Category: Daily News

Burnout among U.S. doctors is becoming more common and now affects more than half of practicing physicians, according to a new study reviewed by Reuters Health. About 54 percent of U.S. doctors experienced at least one symptom of burnout in 2014, compared to about 46 percent of doctors in 2011, researchers report in Mayo Clinic Proceedings. Overall, the researchers found that doctors are about twice as likely to experience burnout as the average U.S. worker.

“Things are unfortunately getting worse for physicians,” said lead author Dr. Tait Shanafelt, of the Mayo Clinic in Rochester, Minnesota. Through a partnership with the American Medical Association, the researchers invited nearly 36,000 U.S. doctors to take a survey in 2014 and compared the responses to a similar survey from 2011.

Of the 6,880 doctors who responded to the 2014 survey, about 47 percent reported high emotional exhaustion, about 35 percent felt depersonalized or saw less value in their work and about 16 percent felt a low level of personal accomplishment.

Burnout rates varied between specialties, with rates topping 60 percent among doctors in emergency medicine, family medicine, urology, rehabilitation and radiology.

Doctors working in urology, rehabilitation, family medicine, radiology, orthopedic surgery, dermatology, internal medicine, general surgery, pathology, psychiatry and general pediatrics all saw significant increases in burnout rates between 2011 and 2014.

Despite no increase in the number of hours worked, only 41 percent of all doctors said they were satisfied with the balance between their work and personal lives, down from about 49 percent in 2011.

In an editorial, Dan Ariely and Dr. William Lanier of Duke University in Durham, North Carolina, pointed to three main psychological issues in the workplace that likely undermine doctors’ wellbeing: loss of autonomy, mental exhaustion and “asymmetrical rewards” – meaning that success is barely acknowledged while mistakes come with heavy punishments. Shanafelt also pointed to doctors’ heavier workloads and increased clerical responsibilities as examples of potential frustrations.

The study team notes that 75 percent of doctors now work for large healthcare organizations, and meaningful progress toward turning around burnout rates will require work by doctors and their organizations. Dr. Mark Linzer, of Hennepin County Medical Center in Minneapolis, said his research shows that healthcare systems with higher burnout rates also provide less quality care to their patients.

Mitchell G. Cohen M.D. is a board- certified orthopedic surgeon who performed spinal surgeries at Pacific Hospital of Long Beach. He is a resident of Irvine, California, and controls two corporate bank accounts under the names Spine Care Center and Mitchell G. Cohen, M.D. , Inc.

Cohen and his attorney signed a written plea agreement in federal court which has now been unsealed. He plead guilty to a single count which charges him with Subscribing to a False Tax Return in violation of 26 U.S.C. § 7206(1). In exchange, the prosecutor agreed to recommend a two-level reduction in the applicable Sentencing Guidelines. The statutory maximum sentence that the Court can impose for violating Title 26, United States Code, Section 7206(1), is 3 years of imprisonment; a one-year period of supervised release; a fine of $100,000; and a mandatory special assessment of $100.

As part of the plea agreement, Cohen agreed to the statement of facts that recited essentially the following. He accepted illegal kickback payments from Michael D. Drobot and a marketer in exchange for performing spine surgeries at Pacific Hospital. Cohen concealed the illegal kickback payments from his patients and the insurance carriers that paid for the patient’s services. He was paid between approximately $5,000 and $15,000 in kickbacks for every spinal fusion surgery performed at Pacific Hospital and deposited kickback payments primarily into his Spine Care Center bank account. Spine Care Center had no legitimate business purpose other than acting as the recipient entity.

In 2009, 2010, 2011, and 2012, Cohen caused Spine Care Center to file a Corporation Income Tax Return, Form 1120, claiming the illegal kickback payments as gross receipts of Spine Care Center. Cohen knew that the illegal kickback payments were not gross receipts of Spine Care Center, but instead should have been reported as individual income on his Individual Income Tax Return. Thus he failed to report $243, 000 in 2009, $214,100 in 2010, $426,335 in 2011, and $394,611 in 2012. Had he properly reported this income he would have been assessed an additional $402,139 in individual income tax. Thus he agreed to payment of no more than $402,139 restitution for taxes.

In 2012, Drobot and Cohen agreed that Drobot would pay him $15,000 in kickbacks for each posterior lumbar interbody fusion surgery performed at Pacific Hospital, and between $5,000 and $7,500 in kickbacks for each cervical fusion spine surgery performed at Pacific Hospital, provided those surgeries were performed using spinal hardware purchased from International Implants, LLC, a medical device distributor owned by Drobot.

In order to disguise the illegal kickback payments from Drobot Cohen entered into two bogus contracts with Drobot’s business entities. First, a Research, Product Development and Training Agreement where he purported to provide consulting services in exchange for a monthly payment of $25,000. Cohen however, provided few legitimate consulting services. Instead, the payments were purely kickbacks for spinal surgeries.

