Psychologist felt 'honest, sincere' before $800K healthcare fraud exposed

John Agar
MLive.com
Originally posted November 21, 2017

A psychologist who defrauded insurance companies of $800,000 spent half of the money on vacations, concert tickets and a mobile-recording business, the government said.

George E. Compton Jr., 63, of Sturgis, was sentenced by U.S. District Judge Gordon Quist to 28 months in prison.

Compton, who pleaded guilty to healthcare fraud, said he was "ashamed" of his actions.

"Until this investigation, I did not hesitate to describe myself as an honest, sincere man," he wrote in a letter to the judge. "Seeing myself from a different perspective has been trying to say the least. ... The worst punishment for my admitted crimes will be the exclusion from the very work I love."

The government said he billed insurance companies for counseling sessions he did not provide, from Jan. 1, 2013, until June 30, 2016.

The article is here.

Google Sets Limits on Addiction Treatment Ads, Citing Safety

Michael Corkery
The New York Times
Originally published September 14, 2017

As drug addiction soars in the United States, a booming business of rehab centers has sprung up to treat the problem. And when drug addicts and their families search for help, they often turn to Google.

But prosecutors and health advocates have warned that many online searches are leading addicts to click on ads for rehab centers that are unfit to help them or, in some cases, endangering their lives.

This week, Google acknowledged the problem — and started restricting ads that come up when someone searches for addiction treatment on its site. “We found a number of misleading experiences among rehabilitation treatment centers that led to our decision,” Google spokeswoman Elisa Greene said in a statement on Thursday.

Google has taken similar steps to restrict advertisements only a few times before. Last year it limited ads for payday lenders, and in the past it created a verification system for locksmiths to prevent fraud.

In this case, the restrictions will limit a popular marketing tool in the $35 billion addiction treatment business, affecting thousands of small-time operators.

The article is here.

Ethics experts say Trump administration far from normal

Rachael Seeley Flores
The Center for Public Integrity
Originally published September 23, 2017

President Donald Trump’s young administration has already sharply diverged from the ethical norms that typically govern the executive branch, exposing vulnerabilities in the system, a small group of ethics experts and former government officials agreed Saturday.

The consensus emerged at a panel titled “Trump, Ethics and the Law” at the Texas Tribune Festival in Austin, Texas. The panel was moderated by Dave Levinthal, a senior reporter at the Center for Public Integrity.

“There have been untidy administrations in the past, but usually it takes a while to see these things develop,” said Ken Starr, a lawyer and judge who served as solicitor general under President George H.W. Bush and is best known for heading the investigation that led to the impeachment of President Bill Clinton.

Ethics laws are based on the idea that norms will be followed, said Walter Shaub, former director of the U.S. Office of Government Ethics (OGE).

“When they’re not followed, we suddenly discover how completely vulnerable our system is,” Shaub said.

The article is here.

Even the Insured Often Can't Afford Their Medical Bills

Helaine Olen
The Atlantic
Originally published June 18, 2017

Here is an excerpt:

The current debate over the future of the Affordable Care Act is obscuring a more pedestrian reality. Just because a person is insured, it doesn’t mean he or she can actually afford their doctor, hospital, pharmaceutical, and other medical bills. The point of insurance is to protect patients’ finances from the costs of everything from hospitalizations to prescription drugs, but out-of-pocket spending for people even with employer-provided health insurance has increased by more than 50 percent since 2010, according to human resources consultant Aon Hewitt. The Kaiser Family Foundation reports that in 2016, half of all insurance policy-holders faced a deductible, the amount people need to pay on their own before their insurance kicks in, of at least $1,000. For people who buy their insurance via one of the Affordable Care Act’s exchanges, that figure will be higher still: Almost 90 percent have deductibles of $1,300 for an individual or $2,600 for a family.

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example. Depending on the plan, medical care received from a provider not participating in a particular insurer’s network might not count toward any deductible or cap at all.

