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Tag: 2016 News

Oregon Study Ranks California as Most Costly Comp in Nation

The Oregon Department of Consumer and Business Services (DCBS) announced the results of its bi-annual nationwide study of the costs of workers’ compensation programs for 2016. The study findings are generally released in the fall of each even-numbered year, in summary form. A full report, including detailed data and notes on methodology, is released several months later. Oregon has been doing these studies in even-numbered years since 1986.

DCBS surveys insurance regulators and workers’ compensation rating bureaus in each of the 50 states plus Washington, D.C., for rate information, as of Jan. 1 of the study year.

The study is based on methods that put states’ workers’ compensation rates on a comparable basis, using a constant set of risk classifications for each state. This study used classification codes from the National Council on Compensation Insurance (NCCI). Of approximately 450 active classes in Oregon, 50 were selected based on relative importance as measured by share of losses in Oregon. To control for differences in industry distributions, each state’s rates were weighted by 2010-2012 Oregon payroll to obtain an average manual rate for that state. Listed in Table 1 of the study are Oregon’s rankings in the top 10 (by payroll) of the 50 classifications used.

According to the study, California once again is the worst state in the union in terms of costs. It ranks at 176% of the study median. It is a good distance away from the second highest state, New Jersey, which ranks 158% of the study median. Rounding off the worst five, third worst is New York at 154%, Connecticut is the fourth worst at at 149%, and fifth is Alaska also at 149%.

On the other end of the spectrum, North Dakota was the lowest cost at 48% of the study median, followed by Indiana at 57%, Arkansas at 58%, West Virginia at 66%, and Virginia at 67% of the study median.

Workers Compensation costs are not the only indicator of concern. California also has the distinction of being the absolute worst in other areas of importance to business.

Between 2008 and 2015 at least 9,000 companies have left California for a better business environment, according to the 378 page study by Spectrum Location Solutions titled, California’s Forty Year Legacy of Hostility to Business.

Joseph Vranich, president of site selection consultants Spectrum Location Solutions (VLS) in Irvine, places the blame on the Golden State’s “hostile” business environment.

The 2015 Chief Executive Magazine annual survey of business climates was completed by 511 CEOs across the U.S.  States were measured across three key categories to achieve their overall ranking: Taxes and regulations, quality of the workforce, and living environment, which includes such considerations as quality of education, cost of living, affordable housing, social amenities and crime rates.

For the 11th year in a row, Chief Executive Magazine found California to be the “worst state for business in 2015.” This placement is not “near the worst” but actually “THE WORST” ranked as 50 out of 50, the lowest rank possible for each of 11 years. CEO’s comments include: “California could hardly do more to discourage business if that was the goal.” “The state regulates and taxes companies unreasonably.” “California is getting worse, if that is even possible.”

Well, yes that is possible. Yet another national study continues to place California at the absolute bottom in the eyes of business officials.

CDI Awards $34.9 Million to Fight Workers’ Compensation Fraud

The California Department of Insurance has awarded $34.9 million in grants to 37 district attorney offices representing 44 counties across California to combat workers’ compensation insurance fraud.

The grants, funded through employer assessments, support law enforcement efforts in investigating and prosecuting workers’ compensation insurance fraud.

Workers’ compensation insurance fraud includes medical provider fraud, employer premium fraud, employer defrauding employee, insider fraud, claimant fraud, and the willfully uninsured operating in the underground economy. These cases, when successfully prosecuted, help level the playing field for honest businesses and discourage future fraudulent activity.

Grant funding is based on assessments from California insured and self-insured employers. California district attorneys apply for workers’ compensation insurance fraud grant funds. The commissioner’s panel reviews the applications and makes funding recommendations to the commissioner, based on multiple criteria, including past performance, the county’s problem statement, and their program strategy for the upcoming year. The panel makes a recommendation to the insurance commissioner, who either accepts or amends the panel’s recommendation. The commissioner’s recommendation is submitted to the Fraud Assessment Commission for their advice and consent, and then the grants are awarded.

