Ex-employees tell of Texas workers’ comp troubles
The Texas Tribune’s Elise Hu has found that the Texas Department of Insurance’s Division of Workers’ Compensation has more than its share of dirty laundry, much of which is finally starting to see the light of day. The division is in charge of sanctioning physicians who are defrauding the state’s worker’s comp system by overbilling and overtreating patients. A recent spate of firings and resignations, along with a review by the Texas Sunset Advisory Commission, have helped illuminate just how dysfunctional the whole thing has become.
The crux of the matter: Staff recommended sanctions against almost 70 physicians, Hu wrote, “Yet since 2005, division records show, the state has sanctioned just five doctors with removal from the workers’ comp system — and only in cases involving paperwork violations rather than harm to patients.”
The broken enforcement system, the former employees say, stems from [Commissioner Rod Bordelon]’s insistence on putting the due process rights of accused doctors ahead of the rights of their allegedly abused patients. That misplaced focus, the employees believe, results in part from political pressure on Bordelon.
Hu discovered that the cases that were unceremoniously shuttered by Bordelon involved millions and millions of dollars in workers’ comp claims, and that the system didn’t have sufficient safeguards against abuse.
Lockhart, Watts, Nemeth and Ford (the employees who either resigned or were terminated) say they left with great disappointment at the lack of enforcement. “You can make a lot of money if you’re a doctor practicing in the workers’ comp system, if you are so inclined,” Ford says. “If you’re dishonest, or if you learn how to game a system, there’s lots of money — I mean, millions of dollars to be made.” The agency document that details investigations into the nine doctors showed that, during the one-to-two year monitoring period, seven of them billed insurers more than $1 million, two billed more than $2 million, and one billed $3.2 million.
It’s a convoluted story heavy with details and angry quotes, but if you’re just looking for a summary of how the terminated employees feel, this seems to be a pretty good one:
“[The office’s] focus since late 2005 has been to protect wealthy doctors who have learned how to game the system and take advantage of injured claimants,” Ford says. “The motives for this protection are open to speculation. Money, political pressure, and career advancement are at the top of the list.”
Patients at risk after free public screening
UPDATE: Commenter CT points out that the students involved were not medical school students but were in the University of New Mexico physician assistant program, a fact confirmed on the university’s web page about the incident.
Following news this week that two drug companies were hit with punitive damages after vials of the anesthetic propofol were re-used and infected patients with hepatitis C, The Associated Press’ Susan Montoya Bryan reports that “a group of New Mexico medical school students failed to properly change needles on devices used for blood glucose testing” putting people at risk for contracting serious diseases, such as hepatitis and HIV.
Photo by AlishaV via Flickr
More than 50 people were tested during a free event during the American Indian Week Pueblo Day on April 24 in Albuquerque, N.M., which was attended by people from all over the world: “The center’s visitor list for that Saturday included more than 1,600 people from across the nation and abroad – including Canada, Italy, Sweden and Germany.”
Bryan reports that the students used devices, similar to home glucose testers, which contain six lancets that are triggered to draw a blood sample. “With each use, the device must be advanced manually to load a new lancet.”
A spokesman for University of New Mexico’s Health Sciences Center says “the devices should not have been used at the public event and not all of the students were properly trained to use them. ”
Public health authorities have requested that those who participated in the testing event call 888-899-6092 or visit the UNM website for more information and referral for screening.
Slow-to-pay insurers may become national issue
Filed under: Health care reform, Health journalism, Hot Health Headline
For The News Journal of Wilmington, Del., Hiran Ratnayake dug through more than 100 complaints filed last year against the state’s insurers for undue delays in payment. In them, he finds some key anecdotes and little hope that companies’ responses would speed up in the future.
State law requires that claims be paid within 30 days, and at least three insurers who do business in the state were handed significant fines for a “pattern of delays.” Ratnayake tells the stories of patients whose claims have been approved but who have made dozens of calls when their insurance companies don’t receive payment and other tactics that appear to be intended to delay payments.
