Tag: 2021 News

The Physicians Foundation released the 2021 Survey of America’s Physicians, COVID-19 Impact Edition: A Year Later, that examines how COVID-19 has affected the nation’s physicians more than a year since the start of the pandemic, from increased burnout rates to the continued epidemic of physician suicide.

Over the past year, COVID-19 has greatly impacted physician wellbeing and mental health, with over 6 in 10 physicians (61%) reporting they experienced feelings of burnout.

This is a significant increase from the 40% of reported physicians in 2018. Yet only 14% of physicians reported they sought medical attention for their mental health symptoms.

Additionally, 8% of physicians indicated they have increased their use of medications, alcohol or illicit drugs weekly as a result of COVID-19’s effects on their practice or employment situation.

A total of 46% of physicians said they have isolated or withdrawn from other people in the last year, more than one in three said they felt hopeless or without a purpose, and 57% reported experiencing “inappropriate episodes of anger, tearfulness, or anxiety.”

The report stated that “difficult working conditions such as a lack of personal protective equipment (PPE) and caring for patients who may be seriously ill for weeks — along with burdensome administrative tasks, long hours, and grief over losing patients — have become the norm, but little has been done to alleviate the heavy mental health toll on physicians.”

Additional findings from the 2021 Survey include:

– – A significantly larger proportion of younger (64%) and female (69%) physicians reported frequently feeling burnout as compared to older (59%) and male (57%) physicians.
– – Physicians who were employed by hospitals or health systems experienced more frequent feelings of burnout (64%) as compared to independent physicians (56%).
– – Nearly 8 in 10 physicians indicated they experienced changes to their practice or employment as a result of COVID-19.
– – Almost half of physicians (49%) reported a reduction in income while 32% reported a reduction in staff as a result of the pandemic.
– – Nearly 70% of physicians indicated they anticipate continuing the use of telehealth in their ongoing practice.
– – Despite the high rates of burnout, nearly half (46%) of physicians said they would still recommend medicine as a career option to young people.

A total of 23% of physicians, across a range of demographics, said they want to retire in the next year, a drop from the 38% who reported wanting to retire in 2020.

The U.S. Department of Justice just published its 124 page Annual Report of the Departments of Health and Human Services and Justice – Health Care Fraud and Abuse Control Program FY 2020.

The Annual Report of the Attorney General and the Secretary detailing expenditures and revenues under the Health Care Fraud and Abuse Control Program for fiscal year 2020 is provided as required by the Social Security Act.

During Fiscal Year 2020, the Federal Government won or negotiated more than $1.8 billion in health care fraud judgments and settlements, in addition to other health care administrative impositions.

Because of these efforts, as well as those of preceding years, almost $3.1 billion was returned to the Federal Government or paid to private persons in 2020. Of this $3.1 billion, the Medicare Trust Funds received transfers of approximately $2.1 billion during this period, in addition to the $128.2 million in Federal Medicaid money that was similarly transferred separately to the Treasury due to these efforts.

In 2020, the Department of Justice opened 1,148 new criminal health care fraud investigations. Federal prosecutors filed criminal charges in 412 cases involving 679 defendants. A total of 440 defendants were convicted of health care fraud related crimes during the year.

Also, in 2020, DOJ opened 1,079 new civil health care fraud investigations and had 1,498 civil health care fraud matters pending at the end of the fiscal year.

Federal Bureau of Investigation (FBI) investigative efforts resulted in over 407 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 101 health care fraud criminal enterprises.

In 2020, investigations conducted by HHS’s Office of Inspector General resulted in 578 criminal actions against individuals or entities that engaged in crimes related to Medicare and Medicaid, and 781 civil actions, which include false claims and unjust-enrichment lawsuits filed in federal district court, civil monetary penalties settlements, and administrative recoveries related to provider self-disclosure matters.

The Report highlights many of the major prosecutions starting on page 15 of the report. Many of them involved California companies.

The first ever kickback action against an EHR developer for receipt of remuneration from a pharmaceutical company involved Practice Fusion Inc., a health information technology developer based in San Francisco.