This year the grants were distributed to the several counties as follows:

Alameda $1,511,933 Sacramento $952,027
Amador $393,896 San Bernardino $1,968,662
Butte $76,378 San Diego $5,028,198
Contra Costa $864,000 San Francisco $758,121
El Dorado $292,828 San Joaquin $472,972
Fresno $1,116,000 San Luis Obispo $54,419
Humboldt $200,000 San Mateo $677,353
Imperial $125,450 Santa Barbara $331,499
Kern $752,904 Santa Clara $2,626,811
Kings $263,875 Santa Cruz $49,000
Los Angeles $6,729,177 Shasta $137,307
Marin $245,000 Siskiyou $46,832
Merced $175,209 Solano $169,476
Monterey $660,000 Sonoma $82,120
Napa $123,609 Tehama $112,127
Nevada $75,049 Tulare $501,165
Orange $4,152,802 Ventura $708,652
Placer $175,000 Yolo $257,010
Riverside $2,084,970 ——————————- —————————-
TOTAL $34,951,831

Former Prosecutor Profiles the Criminal Physician

An oncologist in suburban Detroit ordered “lifetime” chemotherapy, with all its adverse effects, for patients whose cancer was in remission. He ordered it for patients on their deathbed with stage IV cancer. And perhaps worst of all, Dr Fata ordered chemotherapy for patients who never had cancer but believed that they did because of his fabricated diagnoses. Now serving a 45-year prison sentence for fraud, Dr Fata was taken down by a team of Department of Justice (DOJ) prosecutors who included Gejaa Gobena.

Besides personally tackling cases such as Dr Fata’s, Gobena headed the healthcare fraud unit in the DOJ’s criminal division overseeing the prosecution of close to 1000 individuals across the country. Bringing Medicare fraudsters to justice earned Gobena a number of honors, including the Award for Excellence from the Office of Inspector General in the Department of Health and Human Services.

He was interviewed about his work. Medscape just published an article about what he said. “Medicare’s under full assault by fraudsters,” Gobena told Medscape Medical News in the recent interview.

Medscape asked Gobena how and why a tiny minority of physicians are breaking bad, whether it’s cheating Medicare or writing painkiller prescriptions every 10 minutes at an outlaw pill mill. Here are his answers.

Gobena said that the most common factor is financial difficulty. Sometimes it intersects with another factor, which is age. Because you have a doctor in a tough financial situation towards the end of their career, participating in these schemes gives them a way to make some money very quickly. Oftentimes it is personal bankruptcy, or someone who’s been married a couple times, got divorced, has various alimony or child support obligations.

What about medical specialties? Do some types of physicians show up disproportionally in fraud schemes?

Gobena said there were not a ton of specialists that he saw. It’s usually the opposite. He saw a lot of internists billing for tests and services that didn’t make sense and probably should have been billed by specialists in the first place. A  primary care physician suddenly billing for an unusually high percentage of, let’s say, nerve conduction tests. Very expensive, and usually done by neurologists.

Medscape asked about opioid pill mills. “In some cases, you’d have physicians working for nonphysicians. How widespread is that?”

Gobena said it was definitely common in a lot of the schemes that he personally prosecuted or oversaw. It’s a reflection of the fact that until the last few years, the vetting of people who could open a clinic, open a home health agency, was not as strong as it could have been. CMS in the last few years has really stepped up its efforts to screen potential providers. CMS now does criminal background checks. When he first started prosecuting cases, what he saw was people running multiple clinics with no medical background.

One other thing that CMS is doing. In certain regions, they’re putting “freezes” on the ability to open up certain types of services. There has been a freeze in Houston on ambulance companies for a while. There is rampant ambulance fraud down there. So they’re freezing the number of ambulance companies that can be signed up as Medicare providers. Home health, as well, in Houston, South Florida, and Detroit.

In Michigan, it was very easy to open a home health agency if you’re a fraudster. Home health agencies were popping up all over the place, and statistically, it didn’t even make sense when you looked at the population.