In addition Cohen entered into an Outsourced Collections Agreement with Pacific Hospital. The Collection Agreement provided that Cohen would assist Pacific Hospital in collecting its fees for spinal surgeries from insurance carriers, and that in return Pacific Hospital would pay Cohen fifteen percent of the total amount collected. In reality the collection was done by Pacific Hospital staff, without assistance from Cohen.

In total, Cohen received approximately $1,645,225 in illegal kickback payments from Drobot and the marketer between 2008 and 2013.

Beginning in or around 2004, Cohen entered into an agreement with California Pharmacy Management (“CPM”), an in-house dispensary management company owned by Drobot, and later another Drobot entity Industrial Pharmacy Management, in which the Dispensary Management Companies purported to manage Cohen’s in-office pharmacy in return for fifty percent of the gross collections resulting from prescriptions filled at defendant’s pharmacy. In reality Cohen was paid varying amounts averaging between $20,000 and $40,000 per month as an inducement to allow the Dispensary Management Companies to operate his in-office pharmacy and to gain access to his patients including, in particular, defendant’s worker’s compensation payments.

As part of the Plea Agreement Cohen agreed to cooperate fully with the US Attorneys Office, the Federal Bureau of Investigation, the United States Postal Service – Office of Inspector General, the Internal Revenue Service, and, as directed by the USAO, any other federal, state, local, or foreign prosecuting, enforcement, administrative, or regulatory authority.

A similar “cooperation” agreement has been made with other physicians, who are likely to be government informants providing information leading to yet further arrests of colleagues in months to come.

Philip A. Sobol M.D. has signed and filed a Plea Agreement in the United States District Court for the Central District of California. He agreed to plead guilty to a two-count information which charges him with Conspiracy, in violation of 18 U.S.C. § 371, and Interstate Travel in Aid of a Racketeering Enterprise, in violation of 18 U.S.C. § 1952.

In paragraph 3 of the Agreement, he agrees to make payment of half of the agreed-upon forfeited amounts and/or restitution totaling $5.2 million no later than 180 days of the entry of his guilty plea, and the remainder no later than 30 days before his sentencing.

Sobol further agreed to cooperate fully with the United States Attorneys Office, the Federal Bureau of Investigation, the United States Postal Inspection Service – Office of the Inspector General, the Internal Revenue Service, and, as directed by the USAO, any other federal, state, local, or foreign prosecuting, enforcement, administrative, or regulatory authority. This cooperation requires him to respond truthfully and completely to all questions that may be put to him, whether in interviews, before a grand jury, or at any trial or other court proceeding.

In exchange, prosecutors agreed to recommend a reduction in the applicable Sentencing Guidelines.

Sobol specifically admitted in this document that “Beginning in or around 2005, and continuing to in or around April 2013, there was an agreement between two or more persons to commit Mail Fraud and Honest Services Mail Fraud, in violation of Title 18, United States Code, Sections 1341 and 1346 and Interstate Travel in Aid of a Racketeering Enterprise, in violation of Title 18, United States Code, Section 1952(a) (3)” He further agreed that he understands that the total maximum sentence for all offenses to which defendant is pleading guilty is 10 years imprisonment; a 3-year period of supervised release; a fine of $500,000 or twice the gross gain or gross loss resulting from the offenses, whichever is greatest; and a mandatory special assessment of $200.

He agreed that he is “in fact guilty to the offenses” and agreed to a statement of facts stating that he agreed to exchange monetary kickbacks in return for the referral of patients to Pacific Hospital for surgical services paid for primarily through the California Workers’ Compensation System (“CWCS”). In paying the kickbacks and submitting the resulting claims for the surgical services, the conspirators acted with the intent to defraud workers’ compensation insurance carriers and to deprive the patients of their right of honest services. Drobot and other co-conspirators offered to pay kickbacks to doctors and chiropractors in return for their referring workers’ compensation patients to Pacific Hospital for spinal surgeries, other types of surgeries, magnetic resonance imaging, toxicology, durable medical equipment, and other services.

Sobol either performed surgeries on the patients at Pacific Hospital himself, or – particularly in the case of spine surgeries – admitted he referred them to other surgeons, with specific instructions to those surgeons that they were to perform the surgeries only at Pacific Hospital, if possible, as a condition of receiving the referrals.

In response to a ProPublica and NPR highly critical investigation, the National Conference of Insurance Legislators said it will look into an effort by some of the biggest names in corporate America to opt out of workers’ comp.  This year, a group founded by Walmart and several of the biggest employers in America has pushed a campaign to get laws passed in as many as a dozen states within the next decade. Tennessee and South Carolina are seriously considering such bills.

