Attached a troubling article published in the Naplesnews.com and subsequently in today's New York Times reporting a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando. The state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials. The complaint contains allegations raising standard of care issues that fall under the jurisdiction of the Department of Health. With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department. The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.
This raises several problematic issues:
1. If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
2. Rick Scott already said that he wouldn’t get involved except for making the appointment of the head of the health department.
Maybe we should remember that if it looks like a duck, walks like a duck and quakes like a duck then its probably not a giraffe.
Yours
Bernd
Naples Daily News - Printer-friendly story
Rick Scott would pick agency head, but vows to stay clear of any state Solantic probe
The state Department of Health won't say what it has done with complaint against Scott's company
By LIZ FREEMAN
Thursday, October 28, 2010
NAPLES — The state Department of Health won’t discuss its handling of a health-care fraud complaint against Solantic, a chain of walk-in centers co-founded by gubernatorial candidate Rick Scott in 2001.
Solantic currently operates about 30 walk-in centers, mostly around Jacksonville and Orlando.
“We can’t acknowledge or deny the existence of a complaint,” said Eulinda Smith, a state health department spokeswoman.
However, a letter obtained by the Daily News under Florida’s public records law shows the state Agency for Health Care Administration (AHCA) sent the complaint to the state health department Aug. 13, a week after receiving it. Various media outlets reported earlier that it was referred to federal officials.
“The complaint contains allegations raising standard of care issues that more appropriately fall under the jurisdiction of the Department of Health,” Jerome Worley, chief of investigations for the Office of Inspector General with AHCA, wrote in a letter to the state Department of Health. “Please handle the complaint as you deem appropriate.”
The complaint was sent to AHCA anonymously but said the allegations were provided by Dr. Randy Prokes, a former medical director of a Solantic center in Jacksonville. The one-page form lists 10 allegations of wrongdoing and there are 26 pages of abbreviated notes about questionable practices at clinics with names of former or current Solantic employees as potential sources for investigators.
If an investigation was opened and continues beyond Tuesday’s election with the potential that Scott is elected governor, any investigation could make for a conflict for the health department’s secretary, who is appointed by the governor.
When asked while campaigning Thursday how he would handle that situation, Scott said he wouldn’t get involved except for making the appointment of the head of the health department.
“I’d recuse myself from any involvement,” he said. “I’m going to appoint the head of the position, but I’m not going to be involved in any decisions.”
Sent to the health department in mid-August, the complaint against Solantic Urgent Care of Jacksonville may have been dismissed as not part of the department’s purview, or officials may have found the allegations insufficient or unfounded. It is also possible an investigation was opened and continues.
Like many government agencies with investigative authority, the health department won’t confirm if it has the complaint in question.
The complaint caused a frenzy in mid-August when it became public after AHCA decided not to investigate and released it to the media. Scott detoured from campaigning in South Florida and held a press conference in Tallahassee. He told reporters his GOP opponent in the primary, Attorney General Bill McCollum, was using allegations received in an e-mail from Prokes for “Chicago-style smear politics.”
Solantic’s chief executive officer, Karen Bowling, likewise denied the allegations at the time and said Prokes was fired in 2009 for writing a prescription for a pain-killer outside the clinic.
Prokes, who couldn’t be reached for comment, stated in his e-mail to the Attorney General’s Office that he was fired after raising his concerns about wrongful practices at the clinics.
Allegations of potential fraud at Solantic brought back to the campaign forefront Scott’s past as chief executive officer of the former Columbia/HCA, which paid a record $1.7 billion in the late 1990s to settle Medicare fraud fines. Scott denied knowledge of the fraud and was never charged.
With respect to the Solantic complaint, AHCA decided not to conduct a probe because the allegations focus on possible fraud with Medicare and not with state-run Medicaid. As a result, AHCA officials forwarded the complaint to federal Medicare authorities on the same day they sent it to the state health department.
Similar to state investigative agencies, the Office of the Inspector General with the U.S. Health and Human Services “can neither confirm nor deny the receipt of a complaint,” according to Donald White, spokesman for that federal agency.
