Shenanigans, Larceny, And Fraud Define The Corporate Practice of Medicine

Bob Campbell, MD, co-founder of Physicians Against Drug Shortages writes in:

I have been gathering a lot of information for a “Corporate Practice of Medicine” project. Not sure what will come of it if anything but some of the shenanigans are very harmful at times. At other times just simple larceny.

The federal court in Philadelphia has issued a new decision in Aetna v. Mednax/Pediatrix Medical Group, 2018 WL 5264310 (E.D. Pa. 2018) involving fraud allegations asserted by Aetna against Mednax, a pediatric private equity firm.

The federal court held that Aetna’s allegations regarding Mednax’ alleged fraud upcoding scheme could proceed in litigation. Aetna alleged that Mednax routinely listed CPT codes that exaggerated the care needed and performed by designating infants as being sicker than they truly were so that it appeared as if the infants required more intensive treatment than was truly the case. This process allowed Mednax to submit inflated bills to Aetna so that Aetna would reimburse Mednax for more money than was justified.

Aetna also alleged the upcoding scheme permeated Mednax’ operations. Mednax trained and required physicians to engage in upcoding and encouraged physicians to perform unnecessary services to support higher billing rates. Mednax also sometimes inflated the codes itself above the level indicated by the physicians before submitting the claim forms. Aetna obtained evidence from former employees of Mednax that were aware of the upcoding scheme.

The court ultimately held that the specific types of upcoding that allegedly occurred, such as listing an infant as requiring critical care rather than general hospital care, sufficiently established the legal basis for fraud.

The federal court also allowed the litigation against the private equity firm controlling pediatric/neonatal intensive care physicians to proceed far beyond the 2-year statute of limitations based upon the “continuing fraud violation doctrine.”

I just wanted to keep you apprised of additional developments in the fraud realm in the context of private equity firms and some of the concerns raised about driving profits improperly. This is literally in your backyard, but also involves an alleged nationwide scheme.

Medicare for All Will Sabotage Your Healthcare and Your Freedom

Politicians promise to lower costs and assure quality medical care, but voters need to beware.

Here are some common misconceptions about Medicare for All:

Myth: Medicare for All would get rid of profiteering insurance companies and thereby save billions.

FACT: The “insurance” monoliths would still be there to manage the system. Look at the profits of Medicare Advantage plans and Medicaid managed-care contractors. Their business plan is to deny care.

Myth: Quality would be assured by government.

FACT: “Quality” would be defined by government, based on compliance with population-based guidelines, not what is best for individual patients.

Myth: Government would “negotiate” lower prices.

FACT: Government would impose price controls. Cuts of 40 percent to providers have been proposed. Overhead is at least 50 percent of a physician’s revenue, and if a practice can’t cover its costs, it closes.

Myth: The system would be like in Western Europe: free, but with great care available when you need it.

FACT: Private insurance is available and widely used in Europe. It would be outlawed in Medicare for All. Cost-saving methods in Europe include Britain’s Liverpool Care Pathway—dehydrating troublesome patients to death, and expanding euthanasia in Belgium, the Netherlands, and Switzerland.

Myth: Corporations and the “rich” would pay for it with “modest” tax hikes.

FACT: Costs of greater than $40 trillion cannot be paid by any available or proposed source of revenue. And of course business costs are paid by the consumer, or the business disappears.

Myth: Care would be “equal” and “fair.

FACT: It is obviously not possible to reduce spending and give more care to the disadvantaged without cutting off care to some who now receive it (such as the elderly).           “

Obama promised—falsely—that if you liked your health plan or your doctor you could keep your doctor or your health plan. With Medicare for All, your insurance plan would be outlawed, and ‘your doctor’ would be the assigned plan ‘provider,’ who may have minimal training or experience. The candidates supporting Medicare for All are preparing to sabotage the voluntary American system of medical care and replace it with a system that will resemble Venezuela, not Denmark.

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