Press "Enter" to skip to content

Denials for $$; Coma Birth, Now Fraud; Plagiarists at Integrity Meeting

It’s time for this week’s edition of Investigative Roundup, gathering some of the best investigative reporting on healthcare from around the country.

Disability Denials for Profit

Quick denials of disability claims might mean big bucks for the doctors who review them in Tennessee. According to The Tennessean, around 50 physicians contracted by the state have made millions of dollars over the years by speeding through claims. And often they denied the claims, such that the state’s 72% denial rate in 2017 was 6 points higher than the national average.

Contract physicians hired by Tennessee’s Disability Determination Services are paid on a per-case basis — incentivizing high pace. “The federal standard is 1.5 cases per hour. More than half of all Tennessee contract physicians exceeded that,” the newspaper found. “One doctor averaged a case every 12 minutes.” That same doctor reportedly made $2.2 million since 2013 with an 80% denial rate.

Besides the pay-per-claim model, The Tennessean identified other factors that could drive excessive denials: lack of oversight, heavy workload goals, and hiring physicians with a history of misconduct — including one with three separate felony cocaine convictions.

Ten of Millions of Dollars for Nursing Homes Go Unused

North Carolina is sitting on an almost $29-million cache of unspent state-federal funds earmarked to improve nursing homes, reports North Carolina Health News.

This cash stockpile accumulated as federal investigators levied fines against nursing homes in the state. And nursing homes can apply for grants from this civil money penalty (CMP) but need approval from state and federal officials.

“Unfortunately, there are not enough applications for the use of these CMP funds,” Emery Milliken, a deputy director of the Division of Health Service Regulation, told North Carolina Health News.

She said 22 of the 24 applications received were “ultimately” approved. But others pointed the finger at the bureaucratic red tape involved in gaining approvals.

Fraud Investigation for Facility Where Comatose Patient Gave Birth

First there was the woman in a decade-long vegetative state at Phoenix-based Hacienda HealthCare giving birth without the staff realizing she was pregnant. The firm’s CEO then resigned after that story broke.

Now the New York Times reports that, beginning in 2016, state investigators have been probing $3.4 million in “suspicious and potentially fraudulent” Medicaid claims by Hacienda.

A spokesperson for the Arizona Health Care Cost Containment System said it “requested a variety of Hacienda’s financial records, and sought enforcement of its administrative subpoena when Hacienda refused to comply with the request.” Those records still haven’t been turned over, said the Times, which also noted that the facility had been cited earlier for lapses in care.

Hacienda HealthCare has denied wrongdoing.

Yet Even More Problems for Baylor St. Luke’s

Baylor St. Luke’s Medical Center in Houston drops three more top officials after yet another scandal, as reported in an investigation by the Houston Chronicle and ProPublica.

Baylor St. Luke’s president, Gay Nord, and two other executives are leaving the hospital, following disclosures about a patient’s death after receiving the wrong blood type during a transfusion. The hospital had previously been rocked by investigations showing high patient death rates in its heart transplant program, which once had been considered a national model.

The chairman of St. Luke’s board of directors acknowledged the challenges the facility faced over the past year but said that “aggressive action” was necessary to right the hospital’s ship.

Plagiarists at Integrity Conference

Some researchers hoping to present their work at the 6th World Conference on Research Integrity were apparently so eager that they forgot what the conference was about, committing plagiarism in their abstract submissions.

Writing in Retraction Watch, co-organizers of the conference said they were tipped off by one of their reviewers who had spotted plagiarized material. They then used Turnitin, an application that many teachers and professors use to scour students’ work for plagiarism, on all the submitted abstracts and found “12 suspected cases of plagiarism and 18 suspected cases of self-plagiarism.”

Here’s the best part: two of those abstracts had plagiarism as their topics.