The state health department has jurisdiction over possible standard of care infractions by physicians and other state-licensed medical professionals; AHCA licenses medical facilities and investigates potential regulatory violations.
The complaint alleges a number of potential wrongdoings at Solantic, including overbilling of Medicaid, Medicare, private insurance and TriCare, which is the government health plan for veterans. It says insurers were charged physician rates when patients were treated by nurse practitioners, that unnecessary tests were ordered and billed, and that outdated screenings were performed. Another allegation is that unnecessary prescriptions were written so patients purchased medications from internal pharmacies.
Another claim is that a physician’s medical license was misused by Solantic to apply for a clinic license without the physician’s knowledge.
Both in August and recently, Scott campaign officials have said the allegations are old, were trumped up by the McCollum campaign before the primary and that Solantic aggressively responded to the claims.
“The guy (Prokes) was not even in the position to allege what he alleged,” said Brian Burgess, a Scott spokesman. “My understanding from the Solantic attorney, they would be told if there is even something going on.”
Responding to a recent follow-up inquiry by the Daily News to AHCA about why the agency declined to investigate, spokeswoman Tiffany Vause said Solantic clinics hadn’t filed any claims with the traditional Medicaid program but claims were filed with a few Medicaid managed care plans under state contract.
“The agency’s Bureau of Medicaid Program Integrity referred the complaint to these health plans for review,” she said in an e-mail.
In response to the allegation that Solantic used a physician’s license at another clinic site without the doctor’s knowledge, Vause said state law doesn’t allow the agency to sanction a clinic for such activity.
However, medical facilities can be cited during inspections for a variety of deficiencies with state regulations.
Three inspections at Solantic clinics in Orlando, Apopka and Lake Mary show they were flagged because the medical directors had failed to do periodic reviews of billing claims to make sure no fraudulent or unlawful claims were filed. One of the inspections was in late 2007 and two others were in April and August of this year.
AHCA spokeswoman Shelisha Durden said a clinic doesn’t pass an inspection until there are assurances that the billing review is in place and being done.
“The issue is whether the clinic had a process in place where the medical director conducted systematic reviews of the clinic’s bills, and also whether the director conducted these reviews,” she said.
* * * * *
Saturday, October 30, 2010
Sunday, October 24, 2010
Medicaid Reform: Different approaches but one correct answer
In the current edition of the South Florida Business Journal (October 22-28th,2010) the two gubernatorial candidates, Alex Sink (D) and Rick Scott(R)), answered questions related to the business climate in Florida.
One of them pertained to the future of Medicaid:
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Sink: I will form a task force of all Medicaid system stakeholders to develop solutions for reducing this program’s burden on the state budget, and explore ways to address rising costs without jeopardizing the quality of care. Medicaid reforms are needed, as the program consumes about a fourth of the state’s budget; however, policymakers should ensure that changes actually work before imposing them upon the entire state.
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Scott: I will seek a Medicaid waiver in order to allow Florida to create a voucher program in which Medicaid recipients would be able to shop for insurance on the private market. If we were not able get that waiver, I would seek to expand the Medicaid reform pilot program.
Comment: Medicaid reform pilot programs are solely intended to reduce the rapidly increasing Medicaid cost in Florida ($17.9 billion for the 2.6 million recipients - one out of every seven residents - and an 11 percent rise from the previous year) . But whats the reality? Doctors are complaining and refuse to participate because of low payments. Patients complain about delayed and limited services. Who does not complain? HMO's because they get the state contracts to care for Medicaid patients.
Vouchers: The argument sounds compelling. You provide Medicaid patients with a voucher and they can choose their own insurance and providers. The only problem: there are hardly any choices! Doctors drop out of Medicaid due to low payments and the insurance policy options are limited and contracts littered with exclusion criteria and limitations.
So if doctors are wary about Medicaid reform pilot programs why does organized medicine ENDORSES Rick Scott? Shouldn't we endorse the candidate who wants to ensure that changes actually work BEFORE imposing them upon the entire state? Please explain.
