Health care fraud is a hot topic both in Washington and around the country, as well it should be. But if you bring up the subject of fraud in the health care system at your local town hall meeting (by which of course I mean bar, er, church luncheon) what you will most likely hear is an impassioned diatribe about the various and sundry ways that "entitlement programs" are allowing lazy miscreants to "get rich off the system." The vitriol directed at programs labeled "socialized medicine" or "Obamacare" is as thick as it is pervasive. But take a closer look at where money travels in the U.S. health care system, and you'll find that the vast majority of fraud costing billions of U.S. tax dollars is not perpetrated by individual members of the public, but by the health care system itself. If crap always rolls downhill, then money always rolls into the pockets of corporate health care executives...and a fair percentage of that money is ill-gotten indeed.
First, that estimate includes more than just fraudulent claims by consumers, it also includes fraudulent claims sent by physicians' offices themselves due either to a mistake (maybe) or a systematic attempt to increase profits (more likely) in an age of overwhelming and ever-increasing insurance demands.
Second, while the government itself acknowledges that only a maximum of 10% of claims are likely to be fraudulent, even its own health care initiatives overwhelmingly treat the majority of claimants with the presumption of either mistaken eligibility or a fraudulent claim, and good luck to the consumer trying to prove otherwise. For example, the Social Security Administration "awards" an average of only 28% of initial disability claims - denying an average of 72%. Let me say that again. That's 72% of claims denied, compared to a maximum 10% fraud rate. Now you do the math.
Third, and most important to the fraud discussion, all of this financial jargon gets put into some major perspective when we actually consider the downright obscene amount of money people aren't talking about - the money attached to fraud on the corporate side of the equation.
In recent days, federal investigators have turned the spotlight toward what appears to be a repeated and systematic abuse of federal regulations by health care executives striving to further increase their already inflated profit margins, even with the rest of the country suffering a severe recession. In fact, according to ABC News, large players in the health insurance industry reportedly increased their profits by 56% in 2009 - primarily by dropping coverage for consumers. So that company that denied your claim to pay for your recent check-up tests because it couldn't be expected to pay for everyone's check ups probably made a profit in the high millions, if not billions, of dollars last year. If you're shaking your head right now, be sure to take a look through Business Insider's article, "15 Executives Who Get Paid Millions To Deny You Health Care Coverage." To give you a sense of what we're talking about here, these 15 people alone get paid between $800,000 and $38 million each per year to run health care companies with reported yearly revenues anywhere between $2.2 - $81 billion (that's billion with a "b") in 2008. If you crave more recent numbers, you can read about the top 10 most highly paid pharmaceutical executive salaries in 2010, which ranged from approximately $14 - $29 million last year (incidentally, these numbers include only salaries - no bonuses or executive perquisites which actually raise the figures significantly higher). That, my friends, is the kind of money for which people will do - and have done - just about anything.
Which is why the feds are now turning up the heat on the health care industry. Fines alone seem to have done little to dissuade health care companies from engaging in all kinds of fraudulent tactics, from promoting off-label uses of pharmaceuticals to encouraging kickback schemes, in order to increase their profit margins. Corporations have been all too happy to sign over some giant sized checks, only to pass along the cost to consumers in the form of higher prices and less coverage. Now feds are reviving a dusty statute called the Park Doctrine in an effort to hold these high powered executives personally and criminally responsible for the behavior of their companies...and the execs aren't happy about it. So in other words, they want to continue commanding salaries in the multi-million dollar range to run these companies, but they don't actually want to be held responsible for anything their companies do.
The feds say they got frustrated with repeat violations and decided to start using enforcement tools that were already on the books but had been allowed to languish. By some estimates, health care fraud costs taxpayers $60 billion a year, galling when Medicare faces insolvency.
"When you look at the history of health care enforcement, we've seen a number of Fortune 500 companies that have been caught not once, not twice, but sometimes three times violating the trust of the American people, submitting false claims, paying kickbacks to doctors, marketing drugs which have not been tested for safety and efficacy," said Lewis Morris, chief counsel for the inspector general of the Health and Human Services Department.
