Whistleblowers Category Archives — DC Medical Malpractice & Patient Safety Blog Published by Washington, D.C. Personal Injury Lawyers

October 9, 2022

Insurers buck-raking big time off Medicare Advantage

The nation’s biggest health insurers are gaming a giant program to provide health coverage to seniors, exploiting the privatization of Medicare Advantage plans to rake in profits with schemes that have drawn fire from federal prosecutors.

The sustained, costly campaign by insurers to maximize their profits not only leaves older, vulnerable patients at risk of reduced care, it also imperils the overall health of the entire Medicare system, the New York Times found in its investigation, reporting this [see chart above, courtesy the newspaper]:

“Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost. If trends hold, by next year, more than half of Medicare recipients will be in a private plan. But a New York Times review of dozens of fraud lawsuits, inspector general audits and investigations by watchdogs shows how major health insurers exploited the program to inflate their profits by billions of dollars. The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits. As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

September 13, 2022

Hospital shielded heart surgeon with 21 malpractice claims, probe finds

by Patrick A. Malone

He cut a dashing figure in ads and billboards for a New England community hospital, which had an administration desperate for a lucrative heart care program in a region with famous academic medical centers. Dr. Yvon Baribeau, a Canadian-trained heart surgeon, seemed a perfect fit for the Catholic Medical Center, a place where he told colleagues he practically lived because he became one of the institution’s best-paid and busiest specialists.

He earned more than $1 million annually, and just one of his many operations brought in $200,000 to CMS before Baribeau suddenly retired at age 63.

What patients and the public didn’t know about the much-promoted surgeon was his shocking mistreatment of patients in a variety of ways, a notoriously poor medical performance that the Boston Globe has reported made him the holder of “one of the worst surgical malpractice records among all physicians in the United States.”

June 3, 2022

Baby formula mess shows big profits, a filthy plant, and bungled oversight

by Patrick A. Malone

The giant drug maker Abbott and the federal Food and Drug Administration both should hang their heads in shame as more information becomes public as to how they left millions of vulnerable infants hungry and put kids’ health at risk by wrongs involving the manufacture and distribution of a vital foodstuff — baby formula.

Millions of parents have gone into meltdown because of a nationwide shortage of the needed nutrient. It was sparked by the shutdown of Abbott’s formula-producing plant in Michigan, as well as the company’s product recall after babies got sick and died from infections involving Cronobacter sakazakii bacteria.

While Abbott has emphasized that experts have not conclusively linked the bacteria to its formula and the firm has played up its cooperation in a product recall, Robert Califf, the FDA’s chief and a doctor, ripped the company. He told a U.S. House subcommittee that agency inspectors found “egregiously unsanitary” conditions at the drug maker’s plant, the New York Times reported, quoting him, thusly:

July 19, 2021

Sharp reminders of the need to watch out for dangerous doctors

by Patrick A. Malone

Patients, politicians, and regulators may find it tough to believe, so they need sharp periodic reminders: While there are many terrific, dedicated doctors working today, there also are some truly terrible ones. And dealing with the harms of medical malpractice by the incompetent and abusive can require courage and vigilance.

Perhaps a new, streamed Hollywood serial — starring the likes of Alec Baldwin, Christian Slater, AnnaSophia Robb, and Joshua Jackson — can underscore for the public how grisly the results can be until a rare criminal prosecution derails the likes of Christopher Duntsch, a Dallas surgeon so grim he is nicknamed “Dr. Death?”

July 24, 2020

Video evidence casts harsh light on authorities’ use of excessive force

by Patrick A. Malone

In the running battle between authorities and individuals over excessive use of force, the eyes suddenly now have it: The advance of smart phone technology to ubiquity and with quality video recording is giving claimants powerful new evidence. It is not pretty for law enforcement excesses — and even potentially extra-legal escapades.

Not one, not two, but three news organizations — the Washington Post, the New York Times, and ProPublica — report that they have scoured nationwide to find abundant cell phone videos of official responses to protests over the Minneapolis police killing of George Floyd and other African Americans in custody. Here is a sampling of their disturbing articles:

The Washington Post

July 10, 2020

For Big Pharma, a $648M bribery settlement and heat over anti-viral’s price

by Patrick A. Malone

Big Pharma focuses relentlessly on always making a buck, no matter the cost to the rest of us, and even a viral pandemic that infects 2.8 million Americans and kills roughly 130,000 of us won’t interrupt the corporate rapaciousness.

That’s the reality that federal prosecutors have reminded the public about with an announced $678 million settlement with Novartis over the drug maker’s doctor prescribing- and kickbacks-scheme. And it is what Gilead has shown with its planned pricing for remdesivir. It is an anti-viral drug that has shown modest effect in shortening the course of Covid-19 infections and was developed with taxpayer funding.

The Novartis case also paints a damning picture of doctors’ complicity in taking bribes to defraud taxpayers (specifically the Medicare, Medicaid, and Veterans Affairs programs) by pushing company products, including the high blood pressure drugs Lotrel, Diovan, Exforge, Tekturna, Valturna and Tekamlo, and the Type 2 diabetes medication Starlix.

February 23, 2020

University of Michigan doctor accused of decades of sexual misconduct

by Patrick A. Malone

The University of Michigan is investigating allegations that Robert E. Anderson, former head of the university health service and physician to UM football teams coached by Bo Schembechler and Lloyd Carr, sexually assaulted youthful patients across decades.

Anderson worked for the university for more than 30 years and died in 2008. As the New York Times reported:

“Michigan said its campus police department had opened an inquiry last summer, after Warde Manuel, the athletic director, received a message from a former student who said that Anderson had engaged in abuse during medical exams in the ’70s. During the investigation, Michigan said, other people described ‘sexual misconduct and unnecessary medical exams,’ including at least one allegation that wrongdoing had occurred in the ’90s.”

January 10, 2020

Need simple, clear, and direct ideas to be healthier? Heed these 48 words

by Patrick A. Malone

Bravo, brevity. Four dozen words is all it takes for a doctor and noted writer on diet and obesity to offer plenty of sound advice on how to get and stay healthy.

Here are the suggestions from Yoni Freedhoff, associate professor of family medicine at the University of Ottawa, founder and medical director of Ottawa’s Bariatric Medical Institute, blogger at Weighty Matters, and author of “The Diet Fix: Why Diets Fail and How to Make Yours Work:”

“Don’t smoke. Get vaccinated. Avoid trans fats. Replace saturated fats with unsaturated if you can. Cook from whole ingredients — and minimize restaurant meals. Minimize ultra-processed foods. Cultivate relationships. Nurture sleep. Drink alcohol at most moderately. Exercise as often as you can enjoy. Drink only the calories you love.”

October 1, 2019

Health care plagued by cases of a persistent pathology — unmitigated gall

by Patrick A. Malone

There seems to be a never-ending outbreak of a certain kind of pathology in the United States. Big Pharma has it and spreads it around, a lot. So, too, do public health figures. Let’s call this scourge what it is — unmitigated gall.

The problem with this nasty condition is that it afflicts the rest of us. Just consider how stomach-churning these shenanigans can be:

Penalties for bogus prescribing of ‘little red pills’ on elderly dementia patients

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.”