Medscape asked about physicians who work for criminals especially where physicians were recruited into pill mills and did the bidding of people who had gangster nicknames and guns. The physicians were pressured, and sometimes bullied, to keep up a certain level of prescribing and not make waves. “That astounded me.”

Gobena said that there are instances where doctors get into a scheme and then can’t get out. They may not want to prescribe the amount of OxyContin or fentanyl that they’re prescribing. It’s often difficult to get out when the owner of the place is a hardened criminal. But I can’t think of any instance when, at least initially, the doctor didn’t voluntarily agree to be part of the scheme.

Many criminal practices employ patient recruiters who offer people fast food, cash, or some other kind of benefit to visit the office and receive services. An example based on a case he prosecuted 5 or 6 years ago, was a general-practice clinic that came onto his radar because they billed nerve conduction studies for 75% or 80% of patients, an outrageously high percentage given that a typical neurologist will perform these on 30% to 40%.

There were doctors who were signing off on the tests. In addition, there was the owner who hired patient recruiters who would go into the poorer parts of Detroit. They would recruit in low-income housing and soup kitchens, offering $50 to $100 to anyone who had a Medicare card to come to this clinic.

The recruiters would coach the patients based on instructions from the owners. The medical records have to show that there is medical necessity for these nerve conduction studies. So they’d coach the beneficiaries to say that they had pain or that their back or arms had tingling sensations, to show that there was some sort of nerve damage. They told the beneficiaries to tell the doctor that.

The doctors would sign off even though it didn’t make sense to have that high of a percentage coming to a general practice having these exact same symptoms. They often would prescribe opioids in addition.

At the end of the day, the doctor was able to bill for their professional services. The clinic was able to bill for the nerve conduction studies, which would run something like $2500 to $3000 a study. The recruiters would get paid by the owners of the clinic. There was an office manager who would help coach patients when recruiters didn’t do an effective job, and help falsify medical records.

“It takes a village to build a fraud.”

Owner of L.A. DME Company Sentenced to Five Years

A West Los Angeles man who was the owner of a medical supply company has been sentenced to five years in federal prison for his role in a scheme that fraudulently billed more than $4 million to Medicare.

Valery Bogomolny, 44, of Westwood, was sentenced by United States District Judge S. James Otero, who also ordered the defendant to pay $1,266,860 in restitution.

The sentencing of Bogomolny was announced by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division; United States Attorney Eileen M. Decker; Assistant Director in Charge Deirdre L. Fike of the FBI’s Los Angeles Field Office; and Special Agent in Charge Christian Schrank of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Los Angeles Region.

Bogomolny was found guilty by a federal jury in November 2015 of six counts of health care fraud. According to evidence presented at trial, between January 2006 and October 2009, Bogomolny used his company, Royal Medical Supply in the Beverly Grove district of Los Angeles, to bill Medicare $4 million for power wheelchairs, back braces and knee braces that were medically unnecessary, not provided to beneficiaries or both.

The evidence further showed that Bogomolny created false documentation to support his false billing claims, including creating fake reports of home assessments that never occurred. Power wheelchairs were delivered to beneficiaries who were able to walk without assistance. In other cases, Bogomolny signed documents stating that he had delivered equipment when, in fact, the equipment was not actually delivered.

“Royal Medical Supply was a complete fraud,” said United States Attorney Eileen M. Decker. “Many purported patients lived over 100 miles away from the storefront, most of the prescriptions were issued under the names of doctors either associated with or the victims of fraud, and most of the patients never received the equipment paid for by Medicare. Mr. Bogomolny supervised this scheme victimizing U.S. taxpayers, warranting this significant sentence.”

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Central District of California. DOJ Fraud Section Trial Attorneys Ritesh Srivastava and Claire Yan prosecuted the case.

Since its inception in March 2007, the Medicare Fraud Strike Force, which now operates in nine cities across the country, has charged over 2,900 defendants who collectively have billed the Medicare program for more than $10 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Predictive Analytics May Compromise Personal Privacy

Defense giant Northrop Grumman has signed a nearly $92-million contract with the Centers for Medicare and Medicaid Services to build the second phase of a computer system that’s currently focused on reducing fraud but down the road will play a greater role in anticipating beneficiaries’ medical disorders.

