Ranking Highlights Some of Worst Examples in Healthcare

18 Jan, 2023 F.J. Thomas

                               

Sarasota, FL (WorkersCompensation.com) – Before seeking out healthcare services for your injured worker, you may want to see if they are listed on the Lown Institute's 6th Annual Shkreli Awards. 

In 1973, Dr. Bernard Lown originally founded the Lown Cardiovascular Research Foundation in effort to bring about awareness, research, and education. In 2012, the foundation was re-named to the Lown Institute, and the entity collaborated with New America Foundation in their conference aptly named, Avoiding Avoidable Care. The focus of the conference was the global issue of overtreatment. Since then, the institute has grown to a panel of healthcare experts advocating for a better healthcare system. 

Every year, the Lown Institute releases their annual Shkreli Awards, which is a ranking of the top ten examples of deviant behavior in healthcare. Readers of their weekly newsletter send in nominations and the staff at the Lown Institute then review and rank. The judges include not only physicians, but professors, healthcare directors, and editors. 

Medicare Advantage Insurers made top of the list this year. Part of the reasoning behind that ranking is a recent audit by the OIG of as much as $20 billion in overpayments. Given recent individual OIG audit findings of Medicare Advantage plans, paired with the fact that Managed Care CEO’s commonly earn more than double the average annual household salary per day, the ranking is no surprise. Large payers such as UnitedHealth Group, CVS Health, Elevance Health, Kaiser Permanente, Blue Cross Blue Shield of Michigan, Cigna, and Highmark are all included in the top spot due to allegedly having disputed claims of fraud and overbilling. 

Ranking second on the list is a private equity firm in charge of rural hospitals. The fate of rural hospitals has been in question the last few years with numerous closures even prior to the pandemic. Noble Health has made second on the list due to a Kaiser Health report alleging that the company stopped paying for employee’s health insurance even though they were taking out premiums. According to the Kaiser Health report, the company is under federal investigation for keeping $20 million in COVID relief funds after closing the hospital due to unsafe conditions as a result of short staffing and a shortage of supplies. 

One grisly ranking is fourth on the list, CEO Bradley Harris and staff of Novus Hospice located in Frisco, Texas. Harris and multiple employees of the facility were sentenced in August of this year to a total of 84 years for healthcare fraud from 2012 to 2016. According to the news release, Harris billed federal and state programs for services that were never provided, were not directed by a medical professional, and were often provided to patients that were not eligible for hospice. Additionally, Harris wrote out pre-signed prescriptions for controlled drugs to be used without physician oversight. 

Along with these infractions, Harris and two other physicians Mark Gibbs, MD and Laila Hirjee, MD frequently certified terminal illness, defined as with a life expectancy of six months or less, which garnered a payment of $150 per order. According to an NBC Dallas report, a federal investigator stated that Harris instructed facility employees to give the maximum dosage of painkillers to certified patients so they would die faster. 

Number nine on the list leaves you wondering how in the world the provider kept their medical license. Canadian cardiac surgeon Yvon Baribeau, MD was one of the star providers of Catholic Medical Center in Manchester, New Hampshire. According to reports from the Boston Globe and Medpage Today, the surgeon earned well over $1 million annually up until his sudden retirement in 2019 at the age of 63. Upon further investigation, it was discovered that 6 percent of Baribeau’s malpractice lawsuits had resulted in death, and peer surgeons had lobbied for his removal without success for several years. With a total 21 lawsuits, of which 14 were for deaths, Baribeau had one of the worst career malpractice records in history but yet maintained his star position as a surgeon. 

 


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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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