Bernd
One of them pertained to the future of Medicaid:
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Sink: I will form a task force of all Medicaid system stakeholders to develop solutions for reducing this program’s burden on the state budget, and explore ways to address rising costs without jeopardizing the quality of care. Medicaid reforms are needed, as the program consumes about a fourth of the state’s budget; however, policymakers should ensure that changes actually work before imposing them upon the entire state.
SFBJ: Would you make any changes to Florida’s Medicaid system, in areas such as provider funding, eligibility or the continuation of the Medicaid reform pilot program?
Scott: I will seek a Medicaid waiver in order to allow Florida to create a voucher program in which Medicaid recipients would be able to shop for insurance on the private market. If we were not able get that waiver, I would seek to expand the Medicaid reform pilot program.
Comment: Medicaid reform pilot programs are solely intended to reduce the rapidly increasing Medicaid cost in Florida ($17.9 billion for the 2.6 million recipients - one out of every seven residents - and an 11 percent rise from the previous year) . But whats the reality? Doctors are complaining and refuse to participate because of low payments. Patients complain about delayed and limited services. Who does not complain? HMO's because they get the state contracts to care for Medicaid patients.
Vouchers: The argument sounds compelling. You provide Medicaid patients with a voucher and they can choose their own insurance and providers. The only problem: there are hardly any choices! Doctors drop out of Medicaid due to low payments and the insurance policy options are limited and contracts littered with exclusion criteria and limitations.
So if doctors are wary about Medicaid reform pilot programs why does organized medicine ENDORSES Rick Scott? Shouldn't we endorse the candidate who wants to ensure that changes actually work BEFORE imposing them upon the entire state? Please explain.
Bernd
Saturday, October 23, 2010
Malpractice Reform; A Fresh Start
Attached an interesting article published in the New York Times on October 20th, 2010.
In this article Peter Orszag, the former director of the White House Office of Management and Budget, emphasizes that Congress (Democrats AND Republicans alike) " missed an important opportunity to shield from malpractice liability any doctors who followed evidence based guidelines in treating their patients." He argues that malpractice reform, i.e.liability insurance reform, could encourage doctors to adopt new evidence more quickly.
He continues stating that instead of imposing caps on liability a far better strategy would be to provide safe harbor for doctors who follow evidence based guidelines. In such circumstances ANYONE who could demonstrate that he/she has followed the recommended course for treating a specific illness or condition could NOT be held liable! To successfully transform our broken malpractice system he suggests taking the following steps:
1. Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity.
2. Approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work.
3. Develop and fund information technology solutions that quickly suggest best-practice methods of treatment.
4. Align financial incentives for delivering higher-quality care and and to shift Medicare’s payments toward “fee for quality” rather than “fee for service.”
In my opinion we should discuss these ideas, ask for federal funding to start pilot projects and to actively support any such initiatives.
Unfortunately, organized medicine is focusing on liability caps as the ONLY solution for malpractice reform ignoring and discarding ANY other approaches to address and resolve this important issue. At this point in time progressive physicians and other healthcare professionals should form partnerships and alliance to counter this dogmatic position. Healthcare professionals should consider seeking representation in partnership with ALL participants in the healthcare delivery process including PAs,ARNPs,Nurses and hospital administrators and to engage in strategic planning sessions to develop rational responses to increasing complex problems.
This requires new leadership with the ability to listen, to tolerate other opinions and to seek a compromise based on the most common denominator.
Discussing malpractice reform also requires the inclusion of legal professionals and to engage the trial bar in the deliberations.
We must move from confrontation to collaboration and to stop dividing the world into "friends" and "enemies" of medicine.
Maybe just a dream but the opportunity to change is still present.
Yours
Bernd
October 20, 2010
Malpractice Methodology
By PETER ORSZAG
The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.
As President Obama noted in his speech to the American Medical Association in June 2009, too many doctors order unnecessary tests and treatments only because they believe it will protect them from a lawsuit. Instead, he said, “We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines.”
Why does this matter? Right now, health care is more evidence-free than you might think. And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice. As a result, any clinical guidelines that exist often have limited impact.