The story in the Los Angeles Times says it’s the most prominent example of how public and private insurers are spending millions of dollars on “big data” – using advanced technology to predict people’s future healthcare needs based on their interactions with doctors, hospitals and pharmacies, as well as information gleaned from other sources, such as social media.

Such systems, known as predictive analytics, aim to make healthcare more efficient and effective by opening the door to addressing medical issues before they become serious problems.

“There are tremendous advantages to big data in healthcare,” said Gerard Magill, a professor of healthcare ethics at Duquesne University in Pittsburgh. “It’s about creating a comprehensive approach to using medical information.”

The trade-off: Say goodbye to individual privacy.

“Big data requires that information; it’s nonnegotiable,” Magill said. “Individual privacy is gone for the common good.”

Medicare’s contract with Northrop Grumman is one of the largest efforts underway to create a healthcare crystal ball capable of looking into patients’ futures.

“The use of data in healthcare is absolutely critical,” said Dr. Shantanu Agrawal, director of Medicare’s Center for Program Integrity, which is tasked with lowering costs. “Having it be predictive of various issues is extremely important.”

Medicare has been criticized in the past for using a “pay and chase” approach to fraud – that is, paying all 4.5 million claims that are submitted daily and then attempting to determine which ones may have been bogus and trying to reclaim the funds.

Rep. Peter Roskam (R-Ill.), chairman of the House Ways and Means Oversight Subcommittee, said at a hearing on healthcare fraud last month that the agency needs to move faster in implementing “better data analysis and predictive analytics.”

Medicare says the first phase of its Northrop-designed fraud-detection system produced more than $1 billion in savings over the last two years.

Amy Caro, vice president of the health solutions division of Northrop Grumman Technology Services, told me it’s clear that sophisticated algorithms are the best way to spot and crack down on fraudulent medical claims. They’re capable of sifting through millions of submissions and recognizing signs and patterns that indicate a claim may not be on the up and up.

The next step, she said, will be using big data capabilities to get ahead of Medicare and Medicaid beneficiaries’ healthcare needs.

“You have all types of data out there and available,” Caro said. “You’re able to drill down and look for signs of certain diseases or conditions.”

How Hospitals Make You Sick

If the previous occupant of a hospital bed received antibiotics, the next patient who uses that bed may be at higher risk for a severe form of infectious diarrhea, according to a new study reviewed in Reuters Health.

Clostridium difficile (C. diff) diarrhea causes 27,000 deaths each year in the U.S. Hospital patients taking antibiotics are particularly at risk for it, say the authors of the study. Antibiotics disturb the normal healthy bacteria of the gut so a C. diff infection can take hold.

The new study shows that “antibiotics given to one patient may alter the local microenvironment to influence a different patient’s risk” for C. diff infection, the researchers wrote in JAMA Internal Medicine.

“Other studies have also demonstrated that antibiotics can have a ‘herd’ effect – in other words, that antibiotics can affect people who do not themselves receive the antibiotics,” said lead author Dr. Daniel Freedberg of Columbia University Medical Center in New York.

Freedberg and his colleagues studied more than 100,000 pairs of patients who sequentially occupied a given hospital bed in four institutions between 2010 and 2015, not including those who had recent C. diff infection or whose prior bed occupant was in the bed for less than 24 hours.

More than 500 patients, or less than 1 percent of the total group, developed a C. diff infection as the second bed occupant.

The infections were 22 percent more likely when then previous occupant had received antibiotics.

Other factors about the previous bed occupant were not associated with C. diff risk.

People can be carrying C. diff organisms without having any symptoms, Freedberg told Reuters Health by email. When these colonized patients receive antibiotics, C. diff may expand within their gut microbiome and start shedding more spores, which means more spores on the bed, the bedside table, the floor, and other areas, he said.