But now, a national association of state lawmakers has announced that it will investigate a burgeoning effort to let companies opt out of workers’ compensation insurance and write their own plans for how they’ll care for injured workers. The National Conference of Insurance Legislators, whose members serve on insurance committees and often act as gatekeepers for related bills in their states, said the decision was prompted by a ProPublica and NPR story last month that found that employers’ opt-out plans typically provide lower benefits for injured workers, more restrictions and little independent oversight. Texas and Oklahoma currently allow companies to opt out and other states are considering similar plans.

“The issues brought forward by the recent NPR/ProPublica study regarding the Texas and Oklahoma workers’ compensation programs are of significant concern to state legislators responsible for the protection of injured workers,” said North Dakota state Sen. Jerry Klein, a Republican who chairs the association’s workers’ comp committee.

Nearly every state requires employers to carry workers’ comp to provide medical care and lost wages if someone gets hurt on the job. In exchange, workers are barred from suing their employers. But Texas has allowed companies to have no insurance, sometimes forcing injured workers to go to court or arbitration to obtain benefits. And in 2013, Oklahoma passed a law allowing companies there to opt out – while still retaining their immunity from lawsuits – if they adopt an alternative benefit plan.

Proponents say the alternative plans save companies money by removing bureaucracy and providing better medical care.

But ProPublica and NPR analyzed the plans of 120 companies and found that the Texas programs typically cut off medical treatment after about two years, don’t compensate workers for most permanent disabilities and cap payouts for deaths and catastrophic injuries. Workers’ comp typically covers medical care for workplace injuries for life and death benefits for children until they graduate college.

In Oklahoma, companies that opt out must provide the same level of benefits as workers’ comp, but unlike workers’ comp, the benefits are subject to income and payroll taxes. In addition, in almost every plan, workers cannot choose their doctors and must report injuries within 24 hours or risk losing all benefits.

A show of support from the national association would make opt-out bills much easier to pass, while a negative assessment might cause lawmakers to try to block efforts in their states. The group also said it would hold discussions to counter any attempts by the federal government to intervene in state workers’ comp programs.

An earlier ProPublica/NPR investigation found many states have drastically scaled back workers’ comp benefits in recent years. In response, several prominent members of Congress have called for increased federal oversight to ensure states are properly caring for injured workers.

In a series of related cases the former chief financial officer of Pacific Hospital of Long Beach, two orthopedic surgeons and two others have been charged in long-running health care fraud schemes that allegedly referred thousands of patients for spinal surgeries and generated nearly $600 million in fraudulent billings over an eight-year period.

Two of the defendants have pleaded guilty and three others have agreed to plead guilty in the coming weeks. All five defendants have agreed to cooperate in the government’s ongoing investigation into kickbacks for patient referrals and fraudulent bills for spinal surgeries.

The schemes involved tens of millions of dollars in illegal kickbacks to dozens of doctors, chiropractors and others.As a result of the illegal payments, thousands of patients were referred to Pacific Hospital in Long Beach, where they underwent spinal surgeries that led to more than $580 million in bills being fraudulently submitted during the last eight years of the scheme alone. Many of the fraudulent claims were paid by the California worker’s compensation system and the federal government.

In a second, similar scheme that also involved spinal surgeries, doctors received illegal kickbacks for referrals to a Hawaiian Gardens hospital.

Federal prosecutors filed two cases related to the scheme, and earlier three other cases were unsealed by a federal judge. Those named in the cases are:

1) James L. Canedo, 63, of San Pedro, California, the former CFO of Pacific Hospital in Long Beach, who pleaded guilty on Sept. 4 to a criminal information charging him with participating in a conspiracy that engaged in mail fraud, honest services fraud, money laundering, paying or receiving kickbacks in connection with a federal health care program and violating the Travel Act, specifically, interstate travel in aid of a racketeering enterprise. The case against Canedo was unsealed a few days ago by U.S. District Judge Josephine L. Staton of the Central District of California, who is scheduled to sentence the defendant on June 17, 2016.
2) Philip Sobol, 61, of Studio City, California, an orthopedic surgeon who has agreed to plead guilty to conspiracy to commit mail fraud, honest services fraud and violations of the Travel Act; as well as a separate, substantive Travel Act violation. The information against Sobol and a related plea agreement were filed in U.S. District Court, where the Sobol is expected to be arraigned next month.
3) Alan Ivar, 55, of Las Vegas, a chiropractor who formerly resided in San Juan Capistrano, California, and owned several businesses based in Costa Mesa, California, was charged in a criminal information that alleges one count of conspiracy to commit mail fraud, honest services fraud, money laundering and violations of the Travel Act. In a plea agreement also filed at the same time, Ivar admitted that for well over a decade, he had an agreement with the owner of Pacific Hospital to refer patients in exchange for a monthly retainer. Ivar, who also agreed to plead guilty, is expected to be arraigned next month.
4) Paul Richard Randall, 56, of Orange, California, a health care marketer previously affiliated with Pacific Hospital and Tri-City Regional Medical Center in Hawaiian Gardens, pleaded guilty on April 16, 2012, before Judge Staton to conspiracy to commit mail fraud. Randall, who admitted recruiting chiropractors and doctors to refer patients to Tri-City in exchange for kickbacks, is scheduled to be sentenced on April 8, 2016.
5) Mitchell Cohen, 55, of Irvine, California, an orthopedic surgeon, was charged last week with filing a false tax return. Cohen admits in a plea agreement filed on Nov. 16 that he failed to report income received from kickback payments and is expected to be arraigned next month.