How might we encourage doctors to adopt new evidence more quickly? Malpractice reform could help — possibly a lot.
The academic literature tends to play down the role of medical liability laws in driving up health care costs. Doctors themselves, however, almost universally state that malpractice statutes lead to extraneous testing and treatment.
It is also conceivable that because such laws usually focus on “customary practice” — that is, a doctor who has treated a patient the way most other doctors in the area would is considered safe from accusations of malpractice — they create a strong contagion effect among doctors. The laws, no matter how weak or stringent, may therefore explain why doctors in some parts of the country generally adopt much more intensive approaches than those in other areas do.
The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.
The health care reform act that Congress passed earlier this year included a modest set of state pilot projects, including one in Oregon that is intended to experiment with this approach. But these pilots are small; the project in Oregon, for example, has only $300,000 in financing.
What’s needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.
Congress has taken a step in this direction before. As Prof. James Blumstein of Vanderbilt University Law School has pointed out, a little-known provision in the Social Security Act amendments of 1972 provides immunity from malpractice liability to doctors who treat patients in conformity with the standards set forth by so-called quality improvement organizations — nonprofits under contract with Medicare that work to improve care. The provision remains in force, though those organizations have yet to set such standards.
Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity. But no matter which body is put in charge of certification, this approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work. It’s a good start.
Better technology would help, too. Your doctor’s computer should be able to not only pull up your health records (after you have approved such access) but also quickly suggest best-practice methods of treatment. The doctor should then be able to click through to read the supporting research. Subsidies in the stimulus act help doctors pay for this kind of technology.
A final step toward improving standard medical practice will be to better align financial incentives for delivering higher-quality care. Hospitals now lose Medicare dollars, for example, if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.
The health care reform act already includes measures that enable policymakers to shift Medicare’s payments toward “fee for quality” rather than “fee for service.” My next column will discuss these measures, which get far less credit than they should, in more detail.
Opponents of the act are generally off base in criticizing investments in improved care. In complaining about the missed opportunity to reform medical malpractice laws to promote evidence-based medical practice, on the other hand, the critics are entirely on target.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
In this article Peter Orszag, the former director of the White House Office of Management and Budget, emphasizes that Congress (Democrats AND Republicans alike) " missed an important opportunity to shield from malpractice liability any doctors who followed evidence based guidelines in treating their patients." He argues that malpractice reform, i.e.liability insurance reform, could encourage doctors to adopt new evidence more quickly.
He continues stating that instead of imposing caps on liability a far better strategy would be to provide safe harbor for doctors who follow evidence based guidelines. In such circumstances ANYONE who could demonstrate that he/she has followed the recommended course for treating a specific illness or condition could NOT be held liable! To successfully transform our broken malpractice system he suggests taking the following steps:
1. Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity.
2. Approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work.
3. Develop and fund information technology solutions that quickly suggest best-practice methods of treatment.
4. Align financial incentives for delivering higher-quality care and and to shift Medicare’s payments toward “fee for quality” rather than “fee for service.”
In my opinion we should discuss these ideas, ask for federal funding to start pilot projects and to actively support any such initiatives.
Unfortunately, organized medicine is focusing on liability caps as the ONLY solution for malpractice reform ignoring and discarding ANY other approaches to address and resolve this important issue. At this point in time progressive physicians and other healthcare professionals should form partnerships and alliance to counter this dogmatic position. Healthcare professionals should consider seeking representation in partnership with ALL participants in the healthcare delivery process including PAs,ARNPs,Nurses and hospital administrators and to engage in strategic planning sessions to develop rational responses to increasing complex problems.
This requires new leadership with the ability to listen, to tolerate other opinions and to seek a compromise based on the most common denominator.
Discussing malpractice reform also requires the inclusion of legal professionals and to engage the trial bar in the deliberations.
We must move from confrontation to collaboration and to stop dividing the world into "friends" and "enemies" of medicine.
Maybe just a dream but the opportunity to change is still present.
Yours
Bernd
October 20, 2010
Malpractice Methodology
By PETER ORSZAG
The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.