“The next patient who enters the room is thus more likely to be exposed to C. diff spores,” he said. “It’s not easy to sterilize the room/bed between patients because C. diff spores are extremely hardy. To be killed, they need to be soaked in a bleach-containing cleaning agent for an adequate amount of time.”

About half of patients in acute care facilities take antibiotics on any given day, said Kevin Brown of the University of Toronto Dalla Lana School of Public Health, who was not part of the new study.

“That’s a huge portion of patients that could be involved in spreading the infection,” Brown told Reuters Health by email.

But the increased risk is modest, Freedberg added.

“There was a 22 percent relative increase in risk for C. diff with the prior patient’s antibiotics but there was a four-fold increase in risk related to the antibiotics received by the patient him- or herself,” he said.

Other patients, such as other antibiotic user patients within the ward, could have contributed increased risk as well, Brown said.

“Doctors (and patients) should avoid antibiotics in situations where they are not necessary,” Freedberg said. “Too often, antibiotics are prescribed without clear indications.”

“I think this evidence needs to be taken just as an association that needs further exploration,” said Jack A. Gilbert of Argonne National Laboratory in Argonne, Illinois, who was not part of the new study. “While it would be tempting to use these results to change policy, there are so many uncertainties here that such a move would not be advisable.”

Study Reviews Heart Attack AOE-COE Triggers

Intense physical exertion or extreme emotional upset can each trigger a heart attack, and the risk may be highest if the two are combined, according to a new study reviewed in Reuters Health.

“Our study is the largest study exploring this issue, and unlike previous studies we included people from many different countries and ethnicities,” said lead author Andrew Smyth of the Population Health Research Institute at McMaster University in Hamilton, Ontario, Canada.

The association between the triggers and the onset of heart attack was similar across all locations, he added.

The researchers used data from more than 12,000 cases of first heart attack in 52 countries, recorded in the INTERHEART study. After the heart attack, study staff asked patients if they had been engaged in heavy physical exertion or were angry or emotionally upset in the hour leading up to the heart attack and in the same hour on the previous day.

Almost 14 percent said they had been engaged in heavy physical exertion and 14 percent said they were angry or emotionally upset in the hour leading up to the heart attack.

Being angry or physically strained roughly doubled the heart attack risk. If the two factors were combined, heart attack was about three times as likely, as reported in Circulation.

The researchers didn’t explicitly define “upset” or “exertion” for patients, who decided this for themselves, Smyth told Reuters Health by email.

In terms of heart attack triggers, there was no difference between those with and without diabetes or high blood pressure, he said.

“It’s useful to know that either getting angry to an extreme or exercising to an extreme could potentially be harmful especially for middle aged people with cardiac risk factors,” said psychologist Barry Jacobs, director of behavioral sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pennsylvania, and spokesperson for the American Heart Association, who was not part of the new study.

“One of the weaknesses of the study is that it doesn’t define what an extreme physical exertion experience would be or an extreme anger experience,” Jacobs told Reuters Health by phone.

Everyone can benefit from keeping their tempers in check, and when angry, it’s not a good idea to throw yourself into extreme physical exercise, he said.

Study Says Comp Costs Increase as Benefits Decline

Workers’ compensation benefits as a share of payroll are reaching historically low levels, even as employers shoulder more costs, according to a new report from the National Academy of Social Insurance

Until 1995, the U.S. Social Security Administration (SSA) produced the only comprehensive national data on workers’ compensation benefits, coverage, and costs with annual estimates dating back to 1946. SSA discontinued the series in 1995 after publishing data for 1992 -1993. The National Academy of Social Insurance assumed the task of reporting national data on workers’ compensation in 1997. The Academy published its first report that year, extending the data series from 1993 through 1995, and has produced the report annually ever since.

The 19th annual report of the National Academy of Social Insurance on workers’ compensation benefits, coverage, and costs is now available. This report presents new data on workers’ compensation programs for 2014 and updated estimates for 2010 – 2013 with newly available data. The revised estimates in this report replace estimates in the Academy’s prior reports.

The Academy’s measures of benefits and costs are designed to reflect the aggregate experience of two stakeholder groups: workers who rely on compensation for workplace injuries and employers who pay the bills.