"To our way of thinking, the men and women in the corporate suite aren't getting it," Morris continued. "If writing a check for $200 million isn't enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top."
In other words, federal prosecutors seem to feel that the guys making muti-million dollar salaries to run health care-related companies should be held accountable for the activities of those companies. Obviously, the executives feel it is unfair to hold them personally accountable in any way, which makes a lot of sense to m...no wait, that makes no sense at all.
The example currently making headlines is that of Forest Labs, a pharmaceutical company that recently settled a $313 million lawsuit with the Department of Justice which alleged multiple fraudulent activities:
...Forest Laboratories...agreed to a $313 million settlement. The misbehavior: selling an unapproved drug, marketing another drug off-label, and lying to FDA inspectors during a visit. The company's Forest Pharmaceuticals unit pleaded guilty to criminal charges of marketing its unapproved thyroid drug Levothroid--and ignoring the agency's warnings to stop. The plea also covers charges of "misbranding" its antidepressant drug Celexa, which basically means that it promoted the drug for off-label use. In this case, Forest pushed Celexa for use in children even though it was only approved for use in adults, an FDA statement says.
Prosecutors also say that Forest sales reps paid doctors to persuade them to prescribe Celexa and its successor drug Lexapro, giving them cash "disguised as grants or consulting fees," plus expensive meals and entertainment, such as Broadway tickets, a deep-sea fishing trip, and pro baseball tickets. Forest "expressly denies" those claims, despite its agreement to pay some $148 million to settle those and other civil complaints.
Mylan Pharmaceuticals, UDL Labs, AstraZeneca & Ortho-McNiel - $124 million
Omnicare Inc. - $98 million
WellCare Health Plans - $80 million
And those are just the big numbers - there are plenty more multi-million dollar and smaller settlements that add up.
So the next time someone wants to bemoan the prevalence of health care fraud in this country, you can pull out the big guns. We have all been socialized, institutionalized if you will, into thinking of health care fraud as something lazy, impoverished people do in order to milk the system. The reality is much more insidious. There is no point in discussing health care fraud without addressing the massive profits systematically and illegally garnered by health care companies at the expense of American consumers, leaving many of us in the impossible situation of having to choose between paying for our health care or paying our rents or mortgages. After all, if we don't find a way to make it less profitable for corporations to screw the American public on such a massive scale, how effective can we ultimately expect any reform effort to be?
If you're like me, even a photo of the Lombardi trophy makes your heart beat a little bit faster. The looming specter of an NFL lockout has me wondering whether the Grinch might not be working overtime this year. Like every self-respecting football fan, some days all I want for Christmas is for my team to have another shot at a Superbowl title. It doesn't matter to us how realistic that shot may or may not actually be, because for us football isn't about realism. Football is about heart. Football is about drive. Football is about good old fashioned want-it more-than-the-other-guy. Football is about the American Dream, and an impending lockout threatens to shove the death of that dream right up our...noses.
I don't know about you, but I'm just not prepared to cope with that much reality right now. So far I've managed to deal with the recession, the crash of the housing market, the general lack of affordable health care, and a few natural catastrophes through a combination of great effort, a little luck, and an not insubstantial amount of total denial. But take away my any given Sunday and I just might lose some of whatever remains of my grip on reality. I love my town, and my town loves its team of highly padded musclebound testosterone junkies. They shield us from more than the other team. For a few hours a week, they shield us from the helplessness we feel when nuclear plants melt down, the stock market crashes, rivers flood whole states, and the earth tells us where we may no longer stand and remain above sea level. I want them on that wall. I need them on that wall.
But TomDispatch (via Mother Jones) would like me to take a step back and consider what I'm willing to forgo in order to see my men on that evergreen, hashmarked wall this year. What price am I willing to pay, both economically and socially, in order to ensure that my team gets an uninterrupted shot at the Lombardi trophy? And I must admit, because I do not wish to admit, that if I can manage to avoid looking too closely at the price I'm being asked to pay I'll probably pony up a lot more than is actually good for me, for my community, or for the game itself.
