NYT: 5 doctors charged in Subsys Kick-Back

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drusso

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5 Doctors Are Charged With Taking Kickbacks for Fentanyl Prescriptions


"One of the defendants, Dr. Goldstein, sometimes did not even stay for a meal at the programs where he was the featured speaker, instead ordering food from the restaurant and leaving with it, according to the indictment. Before one program in 2014, the indictment added, Dr. Goldstein wrote to an Insys sales representative, asking, “Is dinner take out or we expecting peeps?”

New Rochelle MD Pushed Fentanyl Spray For Big Pharma: US Attorney

Prosecutors made these accusations (defendants are presumed innocent until proven guilty):

Freedman's Participation in the SchemeFREEDMAN was a doctor certified in pain management and anesthesiology who owned a private pain management office on Manhattan's Upper East Side. FREEDMAN, who was also an Associate Clinical Professor at a large hospital in Manhattan ("Hospital-1"), received approximately $308,600 in Speaker Program fees from Pharma Company-1 in exchange for prescribing large volumes of the Fentanyl Spray.In March 2013, a Regional Sales Manager for Pharma Company-1 sent an email to FREEDMAN informing him that he would receive more Speaker Programs in the coming months because Pharma Company-1 wanted prescriptions of the Fentanyl Spray to increase, and urging FREEDMAN to put more patients on the Fentanyl Spray. FREEDMAN responded, in part, "Got it," and significantly increased his Fentanyl Spray prescriptions in the following months, during which he received approximately $33,600 in Speaker Program fees.In 2014, FREEDMAN's prescriptions of the Fentanyl Spray rose even further, and he was the fourth-highest prescriber of the Fentanyl Spray nationally in the final quarter of 2014, accounting for approximately $1,132,287 in overall net sales of the Fentanyl Spray in that quarter. During 2014, FREEDMAN was the highest-paid Pharma Company-1 Speaker in the nation, receiving approximately $143,000.Goldstein's Participation in the SchemeGOLDSTEIN was a doctor of osteopathic medicine who owned a private medical office on the Upper East Side. GOLDSTEIN received approximately $196,000 in Speaker Program fees from Pharma Company-1 in exchange for prescribing large volumes of the Fentanyl Spray. After GOLDSTEIN began prescribing a competitor painkiller, Pharma Company-1 pressured him to stop doing so and switch patients to the Fentanyl Spray, which GOLDSTEIN did.In 2014, GOLDSTEIN was approximately the fifth-highest-paid Pharma Company-1 Speaker nationally. He was the sixth-highest prescriber of the Fentanyl Spray in the last quarter of 2014, accounting for approximately $809,275 in overall net sales of the Fentanyl Spray in that quarter.SCHLIFSTEIN's Participation in the SchemeSCHLIFSTEIN was a doctor certified in physical medicine and rehabilitation who co-owned with GOLDSTEIN a private medical office on the Upper East Side. SCHLIFSTEIN, who also worked as an attending physiatrist and consulting physician at two other Manhattan hospitals, received approximately $127,100 in Speaker Program fees from Pharma Company-1 in exchange for prescribing large volumes of the Fentanyl Spray.In or about October 2013, SCHLIFSTEIN expressed an interest in becoming a Speaker for Pharma Company-1. So a senior Pharma Company-1 executive traveled to New York, and took SCHLIFSTEIN, GOLDSTEIN, and others, to a Manhattan strip club where Pharma Company-1 spent approximately $4,100 on a private room, alcoholic drinks, and "lap dances" for SCHLIFSTEIN and GOLDSTEIN. In the month following that outing and SCHLIFSTEIN's nomination as a Speaker, SCHLIFSTEIN's Fentanyl Spray prescriptions increased substantially.In late 2014, Pharma Company-1 significantly decreased SCHLIFSTEIN's Speaker Programs in order to send a message to SCHLIFSTEIN that he would need to prescribe larger volumes of the Fentanyl Spray. In response, SCHLIFSTEIN repeatedly requested more Speaker Programs. Pharma Company-1 told SCHLIFSTEIN it would assign him more Speaker Programs only if he prescribed larger volumes of the Fentanyl Spray. SCHLIFSTEIN's Fentanyl Spray prescriptions then increased substantially, and Pharma Company-1 rewarded him with more Speaker Programs.By the end of the second quarter of 2015, SCHLIFSTEIN was approximately the 19th-highest prescriber of the Fentanyl Spray nationally, accounting for approximately $593,373 in net sales in that quarter.VOUDOURIS's Participation in the SchemeVOUDOURIS was a doctor specializing in oncology and hematology who worked at a private medical office on the Upper East Side, and was an Assistant Clinical Professor at Hospital-1. VOUDOURIS received approximately $119,400 in Speaker Program fees from Pharma Company-1 in exchange for prescribing large volumes of the Fentanyl Spray.In September 2014, VOUDOURIS, who had recently been nominated as a Speaker, had dinner with, among others, several Pharma Company-1 executives, as well as Roper and Serrano. During the dinner, the Pharma Company-1 Vice-President of Sales told VOUDOURIS that he wanted her to prescribe the Fentanyl Spray to one new patient every day, and that VOUDOURIS would be allocated Speaker Programs if she continued prescribing the Fentanyl Spray.In the week that followed the dinner, VOUDOURIS did not prescribe what Pharma Company-1 viewed as an adequate quantity of the Fentanyl Spray. Roper and Serrano met with VOUDOURIS and told her that Pharma Company-1 expected VOUDOURIS to write more Fentanyl Spray prescriptions. In the months that followed the dinner and this conversation, VOUDOURIS's Fentanyl Spray prescriptions rose significantly.By the end of the first quarter of 2015, VOUDOURIS was approximately the 10th-highest prescriber of the Fentanyl Spray nationally, accounting for total net sales of the Fentanyl Spray of approximately $581,500 in that quarter.BURDUCEA's Participation in the SchemeBURDUCEA was a doctor certified in pain management and anesthesiology, was an Assistant Professor of anesthesiology at Hospital-1, and practiced at an anesthesiology and pain management office associated with Hospital-1. BURDUCEA received approximately $68,400 in Speaker Program fees from Pharma Company-1 in exchange for prescribing large volumes of the Fentanyl Spray. In addition, Pharma Company-1 hired BURDUCEA's then-girlfriend, now wife ("CC-1"), to work as BURDUCEA's sales representative and paid her in large part based on the volume of Fentanyl Spray prescribed by her assigned doctors, including BURDUCEA.By the end of the end of the second quarter of 2015, BURDUCEA was approximately the 14th-highest prescriber of the Fentanyl Spray nationally, accounting for total net sales of the Fentanyl Spray of approximately $621,345 in that quarter.
 
