Guest guest Posted December 14, 2011 Report Share Posted December 14, 2011 [image: Posterous Spaces] [image: Your Daily Update] December 14th, 2011 White House: $5.6 billion in fraud recovered - The Federal Eye - The Washington Post<http://ptmanagerblog.com/white-house-56-billion-in-fraud-recovered-the> Posted about 24 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=86211146> White House: $5.6 billion in fraud recovered By Ed O'Keefe<http://www.washingtonpost.com/ed-okeefe/2011/02/02/ABqNUZE_page.html> Vice President Biden will chair a Cabinet-level meeting Tuesday on plans to cut government waste. (n Smialowski - GETTY IMAGES) The White House says a more aggressive effort to nab deceptive government contractors and deceitful Medicare recipients is paying off — to the tune of billions of dollars. [image: Eye Opener] The Obama administration plans to announce Tuesday that the Justice Department <http://www.justice.gov> recovered more than $5.6 billion in fraud committed against the government in fiscal 2011. Almost $3.4 billion of the funds came in civil fraud recoveries, with more than $2.2 billion tied to criminal fraud, according to administration officials familiar with the announcement who were not authorized to speak publicly on the matter. The announcement is tied to a Cabinet-level meeting to be held Tuesday regarding plans to cut wasteful government spending<http://www.washingtonpost.com/blogs/federal-eye/post/white-house-launch\ ing-new-campaign-to-cut-waste/2011/06/12/AGn3JjSH_blog.html>across federal agencies and departments. Among other cases, the Justice Department reached a $15 million settlement with American Grocers<http://www.businessweek.com/ap/financialnews/D9JJFNS80.htm>, a Texas company that was buying cheap expired food, altering expiration dates on the food and selling it with a steep markup to the federal government to serve to U.S. troops serving in the Middle East. But most of the recoveries were tied to health-care fraud and the work of what officials call Medicare Fraud Strike Forces<http://www.stopmedicarefraud.gov/>, or specialized teams of agents and prosecutors from the departments of Justice and Health and Human Services <http://www.hhs.gov> in nine cities that are monitoring Medicare spending and quickly bringing cases to court, the officials said. Vice President Biden will chair Tuesday’s meeting, which will be attended by several Cabinet secretaries who plan to share similar examples of how they are identifying potential savings or cracking down on wasteful spending and fraud. At HHS, Secretary Kathleen Sebelius is expected to unveil plans for the department to urge insurance companies to withhold payments on suspicious claims by patients who “doctor shop,” or use multiple doctors to obtain prescriptions for painkillers and narcotics including OxyContin and Percocet that can easily be abused or resold illegally. The problem is a growing concern: A Government Accountability Office report released in October <http://www.gao.gov/new.items/d12104t.pdf> found that about 170,000 Medicare beneficiaries were receiving prescriptions for painkillers from five or more doctors at a cost of about $148 million paid by Medicare. In 2008, GAO said one beneficiary was able to obtain prescriptions for a total of 3,655 oxycodone pills from 58 different prescribers. Tuesday’s meeting was also when we were expected to get our first look at how agencies and departments are cutting back on travel and conference costs in the wake of a controversial Justice Department watchdog report<http://www.washingtonpost.com/politics/a-16-muffin-justice-dept-audit-fin\ ds-wasteful-and-extravagant-spending/2011/09/20/gIQAXKyhiK_story.html>that initially accused the department of spending up to $16 on muffins served at a breakfast meeting. The department’s acting inspector general later revised the findings, but not before the Office of Management and Budget <http://www.omb.gov> ordered agencies to curtail and revamp their conference spending plans<http://www.washingtonpost.com/blogs/federal-eye/post/no-more-16-muffins-fo\ r-you/2011/09/22/gIQA2mU8nK_blog.html>in time for Tuesday’s meeting. But administration officials said late Monday that the spending reviews are underway as part of a broader order by President Obama to cut 20 percent of spending on travel, conference costs, technology and “office swag.”<http://www.washingtonpost.com/blogs/federal-eye/post/obama-orders-agency-\ spending-cuts-on-travel-technology-and-swag/2011/11/08/gIQAlOXj3M_blog.html> via washingtonpost.com<http://www.washingtonpost.com/blogs/federal-eye/post/white-ho\ use-56-billion-in-fraud-recovered/2011/12/12/gIQA9IdSqO_blog.html> Medtronic to Settle Kickback Allegations - WSJ.com<http://ptmanagerblog.com/medtronic-to-settle-kickback-allegations-wsjc> Posted about 24 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=86211230> Medtronic to Pay $23.5 Million to Settle Kickback Allegations By NATHALIE TADENA<http://online.wsj.com/search/term.html?KEYWORDS=NATHALIE+TADENA & bylinesea\ rch=true> Medtronic<http://online.wsj.com/public/quotes/main.html?type=djn & symbol=MDT>Inc. has agreed to pay $23.5 million to resolve allegations that it paid illegal kickbacks to physicians who participated in its postmarket studies and device registries to induce doctors to implant the company's pacemakers and defibrillators, the Department of Justice said Monday. The government contends that Medtronic, a medical-device maker based in a Minneapolis suburb, solicited physicians for its studies and registries to convert their business from a competitor's product and to persuade the doctors to