The article is here.

Federal ethics chief resigns after clashes with Trump

Lauren Rosenblatt
The Los Angeles Times
Originally posted July 6, 2017

Walter Shaub Jr., director of the U.S. Office of Government Ethics, announced Thursday he would resign, following a rocky relationship with President Trump and repeated confrontations with the administration.

Shaub, appointed by President Obama in 2013, had unsuccessfully pressed Trump to divest his business interests to avoid potential conflicts of interest, something Trump refused to do.

The ethics watchdog also engaged in a public battle with the White House over his demands for more information about former lobbyists and other appointees who had been granted waivers from ethics rules. After initially balking, the White House eventually released the requested information about the waivers.

Shaub called for a harsher punishment for presidential advisor Kellyanne Conway after she flouted ethics rules by publicly endorsing Ivanka Trump’s clothing line during a television appearance.

The article is here.

CRISPR Makes it Clear: US Needs a Biology Strategy, FAST

Amy Webb
Wired
Originally published

Here is an excerpt:

Crispr can be used to engineer agricultural products like wheat, rice, and animals to withstand the effects of climate change. Seeds can be engineered to produce far greater yields in tiny spaces, while animals can be edited to create triple their usual muscle mass. This could dramatically change global agricultural trade and cause widespread geopolitical destabilization. Or, with advance planning, this technology could help the US forge new alliances.

How comfortable do you feel knowing that there is no group coordinating a national biology strategy in the US, and that a single for-profit company holds a critical mass of intellectual property rights to the future of genomic editing?

While I admire Zheng’s undeniable smarts and creativity, for-profit companies don’t have a mandate to balance the tension between commercial interests and what’s good for humanity; there is no mechanism to ensure that they’ll put our longer-term best interests first.

The article is here.

Conflict of Interest and the Integrity of the Medical Profession

Allen S. Lichter
JAMA. 2017;317(17):1725-1726.

Physicians have a moral responsibility to patients; they are trusted to place the needs and interests of patients ahead of their own, free of unwarranted outside influences on their decisions. Those who have relationships that might be seen to influence their decisions and behaviors that may affect fulfilling their responsibilities to patients must be fully transparent about them. Two types of interactions and activities involving physicians are most relevant: (1) commercial or research relationships between a physician expert and a health care company designed to advance an idea or promote a product, and (2) various gifts, sponsored meals, and educational offerings that come directly or indirectly to physicians from these companies.

Whether these and other ties to industry are important is not a new issue for medicine. Considerations regarding the potential influence of commercial ties date back at least to the 1950s and 1960s. In 1991, Relman reminded physicians that they have “a unique opportunity to assume personal responsibility for important decisions that are not influenced by or subordinated to the purposes of third parties.” However, examples of potential subordination are easily found. There are reports of physicians who are paid handsomely to promote a drug or device, essentially serving as a company spokesperson; of investigators who have ownership in the company that stands to gain if the clinical trial is successful; and of clinical guideline panels that are dominated by experts with financial ties to companies whose products are relevant to the disease or condition at hand.

The article is here.

Contempt for ethics hobbles Trump

Norman L. Eisen and Richard W. Painter
USA Today
Originally published April 26, 2017

Here is an excerpt:

Finally, there is Trump’s core ethics promise to “drain the swamp” in Washington. Instead, he has brought a large number of lobbyists and other persons into his administration with a vast array of personal financial conflicts of interest (exceeded only by those of the president himself). The swamp has become a cesspool — an upscale one, dominated by billionaires. A number of the high-ranking officials in Trump's administration, like their leader, insist upon maintaining   their investments in various businesses, while at the same time conducting official U.S. government policy. The Senate vetting of their conflicts has contributed to the historically slow confirmation pace of Trump nominees (another embarrassment). In government, divided loyalties do not work.