As President Obama noted in his speech to the American Medical Association in June 2009, too many doctors order unnecessary tests and treatments only because they believe it will protect them from a lawsuit. Instead, he said, “We need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine and encourage broader use of evidence-based guidelines.”
Why does this matter? Right now, health care is more evidence-free than you might think. And even where evidence-based clinical guidelines exist, research suggests that doctors follow them only about half of the time. One estimate suggests that it takes 17 years on average to incorporate new research findings into widespread practice. As a result, any clinical guidelines that exist often have limited impact.
How might we encourage doctors to adopt new evidence more quickly? Malpractice reform could help — possibly a lot.
The academic literature tends to play down the role of medical liability laws in driving up health care costs. Doctors themselves, however, almost universally state that malpractice statutes lead to extraneous testing and treatment.
It is also conceivable that because such laws usually focus on “customary practice” — that is, a doctor who has treated a patient the way most other doctors in the area would is considered safe from accusations of malpractice — they create a strong contagion effect among doctors. The laws, no matter how weak or stringent, may therefore explain why doctors in some parts of the country generally adopt much more intensive approaches than those in other areas do.
The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.
The health care reform act that Congress passed earlier this year included a modest set of state pilot projects, including one in Oregon that is intended to experiment with this approach. But these pilots are small; the project in Oregon, for example, has only $300,000 in financing.
What’s needed is a much more aggressive national effort to protect doctors who follow evidence-based guidelines. That’s the only way that malpractice reform could broadly promote the adoption of best practices.
Congress has taken a step in this direction before. As Prof. James Blumstein of Vanderbilt University Law School has pointed out, a little-known provision in the Social Security Act amendments of 1972 provides immunity from malpractice liability to doctors who treat patients in conformity with the standards set forth by so-called quality improvement organizations — nonprofits under contract with Medicare that work to improve care. The provision remains in force, though those organizations have yet to set such standards.
Organizations like the American Medical Association and the Institute of Medicine could also be called upon to issue the needed evidence-based standards for malpractice immunity. But no matter which body is put in charge of certification, this approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work. It’s a good start.
Better technology would help, too. Your doctor’s computer should be able to not only pull up your health records (after you have approved such access) but also quickly suggest best-practice methods of treatment. The doctor should then be able to click through to read the supporting research. Subsidies in the stimulus act help doctors pay for this kind of technology.
A final step toward improving standard medical practice will be to better align financial incentives for delivering higher-quality care. Hospitals now lose Medicare dollars, for example, if they succeed in reducing readmissions. Medical professionals should be given incentives for better care rather than more care.
The health care reform act already includes measures that enable policymakers to shift Medicare’s payments toward “fee for quality” rather than “fee for service.” My next column will discuss these measures, which get far less credit than they should, in more detail.
Opponents of the act are generally off base in criticizing investments in improved care. In complaining about the missed opportunity to reform medical malpractice laws to promote evidence-based medical practice, on the other hand, the critics are entirely on target.
Peter Orszag, the director of the White House Office of Management and Budget from 2009 to 2010 and a distinguished visiting fellow at the Council on Foreign Relations, is a contributing columnist for The Times.
Tuesday, October 12, 2010
Keep it Simple and Stupid: Rick Scott's Healthcare Plan and the FMA
“Florida is not a physician-friendly state to practice medicine because of the high cost of medical liability insurance and excessive lawsuits,....the FMA PAC supports Rick Scott for Governor because he shares our goal of increasing access to quality health care for all of Florida’s citizens. Rick Scott is not afraid of taking on personal injury lawyers and shaking up the status quo in order to get things done for the people of Florida.”
President of the FMA PAC, Dr. Madelyn Butler
I tried to understand Rick Scott's healthcare plan and ideas, which convinced the Florida Medical Association Political Action Committee to endorse him as Gubernatorial Candidate.
First, I searched on his web site and found the following:
* On Abortion: "I believe that abortion is wrong and Roe versus Wade should be overturned."
o What shall I tell a woman who is pregnant but unmarried, unemployed, on food stamps and lives with friends or relatives?
o Teenagers who were raped or married women who were sexually attacked by their husbands?
o Should government tell women and doctors what to do and how to lives their lives?