continue using Medtronic products. Postmarket studies assess the clinical performance of a medical device or drug after it has been approved by the Food and Drug Administration. Registries are collections of data maintained by a device manufacturer concerning its products that have been sold and implanted in patients. The Justice Department alleges Medtronic caused false claims to be submitted to Medicare and Medicaid by using two postmarket studies and two device registries as the vehicle to pay participating physicians illegal kickbacks. Although Medtronic collected data and information from participating physicians, each of the studies and registries required a new or previous implant of a Medtronic device in each patient and the company allegedly paid physicians a fee of approximately $1,000 to $2,000 per patient. " Patients who rely on their health-care providers to implant vital medical devices expect that those decisions will be made with the patients' best interests in mind, " said Tony West, assistant attorney general for the department's Civil Division. " Kickbacks, like those alleged here, distort sound medical judgments with financial incentives paid for by the taxpayers. " Medtronic made no admission that any studies were improper or unlawful. " Medtronic is happy to have this investigation behind us, so we can continue designing and executing clinical trials that generate evidence to improve patient care, outcomes, and cost effectiveness, " said Marshall Stanton, vice president of clinical research and reimbursement for Medtronic's cardiac and vascular group. The settlement resolves allegations contained in two whistleblower lawsuits. As part of the settlement, the whistleblowers will receive payments totaling more than $3.96 million from the federal share of the recovery. Medtronic shares fell 1.3% to $35.45 in trading Monday and were little changed after hours. via online.wsj.com<http://online.wsj.com/article/SB100014240529702034304045770952610\ 65225318.html> A good death is a right we must fight for<http://ptmanagerblog.com/a-good-death-is-a-right-we-must-fight-for> Posted about 16 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=86280387> A good death is a right we must fight for by Lickerman, MD<http://www.kevinmd.com/blog/post-author/alex-lickerman>| in Physician <http://www.kevinmd.com/blog/category/physician> | 6 responses The notion that dying<http://www.kevinmd.com/blog/2010/05/dying-age-era-modern-medicine.html>is a right seems nonsensical to argue: death is given to all of us equally without the need of anyone’s sanction. The right to die well, on the other hand—well, that’s another matter entirely. A good death is, in many cases, something our fellow human beings have great power to grant or deny, and is therefore, sadly, a right for which we must indeed fight. The notion that we’d even need to fight for the right to die well has only come to make sense relatively recently, within the last forty years or so. Prior to that, our ability to prolong dying—meaning, keep extremely ill people going in hopes that they might overcome whatever health problem threatens even when the likelihood is vanishingly small—was actually fairly limited. But with the advent of modern intensive care units and all the amazing technology that’s emerged in the last four decades, we can now stretch the quantity of out our last days often to weeks or even months. Unfortunately, a similar stretching of quality hasn’t yet occurred; if anything, we see the opposite (to be fair, the same technology also stretches some lives to years and even decades, meaning it’s enabled some people to recover from insults that in the past would have undoubtedly killed them). Health providers don’t wield this technology to prolong suffering intentionally. As I argued in a previous post, Knowing When To Stop<http://www.happinessinthisworld.com/2011/06/05/when-to-stop/#.TpiSFnH2dic>, it’s quite difficult to predict the timing of death, even in the terminally ill. In one sense, then, the horrific deaths many patients experience at the hands of modern medicine reflects our species’ profound optimism bias. Even when in our hearts we know it’s time to stop, we often don’t. Yet as we learn more about our own biases, we begin to have more responsibility for mastering them and for making decisions from a place of realistic compassion, not naive hope. If we set aside for purposes of this discussion those patients I discussed in that previous post who we genuinely think might have a chance to recover and focus instead on those who clearly don’t, the need to establish an approach about how to effect death humanely becomes readily apparent. As a result of technological advances, we’re now at a point in our history where we must make active decisions to hasten death, in many instances, in order to prevent suffering that often results from our ability to prolong it. Which makes it all the more tragic when we choose not to. Only three states in the U.S. allow assisted suicide: Oregon, Montana, and Washington. The requirements are that a patient must be of sound mind as confirmed by a physician and other witnesses and must be diagnosed with a terminal illness. But what’s fascinating to me about the way people think about this is the following: though most of the people I’ve asked the question “Are you afraid to die?” have responded “I’m afraid to die in pain,” most of them also, while still in a state of good health, have a difficult time envisioning themselves choosing to swallow poison (admittedly, I’m referring to anecdotal responses of a small number of people). And though intellectually