Encouraging Openness: Is It Just Lip Service?
The health care industry is complex. And to overcome that complexity, we hear much more today about openness and transparency, but are these efforts getting people to speak up?
2006 Internal Audit of the Department of Psychiatry at the University of Minnesota
Following the 2004 suicide of a research subject in a clinical trial investigating the effectiveness of anti-psychotic drugs came four years of litigation — and questions about conflict of interest, recruiting pressure, coercion, ability to give consent, and lack of oversight. In February of this year, a judge ruled that the University of Minnesota had statutory immunity and that there was no evidence that the sponsor's drug caused the death. In the midst of these inquiries, the university launched its own review of internal processes.
Statistics from the internal audit of the Department of Psychiatry revealed many concerns, but with regard to openness and the willingness of staff to speak up, here's what the audit found:
- 39% of the Department of Psychiatry staff responding to the auditor survey said they did not believe they would be protected from retaliation for blowing the whistle on a suspected violation in the department.
- 35% of the Department of Psychiatry staff said in the survey they didn't think their managers provided adequate oversight.
When you're not heard, then what?
More than ever, employees are protected if they come forward as whistleblowers.
In a recent example, the spinal unit of Medtronic will pay $75 million to settle a whistleblower lawsuit alleging that it defrauded Medicare by telling doctors they could bill for an inpatient stay when a cheaper outpatient visit would have sufficed.
The allegations were originally made against Kyphon, which Medtronic bought in November for $4.2 billion.
Medtronic said that the settlement agreement reflects its assertion that neither Kyphon nor its employees engaged in any wrongdoing or illegal activity. The company will sign a corporate integrity agreement (CIA) with the Office of Inspector General for the Department of Health and Human Services, as part of the deal. The CIA focuses on training about appropriate reimbursement advice to customers, and also requires maintenance and implementation of standard compliance processes.
Kyphon charged $3,500 to $5,500 for a surgery kit to treat spinal compression fractures caused by osteoporosis, cancer, or lesions. It was able to keep prices that high by persuading doctors and hospitals to keep patients overnight, which allowed hospitals to charge Medicare up to $10,000 per procedure — even though the patients typically had fully recovered within a few hours, said Mary Louise Cohen, a Washington attorney with Phillips & Cohen. Cohen also said Kyphon would only train doctors who had admitting privileges at their hospitals.
The lawsuit was brought under the federal False Claims Act, which allows whistleblowers to sue on the government's behalf.
Phillips & Cohen said it filed the whistleblower lawsuit in 2005 in federal district court in Buffalo on behalf of Craig Patrick and Chuck Bates. Patrick, of Hudson, WI, was a reimbursement manager for Kyphon, and Bates was a regional sales manager in Birmingham, AL. Patrick left Kyphon after complaints he made about its sales strategy went unheeded, the firm said.
According to an Associated Press report, Patrick went to a Medicare fraud conference in 2005. He said he recognized Kyphon's practices in what he saw at that conference.
"At that moment it just became very clear to me: What we've been doing the whole time was Medicare fraud," he said.
Patrick said he presented the situation to Kyphon's VP of reimbursement and general counsel and was told he was not a team player. He eventually took a different job, with a sharp pay cut.
According to the Department of Justice, Patrick and Bates will share $14.9 million.
The health care industry is complex. And to overcome that complexity, we hear much more today about openness and transparency, but are these efforts getting people to speak up?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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