Despite growth in employment during the economic recovery – and the corresponding uptick in employees covered by workers’ compensation – benefits per $100 of payroll fell from $0.97 in 2013 to $0.91 in 2014, the lowest level since 1980. Benefits as a percent of payroll declined in 46 states between 2010 and 2014, continuing a national trend in lower benefits relative to payroll that began in the 1990s.

Costs to employers, on the other hand, continue to climb. Between 2010 and 2014, employer costs associated with workers’ compensation – such as insurance premiums, reimbursement payments, and administrative costs – grew at a rate nearly 5 times faster than benefits. Nationally, employer costs exceeded total benefits in 2014 by $29.5 billion while costs per $100 of payroll reached $1.35, according to the report, Workers’ Compensation: Benefits, Coverage, and Costs (PDF).

“What we are seeing in these data are still the effects of the economy gradually coming out of the recession of 2008-10,” said Marjorie Baldwin, Chair of the Academy’s Study Panel on Workers’ Compensation Data and Professor of Economics in the W. P. Carey School of Business at Arizona State University. “As more workers are hired, employers immediately incur higher costs for workers’ compensation insurance – the increase in benefits paid comes with a lag, especially for the most costly long-term injuries.”

The ratio of benefits paid per $1 of employer cost has varied over the last 20 years from a high of $0.82 in 1999 to a low of $0.63 in 2006. The ratio has declined from $0.81 in 2010 to $0.68 in 2014, but it is still greater than in the five years leading up to the recession of 2008.

“Declining levels of workers’ compensation benefits could mean that workers are getting injured less frequently and/or that they are returning to work sooner when they do get injured,” said Christopher McLaren, Workers’ Compensation Senior Research Associate at the Academy. “But there have been a number of changes in state laws in recent years limiting access to workers’ compensation benefits, which may also be a factor.”

Class Action Allowed for High Cost of Medical Record Copies.

In 2011, plaintiff Kristen Nicodemus was admitted to Saint Francis Hospital for treatment of injuries sustained when she was burned. Later she engaged an attorney to represent her in a potential lawsuit. This attorney sent a fax to Saint Francis asking that it provide her copies of her medical records, and attaching a signed authorization to release. This was sent to HealthPort who provided Saint Francis with patient medical record release-of-information services pursuant to a contract.

HealthPort responded to plaintiff’s attorney’s request for medical records, sending a “California Agent Fee Information” sheet and an invoice. In a section explaining the invoice charges, the information sheet quoted section 1158, acknowledging its requirement that medical providers must allow attorneys to inspect and copy patient records on presentation of a patient’s written authorization. The information sheet, however, went on to state: “HealthPort has agreed to copy records for you, upon your hiring of HealthPort as your representative/agent for purposes of making such copies. The rates that HealthPort is charging do not fall under [Evidence Code] 1158.”

HealthPort personnel index all requests, assigning them to categories, depending on the context. Requests involving subpoenas or workers’ compensation claims, respectively, for example, are grouped in separate categories.

Evidence Code Section 1158 is designed to require medical providers to produce the medical records demanded by patients prior to litigation in a timely fashion and at a reasonable cost.

At the time of plaintiff’s appeal, section 1158 provided in pertinent part: “Whenever, prior to the filing of any action or the appearance of a defendant in an action, an attorney at law . . . presents a written authorization signed by an adult patient [or by a patient’s guardian, conservator, parent, or personal representative], . . . a licensed hospital . . . shall make all of the patient’s records . . . available for inspection and copying by the attorney at law . . . promptly upon presentation of the written authorization.”

The statute authorizes the requesting attorney to employ a professional photocopier to obtain the records on the attorney’s behalf, and the provider must produce the records within five days. (Ibid.) All “reasonable costs” incurred by a medical provider in locating, copying, or making the records available may be charged to the requesting party, subject to limits set forth in the statute, which include $0.10 per page for reproducing documents measuring up to 8.5 by 14 inches, $0.20 per page for producing documents from microfilm, and clerical costs not to exceed $16 per hour per person for locating and making records available.