we may feel we could certainly be brought to the point where we could swallow poison, I suspect few of us can really project how we’d feel about it at the moment we would do it. But when you listen to people with terminal illnesses who actually do go on to end their lives, you find what is to me a surprising thing: almost to a person (of those assisted suicides actually documented) they say they feel ready, willing, and able. Apparently it is possible to reach a point in one’s dying where fear evaporates under the onslaught of discomfort. It may be strange to say it, but I find this comforting. Death may be inevitable, but fear of death need not. I’d like my death to be as painless as the next person, but if I see it coming (a possibility that increases each year with each technological advance), I’d also like to face it without fear. I don’t know which, in general, causes more suffering in the end, extreme physical pain or the terror of imminent non-being. But if extreme pain also has the power to extinguish extreme fear, all the more reason to think the ability to commit suicide at the time of our own choosing might represent the crucial difference between a good death and a bad one. So my wife and I have discussed it. “You’ll help me take myself out if it gets to that point, won’t you?” she asks me occasionally. I tell her I will—and I really will, if it comes to that—but I wonder how. Not just how I’ll be able to get myself to participate in the death of someone I love (even seeing her in agony, death is just so final), but even I, as a doctor, will make it happen in a state in which it’s illegal. Though it could be argued the laws against assisted suicide in human beings are largely the product of misguided religious thinking, I suspect there’s also involved a secular reluctance to allow our fellow human beings to kill themselves. Even though in many cases it’s hard to argue the prohibition against assisted suicide is actually humane, it’s also quite a difficult thing, emotionally, to allow a suicide to happen, much less to view it. And yet, compassionate action is often hard in general. Tough love typically doesn’t feel good to anyone involved, the giver or the receiver, for example, but it is usually, when done appropriately, compassionate and wise. From the Nichiren Buddhist—and I think secular humanist—perspective the alleviation of pointless suffering must be considered the primary aim in terminal cases. The key concept here, it cannot be overemphasized, however, is “pointless.” Nichiren Buddhism, at least, is founded on the principle that suffering has a critical function in many instances as the catalyst for valuable inner change. Pointless suffering, however, of which the preventable suffering of the terminally ill is but one example, remains, from the Buddhist perspective, the great enemy of us all. Though I’m pledged to prolong life where I can, I’m also pledged to alleviate pointless suffering. Thus, I very much believe in the right of people to freely choose the method and time of their own demise when they find themselves in circumstances where such a choice has become the only option to relieve their pointless suffering. We remain profoundly uncomfortable as a society with this position, but our own technological advances will eventually force us to embrace it. As more and more people die in needless pain and more and more people sit watching, eventually, I believe, we will accumulate enough collective experience to make peace with the notion that what we currently do with our pets is far more humane than what we mostly do with each other. * Lickerman is an internal medicine physician at the University of Chicago who blogs at* Happiness in this World<http://www.happinessinthisworld.com/> *.* * * Stop trivializing conflict of interest<http://ptmanagerblog.com/stop-trivializing-conflict-of-interest> Posted about 15 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=86285251> Stop trivializing conflict of interest by Darrell White, MD <http://www.kevinmd.com/blog/post-author/darrell-white>| in Physician <http://www.kevinmd.com/blog/category/physician> | one response - Embedded media -- click here to see it.<http://ptmanagerblog.com/stop-trivializing-conflict-of-interest> - Embedded media -- click here to see it.<http://ptmanagerblog.com/stop-trivializing-conflict-of-interest> - Embedded media -- click here to see it.<http://ptmanagerblog.com/stop-trivializing-conflict-of-interest> - inShare9 - Embedded media -- click here to see it.<http://ptmanagerblog.com/stop-trivializing-conflict-of-interest> “I’m sorry, Doctor, but we can’t have you give that talk; you have a conflict of interest<http://www.kevinmd.com/blog/2010/06/clinical-trial-conflict-interest-do\ ctors.html>since you’ve been paid to do research on that medicine.” “Well, Senator, it’s a conflict of interest for a doctor to sell those crutches in his office.” “It is the opinion of this newspaper that physicians should declare to each patient any ownership interest they might have in a surgery center so that the patient is aware of any conflict of interest.” And on and on the drums beat, droning incessantly and insistently about the dreaded conflict of interest. In a world now run by the terminally attention deficited, with multi-tasking and synergy-seeking all the rage, we apparently have one domain in which nothing but the purest, most antiseptic, monastic and single-minded devotion to a single task and goal is acceptable: the provision of health care in America. Think about it … the simple existence of other interests is de facto evidence of some nefarious conflict of interest. The