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

carter-300x300The rich and powerful may seem to run amok as the nation lurches through its latest gilded age. But sometimes:

Let’s roll through just some of the situations with the well-to-do that make the rest of us boil:

That board bonus

Maryland Sen. Jill Carter, a Baltimore Democrat (shown above), has done the public a service by dragging into the sunshine the doings of the elites who purportedly oversee UMMS, the $4.4 billion system that runs 13 hospitals across Maryland and with more than 28,000 staffers is one of the biggest employers in the state and Baltimore.

Responding to a constituent’s complaints, Carter introduced legislation to ban board members of the system from receiving UMMS contracts, what fast became a hornet’s nest of what critics are calling sweetheart or insider deals. These lucrative arrangements include, the Baltimore Sun found, digging into board members’ financial disclosure statements:

  • Baltimore Mayor Catherine Pugh getting paid $500,000 for 100,000 copies of a self-published healthy kids’ book;
  • Former state Sen. Francis X. Kelly revealing $16 million in revenues from insurance business;
  • Executive August J. Chiasera reporting eight deals for his bank with more than $3 million in fees and revenue;
  • Health care consultant John W. Dillon’s disclosure he is paid $13,000 a month for “capital campaign and strategic planning;”
  • Roger E. Schneider noting that his practice, Vascular Surgery Associates, generated more than $300,000 in revenue via three contracts.

There were other UMMS deals for board members, including contracts for technology, engineering, ambulance, and pest control services.

Board members—who are supposedly unpaid volunteers—defended their deals, saying they had not sought them out, that they were disclosed (albeit to supposed oversight organizations that did not make the information easy for the public to access), and that many were won in competitive processes. Robert Chrencik, the UMMS CEO who is paid with board authorization $4.2 million annually, also has defended the contracts and made clear that the health system opposes Carter’s efforts to ban them.

But Gov. Larry Hogan has called the deals “appalling,” and Senate President Thomas V. Mike Miller termed them a “disaster.” Miller, who has a seat on the board but has designated a finance expert to sit in his stead, vowed that if UMMS does not clean up its “self-dealing” mess, he will change his appointee to be a former federal prosecutor.

The Baltimore Sun, noting how taxpayers are affected by UMMS and its medical services to thousands, has called the board contracts “a terrible business practice that must be stopped.” The deals, whether recipients acknowledge it or not, are bound to cloud and sway board members’ ability to appropriately help govern a giant health care system, the newspaper said.

As the story keeps developing with revelations that Pugh’s political campaigns also benefited from donations from UMMS board members, executives, and staff, the Baltimore mayor quit the medical system board.

Chrencik, who has led the system since 2008, has been pushed aside and put on leave, while board members Dillon and Robert L. Pevenstein have joined Pugh in resigning. More resignations may follow. And, by the way, about those kids books: UMMS gave thousands of them to the Baltimore schools. The “gift,” however, perplexed educators who didn’t know what to do with unsolicited and unapproved books. They’re sitting in boxes in a warehouse.

A slap at learning disabled

Has anyone missed the onslaught of news coverage about wealthy and powerful parents who have been indicted in a bribery scheme to get their under-achieving teens admitted into colleges and universities like Yale, Stanford, Georgetown, the University of Southern California, and UC San Diego?

The articles may have emphasized the glitz and glamor of the accused: business executives and Hollywood stars.

The sports pages may be full of reports on how the ploy added to jock scandals, with coaches and athletic administrators arrested, fired, and accused of having their hands out, palms up.

Parents and students who play by the rules have been quoted in great detail about their fury — correct as it may be — over the array of known and just disclosed ways that give the affluent a big edge so they can play the college admissions game like all-stars.

But the Kaiser Health News Service also has reminded that the current scandal has run roughshod on students who already struggle to get their due: youngsters with genuine learning disabilities. They have fought, tooth and nail, to get fair, reasonable, and appropriate accommodation, so they can show that, with a little help, they can excel as well as any of their peers.

Prosecutors have highlighted how a confessed admissions scammer exploited accommodations for students with disabilities. His scheme relied on these hard-fought allowances, so he could isolate his privileged youngsters in special settings. In turn, these let him either substitute a test-taking ringer or to fudge standardized exams before they were returned to test-administering companies.

