Charles Ornstein Posts

Mixed messaging from all levels of government is putting Americans at risk and will speed the spread of the coronavirus. No matter what politicians say, public health experts agree. Stay home, even if you feel fine.

Snooping on celebrities has been a bane for health systems around the country for years. The proliferation of electronic medical records systems has made it easier to track and punish those who peek in records they have no legitimate reason to access.

Even the OB-GYN speakers are male. A report cataloguing just who gets paid by drug and medical device companies as speakers shows how gender-skewed the pay gap in medicine is.

The federal government's new database of drug and device industry payments to doctors is even more incomplete than has been reported previously. In a fact sheet posted online, federal officials disclosed that the database, dubbed Open Payments, is missing more than $1 billion in payments made between August and December 2013. These omissions are in addition to information the government has redacted from the payments it has disclosed, citing inconsistencies.

ACA transparency laws start taking effect as government releases limited disclosure of Big Pharma payments to doctors. But what do the payments signify? What errors can be expected? More importantly, what's missing?

Health policy experts say insurers may be bilking the sick in a more subtle ways after proscriptions by the ACA: by forcing people with a variety of illnesses — including Parkinson's disease, diabetes and epilepsy — to pay more for their drugs.

Illinois medical regulators have indefinitely suspended the medical license of psychiatrist Michael Reinstein, who prescribed more of the most powerful and riskiest antipsychotic drug clozapine than any other doctor in the country. The board determined that Reinstein received "illegal direct and indirect remuneration" from the maker of generic clozapine; did not consider alternative treatments for his patients; and disregarded patients' well-being because of potentially life-threatening side effects of the drug.

The federal government has a word for physicians who don’t have financial relationships with pharmaceutical and medical device manufacturers: “Error.” This week, the government began allowing doctors to log into a secure website to check the payments attributed to them by drug and device makers. This information will be made public later this year under the Physician Payment Sunshine Act. In advance, if doctors believe the material about them is wrong, they can contest it. But early reports suggest the new site has some glitches.

Seems that some doctors have found a pretty lucrative side job: billing Medicare for massive numbers of group therapy sessions – even if they aren't licensed psychotherapists.

A Florida doctor's Medicare drug spending spiked in the last couple of years. But Medicare's investigators were stretched too thin to follow up. Millions of dollars – and a misdirected fanny pack – later, a huge prescription fraud ring was uncovered.

ProPublica and other media organizations have put together a study dissecting Medicare data from 2012. The result: strong correlations between doctors that have been disciplined by the board for a variety of factors, and the propensity to overbill or commit fraud through Medicare.

To grasp Medicare's staggering bill for ambulance rides in New Jersey, just visit the busy parking lot of the DaVita St. Joseph's dialysis clinic in the town of Paterson. More than 20 ambulances and a handful of wheelchair vans were parked outside on a recent morning there. Emergency medical technicians wheeled patients in and out on stretchers. As soon as one ambulance departed, another took its place. For each one-way ride, Medicare pays ambulance companies nearly $200, plus $6 a mile.

The Centers for Medicare and Medicaid Services, which oversees the health care programs, has found near $7 billion in overpayments. The problem is, the department doesn't have the money to investigate whether or not those overpayments are fraudulent.

Federal agents have been cracking down on Medicare fraud across the country. Too bad the Medicare system's inefficiencies can't keep. Doctors that have been arrested or sanctioned are still receiving payouts.

Pharmaceutical company payments to doctors extend far beyond rank-and-file clinicians — and deep into the leadership of America’s teaching hospitals. A team of researchers examined the boards of the 50 largest drug companies and found that 40 percent — 19 companies — had at least one board member who also held a leadership role at an academic medical center. Sixteen of the 17 companies based in the United States had at least one. Several had more than one.

Four states – Minnesota, Massachusetts, Oregon, and Maryland – all had rough launches of their insurance exchanges, just like the federal government's HealthCare.gov. Only problem is, the feds stepped up their game and fixed most of the issues; these states continue to struggle.

The media may be suffering some Obamacare fatigue, but new users of the law – and the public writ large – are just now starting to understand the benefits that came with implementation.

Frustrated with lengthy hold times and mounds of questions about their new health care plans, some enrollees are taking to social media to vent, and seek answers. Incredibly enough, this seems to be working. Insurance companies have been responding to tweets sometimes faster than phone calls or emails.

Obamacare is getting mixed reviews as new plans start to come online. Who better to report on these issues than the people mired in the process? Those people just happen to be reporters.

The first half of the Obamacare open enrollment period is over, and yesterday, federal health officials announced sign-up figures from the first three months. After a disastrous start, HealthCare.gov (which handles enrollment for 36 states) began functioning properly. It, along with state-run insurance exchanges, netted more than 2.1 million signups between Oct. 1 and Dec. 28. But are sign-ups on pace to meet the Congressional Budget Office’s projection of 7 million this year?