underlying assumption appears to be that it is impossible to have any additional interest–ownership of a business, a consulting agreement, stock or stock options–without the ability to devote your primary attention to the best interests of your patient. Any other interest is automatically bad, and every physician is guilty and can’t be proven innocent. How did we come to this? There are issues and examples both substantial and trivial, and yet each of them is addressed as if they are one and the same. I bought pens last month for the first time in my professional career (I graduated from med school in 1986). It was weird. Who knew that there was a place called OfficeMax and that this huge store had not one but two aisles of pens to peruse?!I think it was Bics in a Kmart the last time I bought a pen. Somehow this fact means that I have been making decisions for my patients based on all those pens I didn’t buy all these years. There’s only one problem with that: I don’t remember a single thing about even one of those pens. And yet somehow accepting those pens is a conflict of interest. Seriously. Why is it that if I somehow get something from someone, big or small, even if I perform some service or even buy something from them, that it’s a conflict of interest if some company or other might make money from what I do for my patient? Why is every peripheral interest that exists around the little silo in which I practice medicine–a space occupied by me, my staff, and my patient–why is that automatically a conflict of interest with some sort of negative connotation? That I must be doing something bad? Why not just another interest? Why can’t these things be a “convergence of interests” between what is best for my patient and any of the other stuff that might be going on around us? Listen, I get it. There have been instances where docs have pushed inferior products on their patients because they had a significant financial incentive to do so. I’m reviewing a med-mal case right now where the plaintiff had an eye problem which resulted in cataract surgery. The cataract surgeons are not being sued, but I looked over the surgical record and saw that they put an inferior lens implant in this guy’s eye, and I know they did that because they own the surgery center and that lens is dirt cheap. That’s a conflict of interest. But for every surgery center owner like this putz I know 50 who put in state-of-the-art implants because that’s what’s best for their patients. Those docs still make a profit, but it’s smaller because they are putting the patient first. Why is that a conflict of interest? It’s not. Three different companies make 3 versions of the same kind of medicine, all of which have identical efficacy and safety, and all of which sell within pennies of each other. How does one choose among them if one needs to be prescribed? Is it such a heinous insult to humanity to choose to prescribe the product from the company that pays the doc to consult on some other project? Or the company that brought in lunch? Or the one that left a couple pen lights in the office? Tell me, how and why is this a conflict of interest? This trivialization of the concept of conflict of interest is actually weakening the protections that we should have against real conflicts that cause real harm. Pushing unproven technology (artificial spinal discs, anyone?) on unsuspecting patients prior to definitive proof in return for obscene consulting agreements, for example. Applying the same degree of moral outrage to a ham sandwich as we do to conflicts which truly pit the best interests of our patients against some profound interest on the part of the physician that prevents him/her from centralizing the patient is farcical moral equivalence. I think it is actually harming our patients. Our most renowned medical editors, innovators, inventors, and teachers are withdrawing from public positions that require a monk-like aversion to these conflicts of interest. Who will replace them? Will the ascete cocooned in the conflict-free zone and unaware of what developments are on the way contribute? How about the teachers? Will we be taught by specialists who put together the purest power-points from the latest scrubbed articles, priests who are not stained by the sins of the those who are touched by the commerce of medicine by actually touching, you know, patients? Here’s my bid: a true conflict of interest is one in which there is an essential tension between what is best for a patient, and some other ancillary benefit that might accrue to the physician. Something that makes the doc think about that other benefit first, before the patient. Everything else is an “additional” benefit. We should stop this silliness; stop trivializing the concept of conflict of interest through the dumping together of all other interests in the same gutter. We should all be allowed to ignore all but the truest of conflicts as we continue to put our patients’ interests first. We should be allowed to seek a convergence of interests. via kevinmd.com<http://www.kevinmd.com/blog/2011/12/stop-trivializing-conflict-inter\ est.html> [image: App] On the go? *Download Posterous Spaces* for your phone <http://posterous.com/mobile> Sent by Posterous. Is this spam? Report it here<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscriptions>. Manage or unsubscribe email subscriptions<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscri\ ptions> Other questions? We’d love to help. <http://help.posterous.com> Quote Link to comment Share on other sites More sharing options...
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