Certification and Licensure Category Archives — Page 2 of 8 — DC Medical Malpractice & Patient Safety Blog Published by Washington, D.C. Personal Injury Lawyers

August 22, 2019

Do health care’s perverse incentives lure MDs into deliberate misdiagnosis for profit?

When doctors become medical outliers, shouldn’t hospitals, colleagues, insurers, and the rest of us ask how and why an individual practitioner diverges so much from the way others provide care?

Olga Khazan details for the Atlantic magazine the disturbing charges involving Yasser Awaad, a pediatric neurologist at a hospital in Dearborn, Mich. As she describes him, for a decade he racked up hundreds of cases in which he is accused by patients of “intentionally misreading their EEGs and misdiagnosing them with epilepsy in childhood, all to increase his pay.” Khazan says his case “shines a light on the grim world of health-care fraud—specifically, the growing number of doctors who are accused of performing unnecessary procedures, sometimes for their own personal gain.”

In the malpractice cases that are unfolding against him, Awaad’s pay has become a central issue, with evidence showing his hospital contract rewarded him for boosting the number of screenings he ordered and diagnoses he made. Jurors have been told that Awaad, whose salary increased from 1997 to 2007 from $185,000 annually to $300,000, “turned that EEG machine into an ATM.” He earned bonuses exceeding $200,000, if he hit billing targets.

August 2, 2019

Government watchdog, finding abuse complaints doubled, criticizes nursing home oversight

by Patrick A. Malone

With complaints of nursing home abuses doubling between 2013 and 2017, the federal agency with oversight of these facilities must improve significantly its efforts to protect millions of vulnerable seniors, the U.S. Government Accountability Office (GAO) has found.

That recommendation, from one of Uncle Sam’s top watchdogs, infuriated members of the U.S. Senate Finance Committee, which called on the Centers for Medicare and Medicaid Services (CMS) to act fast on six recommendations to address its failures in regulating nursing homes.

Sen. Thomas Carper, a Delaware Democrat, described these as including “CMS – the agency charged with ensuring that these facilities meet federal quality standards – often cannot access information about abusive incidents after they occur and, therefore, cannot take the necessary steps to remedy the situation.”

July 25, 2019

Waste, fraud, and abuse? For health insurers, fat profits matter more

by Patrick A. Malone

What happens when a whistle blower provides detailed information about a burly Texan — with convictions for felony theft and felony injury of a child — and a burgeoning scam to rip off health insurers for $25 million? Pretty much nothing. For years.

If that sounds outlandish, investigative reporter Marshall Allen has a doozy of a tale to tell about a crook in suburban Fort Worth, Texas named David Williams. His long-running defrauding of some of the nation’s biggest health insurers matters to us all because, as Allen reported for the Pulitzer Prize-winning investigative site ProPublica:

“There are a host of reasons health care costs are out-of-control and routinely top American’s list of financial worries, from unnecessary treatment and high prices to waste and fraud. Most people assume their insurance companies are tightly controlling their health care dollars. Insurers themselves boast of this on their websites. In 2017, private insurance spending hit $1.2 trillion, according to the federal government, yet no one tracks how much is lost to fraud. Some investigators and health care experts estimate that fraud eats up 10% of all health care spending, and they know schemes abound. Williams’ case highlights an unsettling reality about the nation’s health insurance system: It is surprisingly easy for fraudsters to gain entry, and it is shockingly difficult to convince insurance companies to stop them. Williams’ spree also lays bare the financial incentives that drive the system: Rising health care costs boost insurers’ profits. Policing criminals eats away at them. Ultimately, losses are passed on to their clients through higher premiums and out-of-pocket fees or reduced coverage.”

July 19, 2019

U.S. must boost hospice oversight, watchdog warns, citing serious lapses

by Patrick A. Malone

Lawmakers and regulators must significantly improve the oversight of the burgeoning business of hospice care, a federal watchdog says. Its report came with two notable numbers: from 2012 through 2016, health inspectors cited 87% of the end-of-life care facilities for deficiencies, with 20% of them having lapses serious enough to endanger patients.

In one case cited by the Office of the Inspector General in the Department of Health and Human Services (HHS), a hospice patient had a deep, poorly treated pressure wound on the tailbone, apparent pain that caused grimacing and — in a crisis requiring a trip to the emergency room — a “maggot infestation’’ where a feeding tube entered his abdomen, the Washington Post reported.