* On Health Care:
o "As a businessman, I know I am held accountable for results, and I held the people in my company accountable for results, too. Delivering quality care at a lower cost to patients was a top priority when I ran Columbia/HCA, and when I started Solantic urgent care facilities here in Florida....In the 1990’s, we were able to transform the hospital industry and prove that free market health care can deliver high quality care at a lower cost to patients."
+ That’s it? We just have to emulate the Columbia/HCA model and open a couple of Solantic Urgent Care centers and we solve all healthcare problems? Guess, I can shred all my healthcare economics test books and magazines, join Rick Scott's model and everything will be just fine. How naive or stupid can anyone be to believe that? Obviously, the FMA PAC does!
o "Rick believes that our health care system should focus on choice, competition, accountability and personal responsibility."
+ So I will have the choice of choosing between an unaffordable health insurance policy or none?
+ Accountability and personal responsibility only applies to the consumers of healthcare but not Rick Scott who just made " some mistakes in his life."
o "Most recently, Rick led the fight to defeat President Obama’s government-run public option. As the founder of Conservatives for Patients’ Rights (CPR), an advocacy group dedicated to the free market principles of choice, competition, accountability and personal responsibility in health care, he was instrumental in defeating the public option plan that would have led to socialized medicine."
+ Fear mongering and painting the government as the boogeyman trying to enslave citizens is a silly and dangerous tactic which just reveals that Rick Scott and friends have no other arguments to offer to resolve the critical problem facing us today and in the near future: how to provide affordable healthcare for an aging population suffering from chronic diseases that consume already 75% of all health care spending.
* On healthcare management experience:
o " I’ve made mistakes in my life...I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader."
+ That’s it! Mistakes imply taking personal responsibility and not blaming others (i.e. Columbia/HCA) for it. These are the lessons he brings to the table and those character traits make him the knight in shining armor for the FMA PAC?
So what can I say about the FMA PAC decision to endorse Rick Scott? A sad day for Florida's doctors. A sad day for medicine.
Yours
Bernd
President of the FMA PAC, Dr. Madelyn Butler
I tried to understand Rick Scott's healthcare plan and ideas, which convinced the Florida Medical Association Political Action Committee to endorse him as Gubernatorial Candidate.
First, I searched on his web site and found the following:
* On Abortion: "I believe that abortion is wrong and Roe versus Wade should be overturned."
o What shall I tell a woman who is pregnant but unmarried, unemployed, on food stamps and lives with friends or relatives?
o Teenagers who were raped or married women who were sexually attacked by their husbands?
o Should government tell women and doctors what to do and how to lives their lives?
* On Health Care:
o "As a businessman, I know I am held accountable for results, and I held the people in my company accountable for results, too. Delivering quality care at a lower cost to patients was a top priority when I ran Columbia/HCA, and when I started Solantic urgent care facilities here in Florida....In the 1990’s, we were able to transform the hospital industry and prove that free market health care can deliver high quality care at a lower cost to patients."
+ That’s it? We just have to emulate the Columbia/HCA model and open a couple of Solantic Urgent Care centers and we solve all healthcare problems? Guess, I can shred all my healthcare economics test books and magazines, join Rick Scott's model and everything will be just fine. How naive or stupid can anyone be to believe that? Obviously, the FMA PAC does!
o "Rick believes that our health care system should focus on choice, competition, accountability and personal responsibility."
+ So I will have the choice of choosing between an unaffordable health insurance policy or none?
+ Accountability and personal responsibility only applies to the consumers of healthcare but not Rick Scott who just made " some mistakes in his life."
o "Most recently, Rick led the fight to defeat President Obama’s government-run public option. As the founder of Conservatives for Patients’ Rights (CPR), an advocacy group dedicated to the free market principles of choice, competition, accountability and personal responsibility in health care, he was instrumental in defeating the public option plan that would have led to socialized medicine."