This probably doesn’t count all the scripts the academic docs fellows and residents wrote at the hospital

I do not find this surprising in any way
 
This probably doesn’t count all the scripts the academic docs fellows and residents wrote at the hospital

I do not find this surprising in any way
Show me. My guess is that fewer hospital employed docs or academic docs get involved primarily because they probably cannot reap the benefits - they are supposed to report this income to their admin.

There may also be less incentive to try to get extra $$ because they are so salaried and, as drusso so eloquently reminds us, they are lazier- ie less incentivized financially...
 
Many of my attendings in the ivory tower during fellowship were big Pharma speakers.

I do not find this surprising. Easy way to augment academic salary. Other scam is to be a shill for the medicolegal complex.

I ate alot of sushi as a fellow
 
Show me. My guess is that fewer hospital employed docs or academic docs get involved primarily because they probably cannot reap the benefits - they are supposed to report this income to their admin.

There may also be less incentive to try to get extra $$ because they are so salaried and, as drusso so eloquently reminds us, they are lazier- ie less incentivized financially...

I see many salaried/academic MD's setting up side gig's and LLC's for consulting and research. My friend is an employed MD psychiatrist and still does disability evals & tele-psych ER back-up on the side. It's all carved out of his employment agreement...as well it should be.
 
I see many salaried/academic MD's setting up side gig's and LLC's for consulting and research. My friend is an employed MD psychiatrist and still does disability evals & tele-psych ER back-up on the side. It's all carved out of his employment agreement...as well it should be.
Yes a side gig... but not directly prescribing and probably with less financial incentive to do extra prescriptions or injections.

Just saying...
 
Yes a side gig... but not directly prescribing and probably with less financial incentive to do extra prescriptions or injections.

Just saying...

Rapid rise in hospital-employed physicians increases costs

"All regions saw an increase in hospital-owned practices each year, ranging from a total increase of 83% to 205% over the four-year span. These trends are particularly troubling because data show that hospital-employed physicians perform more services than their independent counterparts at higher costs, the study concluded."