Furthermore, Ratnayake quotes an expert who predicted that “delays will become more frequent as more people become insured under the [health care reform] act.” The act does not address prompt payment regulations, Ratnayake reports.
In addition to his local reporting, Ratnayake used HHS Secretary Kathleen Sebelius’ speech at Health Journalism 2010 to provide national context.
Sebelius said recently that the federal government would engage in “hand-to-hand combat” with health insurers over problems related to policyholders’ plans.
Warehouses are ‘magnets for pollution’
Mira Loma, a town east of Los Angeles that’s become home to distribution centers and warehouses for some of the nation’s largest corporations, often finds itself playing host to more than 800 tractor trailers an hour.
Photo by cupcakes2 via Flickr
And, even in air-quality deprived Southern California, that makes for some serious pollution.
Caitlan Carroll, of American Public Media’s Marketplace, assessed their impact. Locals complain of soot, stench and respiratory problems and planners openly wish the village of Mira Loma weren’t so close to the warehouse district.
Insider offers view of health innovation
Filed under: Health care reform, Health policy, Hospitals
Blogging for the Harvard Business Review, Simon Stevens (chairman of the UnitedHealth Center for Health Reform & Modernization) seeks to explain why the field of health care is so agonizingly slow to adopt innovation, whether it be 15 years and counting for e-mail communication or several generations for scurvy-preventing limes. Without spoiling Stevens well-chosen analogies and explanations, I can say he makes a case that it comes down to three factors:
- The labor intensive nature of health care
- Failure to spread organizational innovation
- Barriers to new entrants in care delivery
To Stevens’ way of thinking, there is one group positioned to overcome those barriers and push the system forward: Health plans. UnitedHealth and its competitors have the data, platforms and connections to become major change agents in the field of health care delivery, as well as the incentive to put it all to work improving outcomes and decreasing costs.
Pronovost strategy influences Ore. infection data
Filed under: Health data, Hospitals, Public health
Prompted by Peter Pronovost’s keynote speech at Health Journalism 2010, The Oregonian’s Joe Rojas-Burke has been digging through the data on hospital infection rates to be released in accordance with an Oregon law that went into effect last year. The final statewide reporting date comes later this month, but The Oregonian has early results for 11 local hospitals.
Peter Pronovost, M.D., delivers the keynote speech at Health Journalism 2010. (Photo: Pia Christensen/AHCJ)
As part of the story, Rojas-Burke profiled hospitals with particularly low infection rates, especially one which had joined the Stop BSI network championed by Pronovost last month at AHCJ’s conference in Chicago. AHCJ members can see a copy of Pronovost’s presentation here.
The story builds on several things Pronovost shared at the conference, including the program’s background and state-by-state participation statistics.
Related
Other stories and blog posts related to Pronovost’s presentation:
- The Checklist and Future Culture of Medicine, Medical Lessons
- Hospitals slow to adopt renowned program, The Lund Report
- Hospital infection rates, a deadly problem, KSMU-FM
AHCJ members can read more stories from the conference
Texas data shows origin of foreign-trained doctors
Filed under: Health data, Hot Health Headline, Public records
Emily Ramshaw and Matt Stiles of The Texas Tribune looked into where that state’s doctors were trained and who received fast-tracked medical licenses in exchange for treating government-subsidized patients.
They found that “Of the roughly 1,500 doctors who have received fast-tracked licenses in the last three years for agreeing to treat Medicaid and Medicare patients, about 40 percent were trained at international medical schools, while just a quarter were trained at Texas medical schools.”
The site then used the data, obtained from the Texas Medical Board, and Google Gadgets to create an interactive map showing where Texas doctors were educated.
Related
- Tip sheet: Foreign-born doctors exploited by U.S. physicians
- Indentured doctors, Las Vegas Sun
Drug companies hit with punitive damages
A jury has decided Teva Parenteral Medicines and Baxter Healthcare Corp. must pay a combined $500 million in punitive damages in a case involving a hepatitis C outbreak in Las Vegas.
The case, expected to be just the first of hundreds, alleged that the re-use of vials of the anesthetic propofol infected patients with the disease.
