Happy Tuesday. It’s time for this week’s edition of Investigative Roundup, gathering some of the best investigative reporting on healthcare from around the country.
How to Be a Whistleblower
Medicare wants to clamp down on insurance fraud, but the government frequently needs help from insiders, otherwise known as whistleblowers. Whether prompted by moral obligation or money (thanks to a 1980s update in the False Claims Act that gives informants a cut of financial penalties), whistleblowers often play a central role in fraud cases.
The New Yorker examines the reality for those who choose to be informants using Darren Sewell, MD, as an example. Sewell, a vice president at Florida-based Freedom Health, became suspicious of the company’s practices with the Medicare Advantage program. In particular, he believed Freedom was “intentionally rooting out sicker, more expensive enrollees by having sales agents target them and then encourage them to leave Freedom, an illegal practice known as ‘lemon-dropping.'”
What followed was a long and arduous process of becoming a whistleblower. At some points, Sewell’s life seemed to be pulled straight out of a spy novel: clandestine meetings with the FBI in parking lots, wearing a wire, late-night phone calls about recent intel.
But the reality for Sewell, and many whistleblowers, mostly involved a great deal of mundane work accompanied by anxiety over whether their employers would discover the subterfuge. Many worry that they will be blacklisted in their industry.
Those concerns were well-founded for Sewell. The New Yorker describes him as depressed and in financial trouble as the investigation dragged on. Before it was over, he was dead at age 39 after falling in his home. Seven years after the initial filing, the Justice Department joined the suit, and a year later, Freedom settled charges that it violated the False Claims Act for $31.7 million.
More Theranos Details
With promises to change the world via a breakthrough in microfluidic blood analysis, Theranos and its charismatic ex-CEO Elizabeth Holmes became the darling of California’s venture capital world. But the curtain was slowly drawn back on these claims, coming to a head with reporting by John Carreyrou who found no breakthroughs and plenty of unreliable data. Last summer, Holmes’ house of cards toppled when she was indicted on federal charges for defrauding investors.
Although the broad outlines of Theranos’s fall from grace have been widely reported, sensational new details continue to emerge. This week, ABC News released a podcast called “The Dropout” and the network’s “Nightline” program is set to broadcast a documentary about Holmes, who is awaiting trial.
“The Dropout” includes interviews with former employees, teachers, investors, and family friends along with “never-before-broadcast” deposition tapes. Visit the ABC News website here to find out how to listen.
Oregon’s ‘Cruel’ Mental Health Program
Oregon’s “aid and assist” program where mentally ill people charged with crimes are sent to a state facility and kept there until they are deemed able to aid and assist themselves before the case can go on trial is placed under scrutiny in a report by The Oregonian.
The paper found that “it is not uncommon for mentally ill defendants to spend more time confined for being ill than they would ever serve behind bars for the crimes they are accused of,” sometimes keeping those accused in a cruel cycle and costing taxpayers millions.
As court dockets and hospital beds fill up, lawmakers say they are aware of the situation. Yet over the course of 6 years, at least 1,486 people with mental illness have languished for months in state hospitals awaiting to be deemed “able” after being accused of misdemeanors.
Who is behind an advocacy group fighting efforts to lower drug prices? No one knows.
The Washington Post takes a look at some lobbying shops that are less than truthful about their industry ties or paint themselves as “grassroots” when they are anything but.
While many groups lobbying on behalf of the pharmaceutical industry offer a modicum of transparency, the Post focused on Citizens for American Ideas, which uses aggressive PR tactics to defeat price-lowering initiatives — and which goes to great lengths to hide its backers and funding sources. It thus appears to be a “ghost ship” group, an increasingly common way for corporate interests to influence opinion and policy without being identified.
Immigrants Forgoing Kids’ Healthcare
A report from NPR in partnership with KTU and Kaiser Health News explores a healthcare issue that some immigrant families in Texas are facing: forgo healthcare for their child or risk deportation or green card denial.
Such choices have become more pressing in the wake of a Trump administration proposal to deny permanent-resident status to immigrants who use too many government services, such as Medicaid.
One social worker told NPR, “I’m running into families that, when it’s time for re-enrollment or reapplication, they are pausing and they are questioning if they should.”
For example, NPR spoke with a woman who is afraid if she uses any more government services than necessary for her daughter with autism, she won’t get the green card for which she has applied.