Archive for May, 2015

Expert: Fraud Leads to Poor Quality Healthcare

Photo by HFMA.org

Photo by HFMA.org

Harvard professor and healthcare expert Atul Gawande recently noted that the unnecessary medical care endangers patients and robs the taxpayers.  In a recent article published in The New Yorker, Gawande cited fraud as a significant contributor to what leading researchers describe as “low-value care.”  Gawande, a general surgeon, notes that ‘[d]octors get paid for doing more, not less,” and that a huge percentage of Medicare patients receive unnecessary and wasteful care.  You can read Dr. Gawande’s full article on The New Yorker’s website.


Excerpted in Part:

I am a general surgeon with a specialty in tumors of the thyroid and other endocrine organs. In my clinic that afternoon, I saw eight new patients with records complete enough that I could review their past medical history in detail. One saw me about a hernia, one about a fatty lump growing in her arm, one about a hormone-secreting mass in her chest, and five about thyroid cancer.

To my surprise, it appeared that seven of those eight had received unnecessary care. Two of the patients had been given high-cost diagnostic tests of no value. One was sent for an MRI after an ultrasound and a biopsy of a neck lump proved suspicious for thyroid cancer. (An MRI does not image thyroid cancer nearly as well as the ultrasound the patient had already had.) The other received a new, expensive, and, in her circumstances, irrelevant type of genetic testing. A third patient had undergone surgery for a lump that was bothering him, but whatever the surgeon removed it wasn’t the lump—the patient still had it after the operation. Four patients had undergone inappropriate arthroscopic knee surgery for chronic joint damage. (Arthroscopy can repair certain types of acute tears to the cartilage of the knee. But years of research, including randomized trials, have shown that the operation is of no help for chronic arthritis- or age-related damage.)

Virtually every family in the country, the research indicates, has been subject to overtesting and overtreatment in one form or another. The costs appear to take thousands of dollars out of the paychecks of every household each year. Researchers have come to refer to financial as well as physical “toxicities” of inappropriate care—including reduced spending on food, clothing, education, and shelter. Millions of people are receiving drugs that aren’t helping them, operations that aren’t going to make them better, and scans and tests that do nothing beneficial for them, and often cause harm.

 

 

$500 Million Settlement in DaVita Whistleblower Case

The Denver Post reports DaVita HealthCare Partners said Monday it will pay up to $495 million to settle a whistle-blower lawsuit accusing the Denver company of defrauding the federal Medicare program of millions of dollars.

The company, which said it does not admit any wrongdoing, has now settled its third whistle-blower lawsuit since 2012, with payouts totaling nearly $1 billion.

The civil suit, filed in Atlanta in 2011, revolves around a claim by Dr. Alon J. Vainer and nurse Daniel D. Barbir, who both worked for DaVita. They noticed that DaVita was throwing out good medicine that it then billed Medicare and Medicaid for, according to the lawsuit.

Read more about this settlement in The Denver Post.

 

Family Reacts to Whistleblower Suit against IU Health

Dr.RobinsonPic-WTHR

Dr. Judith Robinson

The NBC affiliate in Indianapolis continued its coverage of a whistleblower case filed by James Hoyer law firm client Dr. Judith Robinson.  In a powerful report, WTHR TV Investigative Reporter Sandra Chapman interviewed the mother of a maternity patient who died during childbirth at Methodist Hospital in Indianapolis.

Dr. Robinson is a well-respected Obstetrician/Gynecologist who’s practiced in Indianapolis for 30 years. She chose to come forward as a whistleblower and put her career on the line after witnessing multiple violations of Medicaid rules, which she believes put pregnant women and their babies at risk.

Both WTHR and the Indianapolis Star told the story of Dr. Robinson’s whistleblower case in earlier reports.

Watch the video below to see WTHR’s latest story: “Mom dies during childbirth; Family reacts to $100M suit against IU Health.”

13 WTHR Indianapolis

 

False Claims Act coming soon to Vermont

2000px-Flag_of_Vermont.svgVermont Governor Peter Shumlin will soon have the opportunity to sign into law the state’s first False Claims Act.  The House voted Wednesday to approve the Senate version of H.120, which is modeled after the federal law.

This is an important step for taxpayers in Vermont who will finally have a vehicle with which to recover money that has been stolen from the state.  Read More…