+ Fear mongering and painting the government as the boogeyman trying to enslave citizens is a silly and dangerous tactic which just reveals that Rick Scott and friends have no other arguments to offer to resolve the critical problem facing us today and in the near future: how to provide affordable healthcare for an aging population suffering from chronic diseases that consume already 75% of all health care spending.
* On healthcare management experience:
o " I’ve made mistakes in my life...I learned very hard lessons from what happened and those lessons have helped me become a better businessman and leader."
+ That’s it! Mistakes imply taking personal responsibility and not blaming others (i.e. Columbia/HCA) for it. These are the lessons he brings to the table and those character traits make him the knight in shining armor for the FMA PAC?
So what can I say about the FMA PAC decision to endorse Rick Scott? A sad day for Florida's doctors. A sad day for medicine.
Yours
Bernd
Monday, October 11, 2010
Strange Bedfellows: The FMA and Rick Scott
According to a posting on the Florida Medical Association PAC web site ( see attached) the FMA PAC is endorsing endorsing Rick Scott's candidacy as Governor for our State of Florida!!???
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott Involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Even though I already lowered my expectation regarding FMA's actions and politics I am still surprised that the leadership of such an organization is willing to sacrifice its principles on the altar of political correctness. Sadly, ideology trumped rational thought and consideration. Its hard to believe that the FMA political leadership has omitted considering the following facts in their deliberation process. These facts are available for anyone to read on multiple web sites and were summarized by the Miami Herald in an article published on June 11th, 2010 http://www.miamiherald.com/2010/06/11/v-print/1674327/was-candidate-involved-in-us-healthcare.html, entitled "Was candidate Rick Scott Involved in US Healthcare Scam."
In the article the author states that:
"Scott started what was first Columbia in the spring of 1987, purchasing two El Paso, Texas, hospitals. He quickly grew the company by purchasing more hospitals. A hospital network created efficiencies. Efficiencies created profits.
In 1994, Scott's Columbia purchased Tennessee-headquartered HCA and its 100 hospitals, and merged the companies. When Scott resigned as CEO in 1997, Columbia/HCA had grown to more than 340 hospitals, 135 surgery centers and 550 home health locations in 37 states and two foreign countries, Scott's campaign says. The company employed more than 285,000 people.
Now about Scott's departure in 1997. That year, federal agents went public with an investigation into the company, first seizing records from four El Paso-area hospitals and then expanding across the country. In time it became apparent that the investigation focused on whether Columbia/HCA bilked Medicare and Medicaid.
Scott resigned as CEO in July 1997, less than four months after the inquiry became public and before the depth of the investigation became clear. Company executives said that had Scott remained CEO, the entire chain could have been in jeopardy.
At issue, Scott says, is that he wanted to fight the federal government's accusations. The corporate board of the publicly traded company wanted to settle. And settle Columbia/HCA did.
In December 2000, the U.S. Justice Department announced what it called the largest government fraud settlement in U.S. history when Columbia/HCA agreed to pay $840 million in criminal fines and civil damages and penalties.
Among the revelations from the 2000 settlement, all of which apply to the time Scott was CEO:
• Columbia billed Medicare, Medicaid and other federal programs for tests that were not necessary or ordered by physicians.
• The company attached false diagnosis codes to patient records to increase reimbursement to the hospitals.
• The company illegally claimed nonreimbursable marketing and advertising costs as community education.
• Columbia billed the government for home health care visits for patients who did not qualify to receive them.
The government settled a second series of claims with Columbia/HCA in 2002 for an additional $881 million. The total fine: $1.7 billion."
Furthermore the article continues:
"As part of the 2000 settlement, Columbia/HCA agreed to plead guilty to at least 14 corporate felonies. A corporate felony comes with financial penalties but not jail time, since a corporation can't be sent to prison. Among the 14 felonies, Columbia/HCA pleaded guilty to three counts of conspiracy to defraud the United States.
Also, four Florida-based Columbia/HCA executives were indicted. Two were convicted of defrauding Medicare in 1999 and were sentenced to prison, only to have those convictions overturned on appeal. A third executive was acquitted. A jury failed to reach a verdict on the fourth.
