Short Takes: More Mystery and Meyhem in Health Care

Two readers of Health Care Renewal recently told me that they had no idea of the pervasiveness of bad management and misbehavior in health care until they started reading the stories compiled in the blog. Just to add to that volume, here are a few short takes on health care shenanigans reported this week...

Medco Settles for $155 Million
According to the Associated Press (via the Houston Chronicle) "Prescription-benefits manager Medco Health Solutions Inc. has agreed to pay $155 million in fines to settle fraud, kickback and other charges brought by federal prosecutors in Philadelphia in a whistleblower case dating to 1999." Said US attorney Pat Meehan, "Hidden financial agreements between PBMs and drug manufacturers and health plans, along with the bottom-line pressures of management, can influence which drugs patients receive, the price we all pay for drugs and whether pharmacists serve patients with their undivided professional judgment." Medco denied all wrong-doing, but "Among other charges, Medco was accused of paying health-insurance plans kickbacks to obtain their business and of soliciting kickbacks from drug manufacturers to favor their drugs over competitors' products, partly by illegally pressuring pharmacists and doctors to switch prescriptions. Medco also was accused of destroying patient prescriptions when its mail-order pharmacies did not fill them as quickly as required by its insurance plan contracts." In addition to paying the fine, "Medco also must set up a strict program to ensure it complies with all Medicare requirements and pharmacy practice requirements, with both an independent reviewer and the U.S. Attorney's Office reviewing its records annually for five years." According to Bloomberg News, this is only the fourth largest settlement of a health care false claims act case in 2006. Note that although the company had to pay a substantial fine and upgrade its compliance practices, no individual manager was punished.

California Suspends Managed Care Regulator Over Conflict of Interest
According to the Los Angeles Times, "The Schwarzenegger administration is moving to fire a top HMO regulator who held stock in UnitedHealth Group Inc. when he helped review the 2005 acquisition of PacifiCare Health Systems Inc." It turns out that the Deputy Director of the California Department of Managed Care reported that he held between $10,000 and $100,000 stock in UnitedHealth Group. However, he failed to recuse himself from "participating in the merger approval process, based on the fact that he had a financial interest in UnitedHealth," said a spokesperson for the Department. The Deputy Director "is fighting the move, saying he complied with California disclosure laws and played no role in the state's decision to approve the deal. He said the Schwarzenegger administration had decided to approve the acquisition before he was involved." However, "The department described Donohue as its point person in a final round of negotiations that sought to ensure that the 3.2 million members of Cypress-based PacifiCare would not see their benefits reduced or premiums increased to pay for the controversial acquisition by the 22-million-member UnitedHealth of Minnetonka, Minn." According to the Times, "Donohue was integrally involved in Managed Health Care's review of the proposed acquisition and the agency's negotiation of conditions for approval. He also headed some of the hearings to solicit testimony on the potential effect of the acquisition on consumers and the state's healthcare network. Consumer advocates said Donohue seemed particularly tough on patients at public hearings. 'He was argumentative with anyone who criticized the [health] plans,' said Jerry Flanagan of the Foundation for Taxpayer and Consumer Rights in Santa Monica." A la Indiana Jones, "United, why is it always United?" One wonders why somebody whose primary job is regulating managed care would choose to hold a fairly large position in one of the country's largest managed care companies?

Medical School Dean Resigned After Her Husband Was Violently Attacked
A brief article in the Houston Chronicle revealed that the former Dean of the University of Texas Medical Branch in Galveston, Dr Valerie Parisi, "left the job after her husband was attacked outside the couple's home in July during a controversial period of hundreds of layoffs at UTMB. Strong told police his attackers told him to tell his wife 'she doesn't know who she's (expletive) with.' Parisis said she resigned to protect her family.
Police never identified the masked men who attacked Strong as he was walking the couple's poodle." The misbehavior in health care rarely is violent, so this case is exceptional. Nice "business" we are in, eh?

It's a real challenge for conscientious physicians to uphold their professional values while these sort of events are happening all around them. But if physicians want to uphold their values, and the public wants high quality, accessible, reasonably priced health care, we must all figure out how to deal with the conflicts of interest, unethical behavior, and even outright criminal behavior that seems to be everywhere in health care. These problems are systemic, and until we deal with them as such, not just as local aberrations, they will continue and worsen. Furthermore, in my humble opinion, until there are real, tangible, substantial negative incentives to individuals for misbehavior, misbehavior will continue.