Diagnosis of a woman with “prostate cancer”: the most terrible and greedy US doctors are named

Rebuke and laugh

Every year in January, the Lown Institute announces the Shkreli Awards, naming those who have staggered the imagination with their greed and demonstrated egregious examples of profit in the healthcare system. At the same time, as the founders of the award say, their goal is not only to reveal such situations and make them public, but also to laugh at the behavior of the most greedy. “Profit has become a priority over treatment. Too often our system not only does not heal, but also creates new suffering,” the institute’s website says.

The award was named in honor of the pharmaceutical figure Martin Shkreli, former CEO of the pharmaceutical companies Retrophin and Turing. He became “famous” for raising the price of a drug to treat HIV/AIDS and cancer patients by more than 5,000%. When the public was indignant, he … doubled the price and, as if nothing had happened, said that until now the price had been greatly underestimated. But greed did not lead to good: in August 2017, he was convicted on three charges of fraud, and just the other day, the court ordered him to return $ 64.6 million in profits that he received from a jump in drug prices.

Shkreli, alas, is not alone. There is always someone who is ready to shamelessly cash in on patients. Last year, for example, the winners of the Shkreli Awards were “innovative” speculators who came up with particularly creative ways to siphon money from the healthcare system. These included those who massively referred patients for COVID-19 testing without any justification; drug developers for the same COVID-19 who received a grant from the state for their invention and then charged patients 40 times the cost of its production.

At the beginning of this year, the Shkreli Prize was awarded for the 6th time. The nominees, as has already become customary, were determined by the employees of the Lown Institute based on the results of publications in the media. An authoritative panel of patient activists, clinicians, health policy experts and journalists participated in determining the winners.

ten most greedy

On tenth place turned out to be Wisconsin dentist Scott Charmoli, who broke patients’ teeth to install crowns. His record: He went from placing 434 crowns a year to more than 1,000. Local prosecutors found that he intentionally broke patients’ teeth, drilling them unnecessarily and providing photographs of the damage to insurance companies to justify costly procedures. This helped him earn an additional $1.1 million, according to the Washington Post.

The scheme was exposed when Charmoli sold his practice in 2019, and the new owners went through his files, noting the absurdly high fees for crown procedures. Charmoli was found guilty of health care fraud and sentenced to 54 months in prison and fined over $1 million.

ninth place went to the famous cardiac surgeon, Dr. Yvon Baribo. Throughout his career, Baribo has received 21 medical malpractice claims, including 14 related to the death of patients.

The leaders of the Catholic Medical Center in Manchester, North Carolina, knew that their famous doctor had one of the worst reputations in the country. but continued to support him and even starred in their commercials. And besides, they allowed him to continue operating, despite the objections of other doctors, according to the Boston Globe newspaper. Because of his mistakes, one patient required a blood transfusion (a total of 25 liters of blood was transfused to her!), while another patient, whose chest cavity became “black and necrotic” after the doctor’s operation, was kept on life support for 30 days.

On eighth place – a network of medical laboratories from North Texas, which allegedly found a way to get $ 300 million in additional Medicare payments. The Dallas Morning News investigated this.

Lab workers bribed doctors into ordering unnecessary drug and blood tests for patients. Some doctors received up to $400,000 in kickbacks. The founders of all three labs pleaded guilty to fraud in April 2022.

Seventh place – Catholic health care provider Providence. Providence Public Hospitals is required to provide financial assistance to low-income patients. However, doctors often did the opposite. Instead of providing financial assistance to low-income patients, Providence forced them to pay, and when they didn’t pay, sent debt collectors after them, according to a New York Times investigation. These actions were part of an official campaign to raise revenue.

As a result, more than 55,000 patients became the object of harassment by collectors instead of a discount on treatment. Following a newspaper investigation, the company said it would compensate approximately 760 eligible patients who were previously charged for medical care.

Sixth place – from a large tobacco company. For a century and a half, it has been selling products that cause cardiovascular disease, chronic obstructive pulmonary disease (COPD) and other serious health problems. Now the tobacco giant is looking to capitalize on treating the very diseases it helped create by acquiring companies that develop inhaled therapeutics, according to a STAT News report. Experts are concerned that at one time they even produced medical equipment that was used in the treatment of patients with lung cancer.