Was Scott close to going to prison for his part in the case? It appears not at all.
The former CEO was never indicted and was never questioned in the case, he says. He may have been a target of the investigation -- an ABC News report from 1997 says he was -- but that never translated into charges."
Let's boil this down.
Was Scott running Columbia/HCA when it found itself at the center of a massive federal investigation? Yes.
Did the company pay a record $1.7 billion in government penalties and fines? Yes.
And as we checked in this item, did his former company commit fraud? Yes, it pleaded guilty to fraud charges as part of a settlement.
The million-dollar question is: How much of the blame ultimately falls on Scott? That's an answer we can't provide.
Scott was in charge, so he bears some responsibility and has said so. But there has yet to come to light any detail of how much he knew, and when he knew it. Though that won't keep us from looking.
What did Rick Scott had to say about all that? Either he pleaded the Fifth Amendment, or claims that he did not know what was going on in his own company. I ask myself just one question: How on earth can anyone entrust the keys to the Governors' office to Rick Scott?
Maybe we should admire the Chutzpah (audacity) of Rick Scott and those who endorse his candidacy?
Maybe its time that in light of these facts doctors should reconsider their support for the FMA's endorsement because this time their leadership went too far.
Yours
Bernd
Attachment: FMA PAC web site http://www.fmaonline.org/Layout_1Column.aspx?pageid=2580
FMA PAC – General Election Endorsements
Statewide Races
Governor – Rick Scott
Attorney General – Pam Bondi
Chief Financial Officer - Jeff Atwater
Commissioner of Agriculture - Adam Putnam
Sunday, October 03, 2010
Prescription Drug Prices
In todays Miami Herald State Representative Juan C. Zapata calls for a mandated use of generic drugs for Medicaid and other state-funded programs http://www.miamiherald.com/2010/10/03/1854185/mandate-use-of-generic-drugs-for.html . He is correct saying that the use of generic drugs will slow down the predicted explosive growth of Medicaid expenditures but the mandated use of generic drugs addresses only ONE aspect of the problem. According to a New York Times article , Drug Makers Accused of Ignoring Price Law,” http://www.nytimes.com/2010/10/03/us/03drug.html , drug manufacturers consistently defy complying with a federal law that requires them to provide the government with pricing data needed to calculate discounts on medications prescribed for Medicaid recipients. More than three-fourths of drug manufacturers did not fully comply with the law requiring them to provide price data. They are supposed to file monthly and quarterly reports on what wholesalers paid them for drugs eventually sold to retail pharmacies. Without price data, the federal government cannot compute rebates, and states may be unable to collect them. As a condition of having their drugs covered by Medicaid, pharmaceutical companies must agree to provide discounts in the form of rebates. Drug companies pay the rebates to state Medicaid programs. The federal government and the states share the cost of Medicaid — roughly $400 billion in the last year — and share the savings that result from the rebates. Under the health care law, the minimum rebate on brand-name drugs dispensed to Medicaid recipients was increased to 23.1 percent of the average manufacturer price, from 15.1 percent. The minimum rebate on generic drugs was increased to 13 percent, from 11 percent. The Congressional Budget Office estimates that the changes could save the federal government more than $35 billion over 10 years. Major drug companies are already reporting adverse effects on their revenues. However, drug companies stand to gain many customers with the scheduled Medicaid expansion in 2014. What can be done to address this problem? Under federal law, the government can impose penalties of $10,000 a day on a drug manufacturer that fails to provide the information “on a timely basis. According to the Inspector General at the Department of Health and Human Services the federal government has had this authority since 1990 but has not used it! Why not? We must control and limit the rising healthcare costs and drug manufactures must understand that they can be either be part of the problem, or part of the solution. We also should lift the limitation on prescription drug re-importation and stop the unscrupulous use of antipsychotic drugs, which generate over $14 billion in revenue for drug manufacturers. Otherwise, we have no choice but to resort to rationing of healthcare services and prescription drugs.
Yours
Bernd
Yours
Bernd
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