An attorney for former patient Henry Chanin said the vials provided by the companies were larger than necessary, while “drug company lawyers have maintained that the vials were marked with instructions and warnings, and medical professionals decided what sizes were appropriate.”
Related
- Hep C emerges from dormancy to hit baby boomers
- KQED profiles those who live with disease, injury
- VA hospitals faulted for lax infection control
AHCJ members get tips on covering rate hikes
Bryant Furlow of The New Mexico Independent reported that Blue Cross Blue Shield New Mexico was raising some premiums by about 21 percent. It sounds like a lot, but Furlow wanted to compare it to other states for context. So, he e-mailed the AHCJ electronic discussion list and asked members across the country what their local Blue Cross / Blue Shield increases looked like, and how state insurance regulators had been responding.
That same day, Jim Hall replied with thoughts and a link to his paper’s story about similar hikes in Virginia, and Diane Cochran of the Billings Gazette reported that Montana rates had jumped between 9 and 19 percent. News and links to Massachusetts’ own conflict with Blue Cross came from Kay Lazar at The Boston Globe and Felice Freyer of The Providence Journal offered another set of links from Rhode Island along with some veteran advice:
When you’re comparing among states, keep in mind that there’s a difference between the individual and group markets, with rates more volatile in the individual market. I think the huge California increase was in the individual market only. In RI, individual rates (called Direct Pay here) are tightly regulated and BC takes a loss on those products.
Within a few hours of his request, then, Furlow got data and advice that applied to his own story and hundreds of other health journalists gained context and story ideas they could use at their own publications.
Freyer has some additional cautions for anyone considering a comparison of plans and rates across state lines:
Be sure to compare individual-market rate increases with individual-market rate increases and group with group. Don’t compare individual rates in one state with group rates in another. If you are trying to find out whether the increases in one state are extraordinary compared with other states, you may be able to get at that only in a general sense. It’s hard to compare states because state laws, demographics and economic conditions vary.
The electronic discussion list is one of many benefits reserved for AHCJ members. For more information and a searchable archive, check our guide to the electronic discussion list. If you’d rather call it a Listserv, you’re in charge of getting the rights to the trademark.
What about rate hikes in your area?
Have you written about recent Blue Cross / Blue Shield increase? Share your stories – and any advice or tips you have – in the comments section below.
Disciplined docs turn up on Pfizer payroll
Filed under: Health data, Health journalism, Hot Health Headline
New Scientist’s Peter Aldhous and Jim Giles created an interesting mash-up of two popular health stories, disciplined caregivers and conflicts of interest, by matching a set of Pfizer disclosures on payments to doctors and researchers in 2009 with discipline records from the FDA and the country’s most populous states. They found 26 matches on the state level and four from the feds, matches which accounted for about one in every 50 Pfizer-paid doctors in the states they’d investigated.
They assembled a number of anecdotes for the story, but the most telling related to a physician who was disciplined for faulty research related to a Pfizer drug, yet still paid by the company to lecture on it.
Other Pfizer experts ran into trouble during their research. Among them is Thomas Gazda of Scottsdale, Arizona, who was paid to lecture about Geodon after being reprimanded by the FDA over irregularities in his conduct of a trial of the same drug’s use in children and adolescents with bipolar disorder – one of whom was given more than the maximum allowable dose for five days. The FDA had earlier told Pfizer to exclude Gazda’s data from the results submitted by Pfizer during its efforts to win approval to use the drug for this purpose.
AHCJ has extensive resources for folks looking to do both sides of the mashup, with tips for investigating conflicts of interest from John Fauber of the Milwaukee Journal Sentinel and recommendations for looking into disciplined caregivers from ProPublica’s Charles Ornstein and Tracy Weber.
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Awards for Excellence in Health Care JournalismDeadline: Feb. 3
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
- Focus on freelancing: Tips for buying liability insurance
- Why do some patients get stuck in hospitals for weeks, months?
- Investigate health professionals and the boards that regulate them
- Presidents of AHCJ, SPJ call for more openness from Obama administration