In 2020, it agreed to pay $145.0 million to resolve criminal and civil liability based on its solicitation and receipt of kickbacks from a major opioid company in exchange for implementing clinical decision support alerts in its EHR software that were designed to increase prescriptions for the drug company’s products, and agreed to pay over $26.0 million in criminal fines and forfeiture.

The Los Angeles Times recently ran a feature story about how the California Medical Board protects negligent doctors. The Times cited at least ten California physicians as examples.

One of the ten examples described in the article was Lokesh Tantuwaya, a San Diego spinal surgeon whose license has been revoked three times by the board, which placed him on probation each time. His license remains valid as he sits in jail awaiting trial on charges that he took more than $3 million in illegal kickbacks for surgeries in one of the biggest insurance scams in state history.

Tantuwaya, is a spinal surgeon who performed so many surgeries at a now-shuttered hospital in Long Beach that he was offered a private jet to commute to the facility, has become the subject of multiple malpractice lawsuits and a federal prosecution for his fraudulent healthcare schemes.

The kickback scheme came to light in 2018 and centered on Pacific Hospital of Long Beach which specialized in spinal and orthopedic procedures. The owner of Pacific Hospital, Michael D. Drobot, “conspired with doctors, chiropractors, and marketers to pay kickbacks in return for the referral of thousands of patients for spinal surgeries and other medical services paid for primarily through the California workers’ compensation system,” according to the Department of Justice. During the last five years of its operation, there were more than $500 million in fraudulent medical bills associated with the hospital, and Drobot eventually went to federal prison.

One of Tantuwaya’s patients sued him for malpractice after she went in for a routine back surgery and it went so badly her leg had to be amputated. He was also charged with accepting millions in bribes to perform these surgeries. Yet, despite all of this on his record, the doctor remains licensed.

Tantuwaya was charged with accepting $3.2 million in bribes and was ordered to hand over his passport, a million dollars and the jet. However, he has not yet gone to trial, and has pleaded not guilty. In June of this year, a judge finally ruled he was a flight risk and confined him to Santa Ana jail only after federal agents learned he’d purchased his own private plane and had discussed “fitting it with an extended fuel tank, just in case he needed to go far away,” according to a motion to revoke bond.

“If he were in any other profession, his license would be yanked,” said Marian Hollingsworth, co-founder of the Patient Safety League, “Any reasonable person would ask, ‘Why does he still have his license?’”

His organization claims that as the battle between would-be reformers and the physicians’ professional association rages regularly in Sacramento. It gained fresh momentum this week in the wake of the Times investigation. “As injured patients and consumer rights groups fight for tougher penalties on grossly negligent doctors, California’s powerful physicians lobby is working hard behind the scenes to water down any proposed reforms. So far, the lobbyists seem to be winning.”

For years, reformers have been demanding significant medical license fee increases to beef up enforcement and to alter the balance of the oversight board – from a physician majority to a public member majority – in the hope of getting more patient-friendly decisions in disciplinary cases.

Robert Fellmeth, executive director of the Center for Public Interest Law at the University of San Diego, called the California Medical Assn. a “pernicious cartel” that consistently fights to starve the state medical board of the funds needed to investigate doctors.

The political ties of the medical association have been well documented, particularly since Newsom’s well-publicized blunder sitting next to CMA’s chief executive and top lobbyist at an upscale Napa Valley restaurant last year, seeming to flout COVID-19 safety guidelines the governor had set.

State Senator Richard Roth (D-Riverside) said his bill, SB 806, has strong reforms, such as allowing the board to seek reimbursement from disciplined doctors for investigation and legal costs. The measure is crucial because, with no fee increases in 15 years, the board is “insolvent,” Roth noted.

But in a message to members last June, the doctors’ lobbyists – the California Medical Association – claimed they got the ear of the senator sponsoring those reforms.

Gavin Newsom, whose office is responsible for appointing most of the board members, refused to be interviewed about The Times’ findings or to offer comment.