All five defendants have agreed to cooperate with the government’s ongoing investigation, dubbed “Operation Spinal Cap,” into the kickback schemes, which involved dozens of surgeons, orthopedic specialists, chiropractors, marketers and other medical professionals.

Under the terms of their plea agreements, Sobol faces a federal prison term of up to 10 years; Canedo, Ivar and Randall face up to five years in prison; and Cohen faces up to three years in prison on the tax charge. All of the defendants will be required to pay restitution to the victims of the scheme, which in Canedo’s case will be at least $20 million.

As part of the scheme, the conspirators typically paid a kickback of $15,000 for each lumbar fusion surgery and $10,000 for each cervical fusion surgery. Some of the patients lived hundreds of miles away from Pacific Hospital and closer to other qualified medical facilities. The patients were not informed that medical professionals had been offered kickbacks to induce them to refer the surgeries to Pacific Hospital. From 2005 through 2013, only part of the overall scheme, Pacific Hospital billed insurers more than $580 million for spinal surgeries on more than 4,400 patients. Insurers paid the hospital more than $226 million for the surgeries performed as a result of illegal kickbacks.

The conspirators in the Pacific Hospital scheme concealed the kickback payments by entering into bogus contracts to provide a “cover story” for the doctors, chiropractors and others who received illegal payments. For example, a number of doctors entered into agreements with a Pacific Specialty Physician Management (PSPM), a company owned by Drobot, under which the doctors received as much as $100,000 per month from PSPM in return for the right to purchase their medical practices – an option that was never exercised. PSPM paid some doctors inflated prices for the right to operate their practices and collect on their insurance claims. In still other cases, Pacific Hospital entered into contracts with doctors under which the doctors were to help the hospital collect on its surgery bills to insurance companies, but the hospital’s own collection staff, rather than the doctors, actually performed the collections work. Several doctors entered into lease agreements under which PSPM or Pacific Hospital paid rent for the use of office space, but rarely used the space. And other doctors had agreements to provide consulting services to Drobot’s companies, but did not actually provide the services. Still others, including marketers who introduced doctors to Pacific Hospital, had additional agreements with Drobot’s companies.

Sobol, Ivar and Cohen each received, respectively, $5.2 million, $1.24 million and $1.64 million in kickbacks.Together they referred more than 200 patients to Pacific Hospital.

Two other Drobot companies, California Pharmacy Management (CPM) and its successor, Industrial Pharmacy Management (IPM), were also important players in the scheme. Both companies set up and managed what were essentially mini-pharmacies within doctors’ offices. CPM and IPM bought and dispensed medication that the doctors prescribed to their patients, and these businesses received a portion of the money reimbursed by insurance companies for the medications. Drobot, along with others at CPM and IPM, often agreed to increase the doctors’ shares of the insurance claims in return for those doctors’ referral of patients to Pacific Hospital. In many cases, for doctors who made such referrals, the conspirators “advanced” payments from CPM and IPM before the companies had collected any money for the medications or even prescribed them, and often simply “wrote off” payments as losses when collections fell short.

Randall, who also facilitated the Pacific Hospital scheme by introducing doctors to Drobot and coordinating kickback arrangements, pleaded guilty to participating in a separate, similar scheme involving Tri-City Regional Medical Center. According to his plea agreement, Randall acted as a “marketer” for Tri-City and conspired with hospital executives to pay kickbacks to doctors and chiropractors to refer workers’ compensation patients Tri-City for spinal surgeries. As in the Pacific Hospital scheme, the surgeries at Tri-City involved use of spinal surgery hardware that Randall distributed to Tri-City at inflated prices through his company Summit Medical Group, knowing that the cost would be passed on to insurers. Using proceeds from the sale of the hardware, Randall paid a 5 percent kickback to Tri-City and kickbacks of up to $20,000 per surgery to the doctors and chiropractors who referred the patients. In addition, Randall paid kickbacks to doctors in return for referrals of patients for toxicology tests though a separate company, Platinum Medical. The scheme resulted in several million dollars in losses to insurers.