The White House's lax attitude toward ethics results in both bad ethics and bad policy, and encourages a host of lesser offenses like the recent promotion of Mar-a-Lago — a club where the president is still selling memberships for $200,000 — as the "winter White House" on official web pages of the State Department. Even a cursory check of ethics rules would have revealed that this is flatly prohibited, but nobody bothered to check. The message sent all over the world is that the United States is a land of "pay to play."

The article is here.

GAO to Review Ethics, Funding of Trump Transition

Eric Katz
Government Executive
Originally published April 11, 2017

The federal government’s internal auditor is commencing a review of President Trump’s transition into office, examining potential conflicts of interest, contacts with foreign government and funding sources.

The Government Accountability Office is launching the review after Sen. Elizabeth Warren, D-Mass., and Rep. Elijah Cummings, D-Md., requested it. GAO will determine how the General Services Administration managed the transition and its funding mechanisms, what Trump’s transition spent those funds on and how much private funding it collected. The auditors will also probe the Office of Government Ethics to evaluate what information it made available to the transition team and to what extent Trump’s associates took advantage of OGE’s offerings versus the previous two transitions.

The article is here.

Does everyone have a price? On the role of payoff magnitude for ethical decision making

Benjamin E. Hilbig and Isabel Thielmann
Cognition
Volume 163, June 2017, Pages 15–25

Abstract

Most approaches to dishonest behavior emphasize the importance of corresponding payoffs, typically implying that dishonesty might increase with increasing incentives. However, prior evidence does not appear to confirm this intuition. However, extant findings are based on relatively small payoffs, the potential effects of which are solely analyzed across participants. In two experiments, we used different multi-trial die-rolling paradigms designed to investigate dishonesty at the individual level (i.e., within participants) and as a function of the payoffs at stake – implementing substantial incentives exceeding 100€. Results show that incentive sizes indeed matter for ethical decision making, though primarily for two subsets of “corruptible individuals” (who cheat more the more they are offered) and “small sinners” (who tend to cheat less as the potential payoffs increase). Others (“brazen liars”) are willing to cheat for practically any non-zero incentive whereas still others (“honest individuals”) do not cheat at all, even for large payoffs. By implication, the influence of payoff magnitude on ethical decision making is often obscured when analyzed across participants and with insufficiently tempting payoffs.

The article is here.

The Privacy Delusions Of Genetic Testing

Peter Pitts

Forbes

Originally posted February 15, 2017

Here is an excerpt:

The problem starts with the Health Insurance Portability and Accountability Act (HIPAA), a 1996 federal law that allows medical companies to share and sell patient data if it has been "anonymized," or scrubbed of any obvious identifying characteristics.

The Portability Act was passed when genetic testing was just a distant dream on the horizon of personalized medicine. But today, that loophole has proven to be a cash cow. For instance, 23andMe has sold access to its database to at least 13 outside pharmaceutical firms. One buyer, Genentech, ponied up a cool $10 million for the genetic profiles of people suffering from Parkinson's. AncestryDNA, another popular personal genetics company, recently announced a lucrative data-sharing partnership with the biotech company Calico.

The article is here.

When Evidence Says No, But Doctors Say Yes

David Epstein
ProPublica
Originally published February 22, 2017

Here is an excerpt:

When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?

For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few — it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.

The article is here.

JAMA Forum: Those Pesky Lines Around States

Larry Levitt
JAMA Forum Blog
Originally posted October 19, 2016

Here is an excerpt:

Allowing insurers to then sell plans across state lines would actually worsen access to coverage for people with preexisting conditions, since insurers would have a strong incentive to set up shop in states with minimal regulation, undermining the ability of other states to enact stricter rules.

Let’s say Delaware wanted to attract health insurance jobs to its state with industry-friendly regulations—for example, no required benefits (such as preventive services or maternity care) and no restrictions on medical underwriting (meaning people with preexisting conditions could be denied coverage). Insurers operating out of Delaware could offer cheaper health insurance by cherry-picking healthy enrollees from other states. If New York tried to require insurers to expand access to people with preexisting conditions or mandate specific benefits, its carriers would get stuck with disproportionately sick people.

