inaccuracies as part of an annual review of a health plan. Nevada investigates errors primarily if someone files a complaint. Christine Khaikin, a senior health policy attorney for the nonprofit advocacy group Legal Action Center, said fewer surveys means higher odds that errors go undetected.

    Some regulators, upon learning that insurers may not be following the law, still take a hands-off approach with their enforcement. Oregon’s Department of Consumer and Business Services, for instance, conducts spot checks of provider networks to see if those listings are accurate. If they find errors, insurers are asked to fix the problem. The department hasn’t issued a fine for directory errors since 2019. A spokesperson said the agency doesn’t keep track of how frequently it finds network directory errors.

    Dave Jones, a former insurance commissioner in California, said some commissioners fear that stricter enforcement could drive companies out of their states, leaving their constituents with fewer plans to choose from.

    Even so, staffers at the Arizona Department of Insurance and Financial Institutions wrote in the report that there “needs to be accountability from insurers” for the errors in their directories. That never happened, and the agency concealed the identities of the companies in the report. A department spokesperson declined to provide the insurers’ names to ProPublica and did not answer questions about the report.

    Since January 2023, Arizonans have submitted dozens of complaints to the department that were related to provider networks. The spokesperson would not say how many were found to be substantiated, but the department was able to get insurers to address some of the problems, documents obtained through an open records request show.

    According to the department’s online database of enforcement actions, not a single one of those companies has been fined.


    Credit:
    Anson Chan, special to ProPublica

    Sometimes, when state insurance regulators fail to act, attorneys general or federal regulators intervene in their stead. But even then, the extra enforcers haven’t addressed the underlying problem.

    For years, the Massachusetts Division of Insurance didn’t fine any company for ghost networks, so the state attorney general’s office began to investigate whether insurers had deceived consumers by publishing inaccurate directories. Among the errors identified: One plan had providers listed as accepting new patients but no actual appointments were available for months; another listed a single provider more than 10 times at different offices.

    In February 2020, Maura Healey, who was then the Massachusetts attorney general, announced settlements with some of the state’s largest health plans. No insurer admitted wrongdoing. The companies, which together collect billions in premiums each year, paid a total of $910,000. They promised to remove providers who left their networks within 30 days of learning about that decision. Healey declared that the settlements would lead to “unprecedented changes to help ensure patients don’t have to struggle to find behavioral health services.”

    But experts who reviewed the settlements for ProPublica identified a critical shortcoming. While the insurers had promised to audit directories multiple times a year, the companies did not have to report those findings to the attorney general’s office. Spokespeople for Healey and the attorney general’s office declined to answer questions about the experts’ assessments of the settlements.

    After the settlements were finalized, Healey became the governor of Massachusetts and has been responsible for overseeing the state’s insurance division since she took office in January 2023. Her administration’s regulators haven’t brought any fines over ghost networks.

    The industry doesn’t take the regulatory penalties seriously because they’re so low.

    —Mara Elliott, San Diego’s city attorney

    Healey’s spokesperson declined to answer questions and referred ProPublica to responses from the state’s insurance division. A division spokesperson said the state has taken steps to strengthen its provider directory regulations and streamline how information about in-network providers gets collected. Starting next year, the spokesperson said that the division “will consider penalties” against any insurer whose “provider directory is found to be materially noncompliant.”

    States that don’t have ghost network laws have seen federal regulators step in to monitor directory errors.

    In late 2020, Congress passed the No Surprises Act, which aimed to cut down on the prevalence of surprise medical bills from providers outside of a patient’s insurance network. Since then, the Centers for Medicare and Medicaid Services, which oversees the two large public health insurance programs, has reached out to every state to see which ones could handle enforcement of the federal ghost network regulations.

    At least 15 states responded that they lacked the ability to enforce the new regulation. So CMS is now tasked with watching out for errors in directories used by millions of insurance customers in those states.

    Julie Brookhart, a spokesperson for CMS, told ProPublica that the agency takes enforcement of the directory error regulations “very seriously.” She said CMS has received a “small number” of provider directory complaints, which the agency is in the process of investigating. If it finds a violation, Brookhart said regulators “will take appropriate enforcement action.”

    But since the requirement went into effect in January 2022, CMS hasn’t fined any insurer for errors. Brookhart said that CMS intends to develop further guidelines with other federal agencies. Until that happens, Brookhart said that insurers are expected to make “good-faith” attempts to follow the federal provider directory rules.

    Last year, five California lawmakers proposed a bill that sought to get rid of ghost networks around the state. If it passed, AB 236 would limit the number of errors allowed in a directory — creating a cap of 5% of all providers listed — and raise penalties for violations. California would become home to one of the nation’s toughest ghost network regulations.

    The state had already passed one of America’s first such regulations in 2015, requiring insurers to post directories online and correct inaccuracies on a weekly basis.

    Since the law went into effect in 2016, insurance customers have filed hundreds of complaints with the California Department of Managed Health Care, which oversees health plans for nearly 30 million enrollees statewide.

    Lawyers also have uncovered extensive evidence of directory errors. When San Diego’s city attorney, Mara Elliott, sued several insurers over publishing inaccurate directories in 2021, she based the claims on directory error data collected by the companies themselves. Citing that data, the lawsuits noted that error rates for the insurers’ psychiatrist listings were between 26% and 83% in 2018 and 2019. The insurers denied the accusations and convinced a judge to dismiss the suits on technical grounds. A panel of California appeals court judges recently reversed those decisions; the cases are pending.

    The companies have continued to send that data to the DMHC each year — but the state has not used it to examine ghost networks. California is among the states that typically waits for a complaint to be filed before it investigates errors.

    “The industry doesn’t take the regulatory penalties seriously because they’re so low,” Elliott told ProPublica. “It’s probably worth it to take the risk and see if they get caught.”

    California’s limited enforcement has resulted in limited fines. Over the past eight years, the DMHC has issued just $82,500 in fines for directory errors involving providers of any kind. That’s less than one-fifth of the fines issued in the two years before the regulation went into effect.

    A spokesperson for the DMHC said its regulators continue “to hold health plans accountable” for violating ghost network regulations. Since 2018, the DMHC has discovered scores of problems with provider directories and pushed health plans to correct the errors. The spokesperson said that the department’s oversight has also helped some customers get reimbursed for out-of-network costs incurred due to directory errors.

    “A lower fine total does not equate to a scaling back on enforcement,” the spokesperson said.

    Dr. Joaquin Arambula, one of the state Assembly members who co-sponsored AB 236, disagreed. He told ProPublica that California’s current ghost network regulation is “not effectively being enforced.” After clearing the state Assembly this past winter, his bill, along with several others that address mental health issues, was suddenly tabled this summer. The roadblock came from a surprising source: the administration of the state’s Democratic governor.

    Officials with the DMHC, whose director was appointed by Gov. Gavin Newsom, estimated that more than $15 million in extra funding would be needed to carry out the bill’s requirements over the next five years. State lawmakers accused officials of inflating the costs. The DMHC’s spokesperson said that the estimate was accurate and based on the department’s “real experience” overseeing health plans.

    Arambula and his co-sponsors hope that their colleagues will reconsider the measure during next year’s session. Sitting before state lawmakers in Sacramento this year, a therapist named Sarah Soroken told the story of a patient who had called 50 mental health providers in her insurer’s directory. None of them could see her. Only after the patient attempted suicide did she get the care she’d sought.

    “We would be negligent,” Soroken told the lawmakers, “if we didn’t do everything in our power to ensure patients get the health care they need.”

    Paige Pfleger of WPLN/Nashville Public Radio contributed reporting.