Sportswriter Robert Lipsyte pens a thought-provoking article on the nature and economics of professional football, and what we fans are willing to put up with in order to avoid even one season without it. Are we willing to give up the values that founded the American Dream in order to ensure uninterrupted viewing of its most popular athletic manifestation? Read Why The NFL Would Do Us A Favor By Calling Off The Upcoming Season and decide what it's worth to you.
I tried to stick to posting a brief, objective comment on the screamingly obvious design flaw in this study, I really did. But there was a "problem" with my account which led to my comments being repeatedly deleted from the site, so now I just can't resist a full-fledged rebuttal.
Everyone, I would like to introduce you to Carrie Lukas, an intelligent, educated, and probably well-meaning writer who nevertheless knows next to squat about research design or gender-influenced economics...which does not stop her from spouting out drivel about them at every possible (not to mention extremely profitable) opportunity. In fact, scratch that whole well-meaning part and replace it with "highly motivated by personal gain and a total disregard for little things like "facts" and "evidence."
Ms. Lukas's most recent misinformed diatribe was posted in yesterday's Wall Street Journal as a review of a "study" which supposedly found that the wage gap between men and women no longer exists. Yippie! Now we're all on a level playing field and what a relief to not have to worry about equal pay for equal work anymo...wait, what?
The reality is that this study actually points more evidence toward the fact that on a level playing field, women are entirely capable of performing just as well as men - and their salaries have begun to reflect that. But institutionalized gender bias distorts that playing field as soon as relationships and children enter the mix, and it is women with families - and their salaries - that suffer the most as a result. In fact, the wage gap between mothers and non-mothers is larger than the gap between women and men. To my mind, this is evidence that men are indeed beginning to take on more of the child rearing and homemaking chores...and perhaps their own salaries are beginning to show the strain.
And therein lies the great problem with gender bias; not that it oppresses one gender or another, but that it necessarily denigrates both genders at the same time. You simply cannot shove half of the population of an entire society into a one-size-fits-all boxed stereotype without automatically shoving the other half into the polar opposite box...and neither gender belongs there. Societal change is a process of two steps forward and one step back, and though we've come a long way there is still an awful lot of room for improvement.
Personally, I'll believe we've achieved true gender equality in this country when I see women taking the football field and men shaking the pom pons.
Here at INSTITUTIONALIZED we believe that our society tends to filter information through layers of systematic, below-the-radar, even unintentional prejudice, including institutionalized racism. Nor do we hold ourselves apart from such behavior; on the contrary. Our point here is that these prejudices are so ingrained in our socialized world view that most of us don't even recognize them as prejudice.
Case in point: The post that launched INSTITUTIONALIZED - our discussion of the whole Charlie Sheen meltdown. Do we think the guy's crazy with a capital Z? You bet your Adonis DNA we do. But we questioned the degree to which immediate medical intervention was really necessary. We were speaking from the perspective of his audience, but we nevertheless failed to point out that Sheen has a fairly nasty history with domestic violence, including but not limited to "accidentally" shooting his then fiancee actress Kelly Preston in the arm (after which she subsequently ended their engagement. Yup, sounds like an accident to me). While we were focusing on making the point that Sheen is not a threat to his audience, who but self-admitted abuser Chris Brown should point out our own unintentional hypocrisy? At the same time our society continues to condemn him at every opportunity for battering Rhianna (and rightfully so), Sheen has reportedly begun touring with a one-man-show netting him $7 million a month. He is currently adding more dates, since tickets for the original tour sold out in 18 minutes. 18 minutes you guys.
Brown addressed his aggravation with society's apparent willingness to embrace Sheen's violence while condemning his own after an interview on Good Morning America. Rather than getting an interview designed to promote his album (the only reason most performers agree to participate in such interviews at all) the interviewer focused in large part on Brown's past domestic violence charges.