July 18, 2019

Cutting resident doctors’ hours doesn’t harm quality of patient care, study finds

by Patrick A. Malone

Will the medical educators finally get that it makes no sense to force residents to toil like field animals? Yet another study, this latest from Harvard experts, finds that keeping residency training hours at more humane levels does not significantly affect quality of patient care, including inpatient mortality.

Let’s be clear: The grueling preparation for MDs is only relatively better than before, capping their training time to 80 hours a week.

Medical educators, hospitals, and doctors themselves have criticized that limit since it was imposed after long study and much argument in the profession by the Accreditation Council for Graduate Medical Education (ACGME), the group that accredits MD training programs.

July 16, 2019

Will GOP attack on Obamacare foil good plans to better kidney disease care?

by Patrick A. Malone

More than 37 million Americans who suffer from chronic kidney disease soon may see big changes in the way their disabling condition gets treated, potentially also reducing the $100 billion that the federal Medicare program pays for care of the body’s crucial blood cleaning organs.

President Trump issued an executive order calling on the federal government to use all means possible to attack kidney disease in three key ways:

Reduce the number of patients who suffer from kidney failure;

June 9, 2019

Uncle Sam forced to disclose secret list of 400 poorly performing nursing homes

by Patrick A. Malone

Federal regulators have given up the unwarranted secrecy enshrouding their watchdog efforts on the nation’s most problematic nursing homes.

With prodding from the U.S. senators from Pennsylvania, Democrat Bob Casey (above left) and Republican Pat Toomey (above right), the Centers for Medicare and Medicaid Services (CMS) disclosed its list of hundreds of nursing homes that perform so poorly they are on the brink of regulators’ most dire supervision.

CMS had declined to disclose its candidates for designation as a “Special Focus Facility” (SFF), preferring instead just to tell the public about its worst of the worst nursing homes, 88 facilities with the SFF tag that receive a targeted, higher level of inspection because of their poor performance. The most rigorous oversight can be resource intensive, and CMS can only scrutinize at the highest level a few poor performing homes, whose infamy is made public. When one facility “works its way off” an SFF designation by improving its failings, others are on the heretofore secret list to take their place.

March 22, 2019

Health care has its share of gaming by the deep-pocketed and powerful

by Patrick A. Malone

The rich and powerful may seem to run amok as the nation lurches through its latest gilded age. But sometimes:

They get reined in by public shaming, as seems to be occurring with a developing scandal over insider deals in the University of Maryland Medical System (UMMS).
It takes prosecutors to check abuses, as is occurring with the college admissions mess and notably how it harms students with genuine need for learning accommodations.

March 7, 2019

If a news reporter can get named a ‘Top Doctor,’ how do patients find reliable info on good MDs?

by Patrick A. Malone

Truth can be stranger than fiction, and for an investigative journalist covering the outrages of health care costs, ProPublica reporter Marshall Allen had a dream medical story call him on his phone: A well-known New York company reached out and told him he had been “honored” as one of the nation’s Top Doctors.

Not bad for a guy with an English degree from the University of Colorado and zero medical credentials, he reported in a recent, wry article.

He tried to explain to a saleswoman for the company how unqualified he was. But after a chat and after negotiating a “nominal fee” for his accolade — down to $99 from $289 — he bought a plaque and the right to promote himself as a specialist in “investigations” and a Top Doctor.

December 21, 2018

As assisted living facilities increase dementia care, resident safety risks rise

by Patrick A. Malone

They look like nursing homes, but they’re not. And for the health and safety of our elderly loved ones, we must know the difference.

These so-called assisted living facilities, operating with much less regulation and oversight than nursing homes, are raising concerns about the safety and quality of their dealings with a growing number of elderly Americans. That’s because they’re full not only of older residents but also difficult — and costly to care for — seniors with dementia.

Jordan Rau, of the independent, nonpartisan Kaiser Health News Service, deserves credit for diving deep into rising complaints and documented harms to residents of facilities “originally designed for people who were largely independent but required help bathing, eating or other daily tasks.” These places, “unlike nursing homes … generally do not provide skilled medical care or therapy, and stays are not paid for by Medicare or Medicaid.”