Delaware is not a random example here. This is exactly what happened in the credit card industry after the Supreme Court ruled in 1978 that credit card companies could follow interest rate rules in the states where they operate, not the state where the cardholder lives. Two states—Delaware and South Dakota—moved quickly to deregulate interest rates, and banks followed suit by moving their credit card operations to those states. By 1997 Delaware had 43% of the nation’s credit card volume.

The blog post is here.

Teaching Ethics In The Trump Era

Kelly Richmond Pope
Forbes Magazine
Originally posted January 15, 2017

Here is an excerpt:

Ethical leadership should be a nonpartisan value that we all share. Ethics is under attack and I am no longer sure how we defend it. In class, we often have discussions about conflicts of interests and the dangers conflicts of interest have on the auditor-client relationship. According to the AICPA website. ‘accountants in public practice should be independent in fact and appearance when providing auditing and other attestation services’. When my students see New York Times headlines like ‘Scott Pruitt, Trump’s EPA Pick Backed Industry Donors Over Regulators’, what should they think? Do ethics rules apply to everyone or only a few?

I spend my time teaching future CPAs that we must continue to adhere to a strict code of ethical conduct but I fear they are growing weary of this message. The headlines that my students are now seeing is very confusing and really causes them to question the role of ethical leadership. If we operate under the mantra of ‘do what I say and not what I do’ I fear that will be revisiting the 2008 financial crisis in the very near future.

The article is here.

Why Ethical People Make Unethical Choices

By Ron Carucci
Harvard Business Review
Originally posted December 16, 2016

Most companies have ethics and compliance policies that get reviewed and signed annually by all employees. “Employees are charged with conducting their business affairs in accordance with the highest ethical standards,” reads one such example. “Moral as well as legal obligations will be fulfilled in a manner which will reflect pride on the Company’s name.” Of course, that policy comes directly from Enron.  Clearly it takes more than a compliance policy or Values Statement to sustain a truly ethical workplace.

Corporate ethical failures have become painfully common, and they aren’t cheap.  In the last decade, billions of dollars have been paid in fines by companies charged with ethical breaches. The most recent National Business Ethics Survey indicates progress as leaders make concerted efforts to pay holistic attention to their organization’s systems. But despite progress, 41% of workers reported seeing ethical misconduct in the previous 12 months, and 10% felt organizational pressure to compromise ethical standards. Wells Fargo’s recent debacle cost them $185 million in fines because 5300 employees opened up more than a million fraudulent accounts.  When all is said and done, we’ll likely learn that the choices of those employees resulted from deeply systemic issues.

The article is here.

Federal Court Certifies Nationwide Class Action Challenging UBH Coverage Criteria

Press Release
Originally released September 20, 2016

In a significant mental health ruling, the United States District Court for the Northern District of California has come one step closer to ordering health insurance giant United Behavioral Health (UBH) to revamp its medical necessity criteria and reprocess thousands of outpatient, intensive outpatient and residential treatment claims it denied since 2011. Plaintiffs in two companion class-action lawsuits, Wit et al. v. UnitedHealthcare et al. and Alexander et al. v. United Behavioral Health, allege that UBH systematically denies coverage for mental health treatment by developing and applying "medical necessity" criteria that are far more stringent than generally accepted standards of care.

"Yesterday's class certification order is an important victory in the fight for mental health parity," said Meiram Bendat, president of Psych-Appeal, Inc. and co-counsel for the plaintiffs. "It signals that health insurers can be held responsible, on a class-wide basis, for denying insurance coverage for mental health treatment to those desperately in need. Without class certification, few, if any, patients will have the financial or emotional resources necessary to challenge this type of misconduct individually."

