Victims of medical malpractice and health care errors must be aware of the systemic problem within the health care industry which puts profits over people.
Victims suffering severe bodily injuries in an accident, or those who rely upon their health care providers for proper diagnosis and treatment, must trust those medical professionals to know what they are doing, and to act with integrity and expertise. Unfortunately, all too often hospitals, doctors, clinics, nursing homes, and care facilities fail in their duty of care. Patients are harmed and sometimes die as a result.
It is for this reason that both Indiana and Illinois have extensive legal protections for those harmed by medical errors and health care mistakes in the form of medical malpractice, wrongful death, negligence, and products liability laws. Victims can seek legal redress in our civil courts when harm occurs.
There are those who criticize claims made against physicians and medical centers, arguing that these demands are based upon greed and many abuse the system to the extent that the entire medical profession is harmed. See, e.g., the NPR discussion in “This GOP Health Bill Proposes New Limits to Medical Malpractice Awards,” written by Michelle Andrews and published on June 28, 2017.
However, the reality is putting profits over people is an entrenched part of the current health care industry. Victims of medical mistakes and health care errors who assert their claims for justice are doing so against a for-profit industry that is shocking in its aggressive pursuit of money.
Consider the following from the December 2018 Department of Justice News Release:
1. 2018: Justice Department Recovers Almost $3 Billion for Health Care Fraud
According to the U.S. Department of Justice, during its fiscal year 2018, it succeeded in recouping over $2,800,000,000.00 through both settlements and civil judgments based upon false claims and outright fraud cases.
Almost all of this money (90%) involved the health care industry ($2.5 Billion). Moreover, this was the NINTH year in a row the DOJ’s civil health care fraud settlements and judgments topped $2 Billion.
The corruption involves the entire health care industry. The DOJ recoveries came from a variety of prosecutions against:
- drug and medical device manufacturers
- managed care providers
- hospitals
- pharmacies
- hospice organizations
- laboratories
- physicians.
Health Care Providers for Profit
Several examples are provided by the Justice Department of health care fraud settlements and civil fraud verdicts over 2018.
The greed is rampant, as is the obvious lack of concern for patient care in the face of making a higher profit.
Among the itemized examples where the Justice Department was victorious:
- Settlement of $625 Million with AmerisourceBergen Corporation (and some subsidiaries) in a case alleging the company repackaged drugs intended for cancer patients for purposes of profit;
- Settlement of $33.2 Million with Alere in a case alleging the manufacturer intentionally sold a defective product (a “materially unreliable testing device” ) that was supposed to help in the diagnosis of drug overdoses, acute coronary syndrome and other serious conditions.
- Settlement of $210 Million with United Therapeutics Corporation in a kickback case alleging the drug company used a foundation as an illegal conduit to pay the co-pay obligations of thousands of Medicare patients taking its PAH drugs.
- Settlement of $23.85 Million with Pfizer in a kickback case alleging the drug company used a foundation as a conduit to pay the co-pays of Medicare patients taking Pfizer drugs, and that Pfizer raised the price of one of those drugs by 40 percent in just three months.
- Settlement of $270 Million by HealthCare Partners Holdings LLC (HCP), doing business as DaVita Medical Holdings LLC, to resolve its liability in a whistleblower action alleging HCP engaged in “one-way” chart reviews in which (1) it scoured its patients’ medical records to find additional diagnoses that enabled managed care plans to obtain added revenue from the Medicare program while (2) ignoring inaccurate diagnosis codes revealed by its reviews that, if deleted, would have decreased Medicare reimbursement or required the plans to repay money to Medicare.
- Settlement of over $216 Million and a criminal plea involving former hospital chain Health Management Associates (HMA) over claims (1) it billed government health care programs for more-costly inpatient services that should have been billed as observation or out-patient services, (2) paid illegal remuneration to physicians in return for patient referrals to HMA hospitals, and (3) inflated claims for emergency department facility fees. Its subsidiary, Carlisle HMA Inc., pled guilty to one count of conspiracy to commit health care fraud arising from illegal conduct designed to aggressively increase admissions to the hospital and paid $35 Million in fines.
- Settlement of $84.5 Million by William Beaumont Hospital (Detroit) in a case alleging the hospital had “improper relationships” with eight referring physicians for the purpose of getting patient referrals.
- After a 2 week two-week jury trial, an award of over $114 Million for paying doctors illegal remuneration disguised as “handling fees” of between $10 and $17 for each patient referred, as a kickback scheme where doctors were referring patients for medically unnecessary tests. The defendants were two blood testing laboratories: Health Diagnostic Laboratory of Richmond, Virginia (HDL), and Singulex Inc., of Alameda, California (Singulex).
- Another jury verdict came with a $5.5 Million award against neurosurgeon Dr. Sonjay Fonn; his fiancé Ms. Deborah Seeger, and their professional corporations, in a case alleging a kickback scheme where Dr. Fonn performed spinal fusion surgery using implants for which his fiancé received commissions, which were used to benefit Dr. Fonn in the form of lavish purchases such as a yacht and home improvements.
- Settlement of $65 Million with Prime Healthcare Services Inc., Prime Healthcare Foundation Inc., and Prime Healthcare Management Inc. (collectively “Prime”), and Prime’s Founder and Chief Executive Officer, Dr. Prem Reddy, in a case alleging that 14 Prime hospitals in California knowingly submitted false claims to Medicare by admitting patients who required only less costly, outpatient care and by billing for more expensive patient diagnoses than the patients had. Dr. Reddy paid $3.25 million of the overall settlement.
Patients in Indiana and Illinois Should Be Aware of Health Care Industry Motives and Abuses
This list of settlement amounts and jury verdicts obtained by the Justice Department reveals an industry that is filled with those more interested in profits than in proper patient care.
The fact is there exists an established pattern where the DOJ has obtained billions of dollars in health care fraud recoveries each year for the past decade, which suggests things are not getting better.
How many health care providers (hospitals, doctors, pharmacies, drug companies, etc.) simply consider the risk of getting caught as the cost of doing business? How many are focused on making money instead of helping patients? See, “The $272 billion swindle: Why thieves love America’s health-care system,” published by the Economist on May 31, 2014.
Patients and their loved ones must be alert to the possibility that they might fall victim to a medical provider more concerned with making money than providing quality health care.
Everyone needs to understand these dangers, and that there are private claims (as well as DOJ actions) that can be filed for victims seeking justice for harm resulting from medical error or health care mistakes. Please be careful out there!