The United States has intervened in six complaints pending in Northern California federal court, alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to receive higher reimbursements.

The Kaiser Permanente consortium members (collectively Kaiser) are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California.

Under Medicare Advantage, also known as the Medicare Part C program, Medicare beneficiaries have the option of enrolling in managed care insurance plans called Medicare Advantage Plans (MA Plans). MA Plans are paid a per-person amount to provide Medicare-covered benefits to beneficiaries who enroll in one of their plans.

The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare program, adjusts the payments to MA Plans based on demographic information and the diagnoses of each plan beneficiary. The adjustments are commonly referred to as “risk scores.” In general, a beneficiary with more severe diagnoses will have a higher risk score, and CMS will make a larger risk-adjusted payment to the MA Plan for that beneficiary.

Medicare requires that, for outpatient medical encounters, MA Plans submit diagnoses to CMS only for conditions that required or affected patient care, treatment or management during an in-person encounter in the service year.

In order to increase its Medicare reimbursements, Kaiser allegedly pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounter, in violation of Medicare requirements.

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to receive a share of any recovery.

The False Claims Act also permits the government to intervene in such lawsuits, as it has done, in part, in these cases. The cases are consolidated in the Northern District of California and captioned United States ex rel. Osinek v. Kaiser Permanente, 3:13-cv-03891 (N.D. Cal.); United States ex rel. Taylor v. Kaiser Permanente, et al., 3:21-cv-03894 (N.D. Cal.); United States ex rel. Arefi, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-01558 (N.D. Cal.); United States ex rel. Stein, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-05337 (N.D. Cal.); United States ex rel. Bryant v. Kaiser Permanente, et al., 3:18-cv-01347 (N.D. Cal.); and United States ex rel. Bicocca v. Permanente Med. Group, Inc., et al., No. 3:21-cv-03124 (N.D. Cal.).

This matter was investigated by the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Offices for the Northern District of California and the District of Colorado, with assistance from HHS-OIG.

The claims in which the United States has intervened are allegations only, and there has been no determination of liability.

Hundreds of staffers at two major hospitals in San Francisco have tested positive for coronavirus in July, with most of them being breakthrough cases of the highly infectious Delta variant, The New York Times reported Saturday evening.

By the CDC’s definition, a breakthrough infection is a COVID case that occurs in someone who is fully vaccinated, meaning 14 or more days after completing the recommended doses of an authorized vaccine. Some say the word “breakthrough” is a euphemism for a vaccine failure.

The University of California, San Francisco Medical Center told media outlets that 183 of its 35,000 staffers tested positive. Of those infected, 84% were fully vaccinated, and just two vaccinated staff members required hospitalization for their symptoms.

At Zuckerberg San Francisco General Hospital, at least 50 members out of the total 7,500 hospital staff were infected, with 75-80% of them vaccinated. None of those staffers required hospitalization.

UCSF’s chief medical officer, Dr. Lukejohn Day, told The Times the numbers from his hospital showed just how important and effective vaccinations are.

“What we’re seeing is very much what the data from the vaccines showed us: You can still get COVID, potentially. But if you do get it, it’s not severe at all,” Day said.

Day also told ABC7 News that at least 99% of the cases at UCSF were traced back to community spread, but that hospital officials are still investigating and conducting contact tracing.

He added that most of the cases presented mild to moderate symptoms, and some were completely asymptomatic. He said the cases were spread among doctors, nurses, and ancillary staff.

“We sort of are seeing that across the board,” he said. “We have so far not detected any patient-to-staff or staff-to-patient transmission right now.”

The highly infectious Delta variant has been deemed more transmissible than the viruses that cause the common cold, Ebola, and smallpox, and is equally as contagious as chickenpox, the US Centers for Disease Control and Prevention said in internal documents.

The Delta variant has also been known to spread among vaccinated people in breakthrough cases, prompting the recommendation, if not requirement,that even fully vaccinated people wear masks indoors in areas with high transmission rates.