HealthPort’s invoice to plaintiff’s counsel sought payment of $86.52, and provided directions for payment. The amount included a $30 “basic fee,” a $15 “retrieval fee,” $25.25 for copying 101 pages at $0.25 per page, $10.30 for shipping, and $5.97 for sales tax. Plaintiff’s attorney paid HealthPort’s invoice in full, noting on the check’s memo line, “under protest – in violation of CA EVID CODE 1158,” He later filed suit alleging causes of action for violation of section 1158 and violation of the Unfair Competition Law (UCL) (Bus. & Prof. Code, § 17200 et seq.) and moved to have the action certified as a class action. The trial court denied this motion and plaintiff appealed. The Court of Appeal reversed in the published decision of Nicodemus v Saint Francis Memorial Hospital..

Section 1158 enables the patient to seek freely advice concerning the adequacy of medical care and to create a medical history file for the patient’s information or subsequent use. It operates to prevent a medical provider from maintaining secret notes which can be obtained by the patient only through litigation and potentially protracted discovery proceedings.

“The common question here is the application of section 1158 to HealthPort’s uniform practices in response to attorney requests for medical records. The fact that each class member ultimately may be required to establish his or her records request was submitted before or in contemplation of litigation does not overwhelm the common question regarding those uniform copying practices. The trial court erred in ruling otherwise.”

So How Many Doctors Are Getting Kickbacks Anyway?

Nearly three-quarters of U.S. dermatologists received payments worth a collective $34 million from drug companies in 2014, according to a new analysis of a public database reported by Reuters Health.

In most cases, the payments were worth less than $50, researchers found. But a few doctors were taking industry payments worth at least $93,622.

“Most dermatologist in the U.S. – about 73 percent according to this database – received some form of payment from industry,” said lead author Dr. Marie Leger, a dermatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City. “That being said, most dermatologists get a modest amount from industry.”

It’s difficult to know what these payments mean, but seeing how money flows from industry to the dermatology profession is important to understanding the relationship between those two groups, Leger told Reuters Health.

She and her colleagues analyzed data from the Centers for Medicare and Medicaid Services Sunshine Act Open Payment database, which records payments made to doctors from U.S. medical manufacturers and group-purchasing organizations.

They found that in 2014, 8,333 dermatologists received 208,613 different payments totaling about $34 million. Those payments could take a number of forms, including gifts, grants, education, consulting and food and beverages.

That $34 million, however, represents less than 1 percent of the roughly $6.5 billion paid to doctors in 2014, the researchers report in JAMA Dermatology.

A quarter of dermatologists received less than $100, 63 percent received less than $500 and 78 percent received less than $1,000. The top 10 percent of doctors received at least $3,940, which represented 90 percent of the total paid to dermatologists.

“I think we knew there were interactions, but we didn’t know how many interactions there were,” said lead author Dr. Hao Feng, of NYU Langone Medical Center in New York City. “We were surprised that in general it was a modest amount of money.”

The top 1 percent of dermatologists received at least $93,622, which accounted for 44 percent of the total.

About 81 percent of the compensation to the dermatologists came from drug companies.

Almost a third of payments were listed as speaking fees, about 22 percent were listed as consulting fees and about 17 percent were listed as research payments.

Dr. Jack Resneck, of the University of California, San Francisco School of Medicine, points out in an accompanying editorial that the payment database is limited.

He wrote that it can be improved if providers are allowed to see what payments industry submit and by the categories better describing interactions.

“Some straightforward changes would substantially improve the situation,” he wrote.

Since the database is missing information about the context of these payments, it’s difficult to get a better understanding of the interaction between industry and doctors, Feng told Reuters Health.

“That’s something that is really difficult – if not impossible – to get from this database,” said Feng.

For example, Leger wondered if the financial connection between industry and dermatology may affect how the specialty advocates for patients in terms of drug costs.

“I think this study maps points of contact in an important way and I think there’s more to explore for what those points of contact mean,” she said.