Savannah Treviño-Casias, 23, an Arizona State University senior who had to turn her life inside out to get accommodations for her learning disability when she took the SAT, denounced the admission ploys, telling KHN: “It felt like such a big slap in the face. I was pretty disgusted. It just makes it harder for people who actually have a diagnosed learning disability to be believed.”

Matthew Cortland, a lawyer and disability activist based in Boston, told the health news service: “There are already too many hoops and hurdles disabled students must navigate in order to vindicate their civil right to higher education. My fear is that these celebrity fraudsters will incite a crackdown on accommodations. Schools and testing companies will make it even more burdensome for disabled students to get the accommodations that allow them to realize their civil right to access higher education.”

Parents and students noted that it can make a world of difference if, for example, students with hearing impairments can get the help of a sign-language interpreter while taking the SAT or ACT. Or if teens who are on the spectrum can be given a quiet space, breaks, and appropriate added time during the exams. Such steps don’t give teens with disabilities an advantage or edge, KHN noted, it helps to “level the playing field.”

And, by the way, just how awful did it sound when, according to the indictment, scammers told parents they needed to make their kids seem more deserving for accommodations by getting the teens to act “stupid, not to be as smart as [they are]. The goal is to be slow, to be not as bright …”

A slap on the wrist

When enterprises with dozens of clients, paying on average $80,000 to $90,000 a year, get hit with an occasional $28,000 fine, is this just a “cost of business” that goes largely ignored?

That’s the tough question posed in a KHN story on how the Trump Administration has heeded complaints from profit-making nursing home operators and eased up on fiscal penalties for problems found in inspections. The moves benefit the richest operators, while continuing to sting smaller, poorer ones.

As the health and medical news service reported:

Encouraged by the nursing home industry, the Trump administration switched from fining nursing homes for each day they were out of compliance — as the Obama administration typically did — to issuing a single fine for two-thirds of infractions, the records show. That reduces the penalties, giving nursing homes less incentive to fix faulty and dangerous practices before someone gets hurt. ‘It’s not changing behavior [at nursing homes] in the way that we want,’ said Dr. Ashish Jha, a professor at the Harvard T.H. Chan School of Public Health. ‘For a small nursing home, it could be real money, but for bigger ones it’s more likely a rounding error.’ Since Trump took office, the administration has heeded multiple nursing home complaints about zealous oversight. It granted facilities an 18-month moratorium from being penalized for violating eight new health and safety rules. It also revoked an Obama-era rule barring homes from pre-emptively requiring residents to submit to arbitration to settle disputes rather than go to court. The slide in fines occurred even as the Centers for Medicare & Medicaid Services issued financial penalties 28 percent more frequently than it did under Obama. That’s due to a policy begun near the end of Obama’s term that required regulators to punish a facility every time a resident was harmed, instead of leaving it to their discretion. While that policy increased the number of smaller fines, larger fines became less common. The total amount collected under Trump fell by 10 percent compared with the total in Obama’s final year, from $127 million under Obama to $114 million under Trump.

To keep matters in perspective, with a graying nation, the nursing home industry has burgeoned into a sector with an estimated $140 billion in annual revenues. More of us than expected will spend some time in them, researchers at the nonpartisan, independent RAND Corporation have found, reporting that, “[C]onditional on having a stay, the average nursing home stay was 272 nights and for 10 percent of the study group, the stay was much longer—more than 1,000 nights.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damages that can be inflicted on them and their loved ones by nursing home neglect and abuse. Rather than acting as lapdogs for the industry, federal regulators need to show more teeth as watchdogs for vulnerable nursing home residents and their safety and well-being. This is even more crucial as Uncle Sam, in an effort to curb costly hospital stays, has given hospitals more incentives to push patients out the door and into less costly nursing home care.

A U.S. Senate committee recently conducted a hearing on “devastating” nursing home abuse, and senators have promised there will be digging and a report on this nightmare, including sexual assaults of elderly women. Lawmakers also need to dig into the fines and other methods by which regulators hope to get institutions to treat residents better.

This isn’t tough in a fair-minded, equality-seeking democracy like ours: Nursing home operators with deeper pockets should not get away with wrongdoing by paying light fines, nor should health system board members get insider deals and wealthy parents can’t be allowed to bribe their kids into college.

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