After the interview Brown reportedly threw a nice little hissy fit and then tweeted the following:
"I'm so over people bringing this past shit up!!! Yet we praise Charlie sheen and other celebs for their bullshit!"
(He apparently caught enough flak for that comment that he later deleted it.)
Now don't get me wrong, if anyone has the right to be annoyed with the constant media attention over the beating it's Rhianna, and she seems to be handling it just fine, so Brown can stick a sock in it as far as that goes. But he's not wrong about the interplay of racism and criminal justice issues.
Wouldn't it be so simple to explain the disparity by believing that African Americans are just inherently worse, meaner, more violent people than Whites? That way everything would be someone else's fault, we wouldn't have to pay attention to what's going on in the system, or examine our own beliefs, or ask how and why a nation supposedly founded on personal freedoms is systematically punishing its own citizens for being born the wrong color?
I was at a small party yesterday when one of those awkward silences fell, and, because I am a red-blooded American, I said the only thing I could think of that was certain to reinvigorate the room.
"So, how 'bout that Charlie Sheen?" It worked.
If you have somehow missed the unbelievably entertaining rants actor Charlie Sheen has treated us all to in the past week, what can I say. Catch up.
Now, I would be lying like a dog if I said I hadn't joined in the fontrum, the schadenfreude, the joy at the wrongness of it all. Charlie is having a meltdown, and he's doing it on national, nay - global, television.
And yet, could there be a method to his delightfully public madness? I submit, for your consideration, the following evidence:
Did he plan all of this? It seems unlikely, but no more unlikely than anything Sheen has said or done lately.
But more to the point, what is it about Sheen's outrageous behavior that has captured the interest of, well, practically everyone? Anyone who has spent time with a person diagnosed with bipolar personality disorder (a.k.a. manic depression) will recognize Sheen's grandiose diatribes as par for the course during a manic phase. Delusions, paranoia, a general break from reality and insistence that he is the only one who knows what's really going on are far from unusual.
But what is so intriguing, so inviting, so entertaining is the unique situation Sheen is in due to his celebrity status, which has only increased during his wild episodes. Sheen has the resources and the outlet to literally say anything he thinks, to do anything he wants. And who among us can honestly say we have never wished we could do the same?
It is notoriously difficult to get a person in the middle of a manic episode to take medication, and for good reason. Mania feels good. It is exhilarating. It draws attention, as Sheen could clearly attest. Perhaps most importantly, mania is often characterized by a rise in both creativity and fearless self-expression. Indeed, many scholars have theorized a link between bipolar disorder and the expression of creative genius. Sheen may be in good company here. Without the creativity and bravado of people who suffered from bipolar disorder, we would arguably be deprived of masters like Edgar Allen Poe, Earnest Hemingway, and Vincent Van Gogh.
That's not necessarily to say that Sheen is a genius. He seems to be rather on the other end of the spectrum for now. But he is far from alone in reacting to the bipolar diagnosis with disdain and mistrust, saying "And then what? What's the cure? Medicine? Make me like them?" Many people taking mood-stabilizing medications express similar frustration. Medication may calm them, but it also dampens their creativity, their expressiveness, their sense of uniqueness. In order to be accepted, society demands that they tone down erratic behavior, increase their concern about how they are perceived by others, and generally pull it together enough to go with the flow. Perhaps it would be worthwhile to ask ourselves, are we medicating them to improve their quality of life, or our own? Do we want them to act more "normal" because it is in their best interest, or because they are making us uncomfortable?
And when it comes right down to it, who are we to insist that Sheen, or anyone else, change to meet our expectations of who and what they should be? Of course we must intervene when people represent a threat to themselves or others. But Sheen is no threat to us. You and I are just an audience. When it comes down to it, we don't really know what's going on behind the curtain. What we do know is that he is outrageous, provocative, controversial, and highly entertaining. And really, what more can we ask of a pop culture icon?