Fifth place – from the pharmaceutical giant, which tried to avoid responsibility for the production and sale of products that cause cancer. For decades, manufacturers have known that asbestos, a deadly carcinogen, could be in their talc baby powder, but they continued to sell it anyway. Now the company is facing lawsuits from 40,000 (!) cancer patients, many of whom are black women, because the company allegedly marketed its talc-based products specifically for this category of the population.

To avoid lawsuits, the company created a “daughter” on which they threw off everything related to baby powder, and then declared this shell company bankrupt. Despite this “bankruptcy”, last year the pharmaceutical giant itself entered the top 50 largest companies according to Fortune magazine.

Fourth place – the CEO of the hospice and his associates, who allegedly forced employees to “accelerate” the death of patients in order to avoid restrictions on government subsidies.

Bradley Harris, CEO of Novus Hospice in Frisco, Texas, and a dozen other Novus employees have been sentenced to 84 years in prison for healthcare fraud. The U.S. Department of Justice said Novus employees received pre-signed prescription pads and dispensed powerful drugs to patients without guidance or oversight from doctors.

According to the FBI investigation, Harris allegedly told staff to administer horse-sized doses of painkillers to patients to expedite their departure, in order to shorten the average length of a patient’s stay in the hospital. This helped to avoid restrictions on government reimbursement. During the FBI investigation, it turned out that Harris allegedly sent a text message to one of the Novus employees: “You must make this patient die.” True, it is not known for certain whether overdoses were actually administered to patients.

On third place – a company that owns a network of hospitals. She figured out how to cash in on a drug discount program designed for the poor.

The Drug Program provides social network hospitals with large discounts on drugs to ensure access to treatment for low-income patients. Bon Secours Health System’s Richmond Hospital in Virginia has made significant profits from this program, even though it doesn’t have an intensive care unit, a maternity ward, or even a permanent MRI machine. That’s because Bon Secours was diverting profits from Richmond Community to its other hospitals in wealthier areas, according to a New York Times investigation. In essence, she was laundering money through a poor hospital to her rich branches.

Second place – from a private company that came up with a way to make money by destroying rural hospitals and leaving patients in unsafe conditions and employees without health insurance

When Noble Health bought two rural hospitals in Missouri, and doctors hoped that now their lives would improve. Instead, hospital staff faced shortages of supplies and medicines, creating an unsafe environment for patients.

In addition, Noble Health stopped paying for health insurance for employees, despite deducting money from their paychecks that should have gone towards insurance premiums. According to Kaiser Health News, some employees now have to pay hundreds of thousands of medical bills because they didn’t know they weren’t insured. Noble Health closed hospitals after two years, receiving $20 million in federal COVID-19 relief funds. Today the company is under investigation.

And finally first place occupied by health insurance companies that systematically inflated medical bills, pumping out billions of taxpayer money.

Most of the major insurers that work under the Medicare Advantage program (like our CHI) have been accused by the US government of fraud or overbilling, according to an investigation by the New York Times. Experts estimate that overpaying Medicare Advantage insurers will cost taxpayers $25 billion in 2020. Because the Medicare Advantage program pays private insurers a set amount per patient based on risk, insurers have an incentive to “mine” patients for diagnosis—for example, to add diagnoses.

Thus, in one case, the insurer added the diagnosis “prostate cancer” to the woman’s medical record, and the insurance company explained that when a married couple has any disease, both are diagnosed.

A similar story happened in Moscow several years ago, when taxpayers began to find in their personal accounts on the public services website information about visiting doctors, undergoing diagnostics, etc., which they did not do. True, then they made some noise, but no one was held responsible.

According to the results of a US investigation conducted by journalists, allegations of fraud or overbilling have been filed against the 10 largest insurance companies working under the Medicare Advantage program.

Experts are sure that in Russia there are also people and organizations worthy of this award, but so far no one has thought of establishing it. No one conducts high-profile investigations in our country, and numerous lawsuits against clinics that are trying to spin patients for money, in most cases, end not in favor of patients.