The plaintiffs' health plans, governed by the Employee Retirement Income Security Act (ERISA), require UBH to evaluate medical necessity according to generally accepted standards of care. UBH's proprietary medical necessity criteria purport to reflect these standards. However, the plaintiffs allege that a push for profits has led UBH to develop criteria that overemphasize acute mental health and substance use disorder symptoms and disregard chronic or complex conditions that require ongoing care, in contravention of generally accepted standards.

UBH is a subsidiary of UnitedHealth Group and is the country's largest managed behavioral health care organization, serving more than 60 million members.

Psych-Appeal, Inc. and Zuckerman Spaeder LLP have been appointed class counsel by the federal court and also represent plaintiffs in similar cases against Health Care Service Corporation (Blue Cross and Blue Shield of Illinois, Texas, New Mexico, Montana and Oklahoma), Magellan Health Services of California and Blue Shield of California.

The pressor is here.

Mental health care 'is ruining lives'

By Nick Triggle
Health correspondent - BBC
Originally posted February 15, 2016

Inadequate and underfunded mental health care in England is leading to thousands of "tragic and unnecessary deaths" a review has found.

The report - by a taskforce set up by NHS England - said around three-quarters of people with mental health problems received no help at all.

It said more needs to be done to tackle rising suicide rates.

Ministers agreed with the findings, committing a £1bn extra a year by 2020 to treat a million more people.

This is to come out of the £8.4bn the government has promised to the health service during this Parliament and comes on top of extra money already announced for children's services.

Prime Minister David Cameron said the plan would help put "mental and physical healthcare on an equal footing".

The article is here.

Editorial Note: In spite of federal legislation in the United States insuring mental health parity, there are frequent reports of insurance companies not following the law.  Additionally, the mental health system in the US is chronically underfunded through insurance companies as well as local, state, and federal systems.

End-of-life care in U.S. not as costly as in Canada

By Jessica McDonald
newsworks.org
Originally posted January 10, 2016

The United States has a reputation for providing costly -- and often unwanted -- end-of-life care. But the first study to do an international comparison finds it's not as egregious as we thought.

Compared with patients in other developed nations, Americans diagnosed with cancer spend more time in the intensive care unit and get more chemotherapy in the last months of their lives.

But fewer patients are in the hospital when they die. And the overall bill, while high, isn't the steepest. That honor goes to Canada.

"We found that end-of-life care in the United States is not the worst in the world, and I think that surprises a lot of people," said Dr. Ezekiel Emanuel, a medical ethicist at the University of Pennsylvania.

The article is here.

Is the sale of body parts wrong?

Julian Savulescu
J Med Ethics 2003;29:138-139
doi:10.1136/jme.29.3.138

Discussion of the sale of organs is overshadowed by cases of exploitation, murder, and corruption. But there is also a serious ethical issue about whether people should be allowed to sell parts of the body. It applies not only to organs, such as the kidney or parts of the liver, but also to tissues, such as bone marrow, gametes (eggs and sperm) and even genetic material. The usual argument in favour of allowing the sale of organs is that we need to increase supply. In the US, as few as 15% of people who need kidney transplants ever get a kidney. Cadaveric organs will never satisfy the growing demand for organs. Worldwide, hundreds of thousands, if not millions, die while waiting for a transplant.

The entire article is here.

Generation XXX

The Economist
Originally published September 26, 2015

Here is an excerpt:

Whenever pornography becomes more available, it sparks a moral panic. After the advent of girlie magazines in the 1950s, and X-rated rental films in the 1980s, campaigners claimed that porn would dent women’s status, stoke sexual violence and lead men to abandon the search for a mate in favour of private pleasures. Disquiet about the effects of online pornography is once more rising (see article). Most of it is now free. As commercial producers fight over scarce revenue, their wares are becoming more extreme. Because of smartphones, tablets and laptops, hardcore material can be accessed privately by anyone. The result is that many teenagers today have seen a greater number and variety of sex acts than the most debauched Mughal emperor managed in a lifetime.

The entire article is here.