The EOB's don't lie...
 
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That article links to a different site, physicianadvocacyinstitute.com, a nonprofit dedicated to promoting independent practices. So biased.


What’s worse, your highlighted statement seems to be taken, incompletely, from this statement in the advocacy site:

“When physicians are employed by hospitals or health systems, they perform more services in a HOPD setting than independent physicians.”

Note the phrase “in a HOPD setting”...... which is obvious.”, but does not state increased use across the board.
After all, this increase would go against your preconceived notions that HOPD physicians are not as productive as private practice...
 
That article links to a different site, physicianadvocacyinstitute.com, a nonprofit dedicated to promoting independent practices. So biased.


What’s worse, your highlighted statement seems to be taken, incompletely, from this statement in the advocacy site:

“When physicians are employed by hospitals or health systems, they perform more services in a HOPD setting than independent physicians.”

Note the phrase “in a HOPD setting”...... which is obvious.”, but does not state increased use across the board.
After all, this increase would go against your preconceived notions that HOPD physicians are not as productive as private practice...

Okay, fine. Maybe this will satisfy your demands for a suitable "level of evidence" supporting that profits from site of service differentials and health system monopolies are nothing less than blood money:

Which firms profit most from America’s health-care system

"The dark view is that pockets of rent-seeking have become endemic in America’s economy. Wherever products are too complex for customers to understand, and where subsidies and complex regulation add to the muddle, huge profits can opaquely be made. Remember mortgage-backed securities?"

In other words, SOS df's and health system revenue arbitrage is RENT-SEEKING.
 
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i wont argue that SOS does increase costs to the system. my point isnt about SOS differential or high costs of employed physicians. that is diverting from my original point.

the concern is that when financial gain is tied directly to the incentive to do more.

purely from a physician standpoint, the ethical dilemma that we face do more, and make more money.

is this a cause - direct or indirect - towards the overuse of IPM, or the opioid crisis? at least from the opioid crisis, this is what the DEA reports seem to imply...
 
i

purely from a physician standpoint, the ethical dilemma that we face do more, and make more money.

That's broken collectivist ideology not reality. There is no empirical data to support that fee-for-service increases costs...in fact, that's the point of the JAMA study. It's a medical reversal. There is no cause-and-effect between payer source (socialized payment vs FFS) and cost.

“I’ve been looking at other countries and seeing there’s a lot of fee-for-service in other countries, and other countries are struggling with overutilization.”

Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths
 
That's broken collectivist ideology not reality. There is no empirical data to support that fee-for-service increases costs...in fact, that's the point of the JAMA study. It's a medical reversal. There is no cause-and-effect between payer source (socialized payment vs FFS) and cost.

“I’ve been looking at other countries and seeing there’s a lot of fee-for-service in other countries, and other countries are struggling with overutilization.”

Why Is U.S. Health Care So Expensive? Some of the Reasons You’ve Heard Turn Out to Be Myths
I agree.

I think what's missing in most analyses of our healthcare system is the willpower, decision making, and personal responsibility of patients. The policy people want to convince us that obesity is the result of our "healthcare system". That overutilization is the result of physicians serving up unnecessary procedures to patients who are bystanders in their health. This is a major flaw in the research that compares healthcare delivery in one culture with another. It's apples to oranges.
 
i wont argue that SOS does increase costs to the system. my point isnt about SOS differential or high costs of employed physicians. that is diverting from my original point.

the concern is that when financial gain is tied directly to the incentive to do more.

purely from a physician standpoint, the ethical dilemma that we face do more, and make more money.

is this a cause - direct or indirect - towards the overuse of IPM, or the opioid crisis? at least from the opioid crisis, this is what the DEA reports seem to imply...

Ask your employer to show you YOUR "contribution margin" and "physician enterprise value" statistics. If they tell you "we don't track those" they're lying. Take the former and back out the arbitrage revenue (ancillary fees you generate from SOS d(f), radiology, lab, etc). That's the part of the of the problem you OWN.
 
Ask your employer to show you YOUR "contribution margin" and "physician enterprise value" statistics. If they tell you "we don't track those" they're lying. Take the former and back out the arbitrage revenue (ancillary fees you generate from SOS d(f), radiology, lab, etc). That's the part of the of the problem you OWN.

Be aware of how they will manipulate your clinic expenses. Ask for a breakout of all employees charged to your profit center. You will most likely discover that 1/3 or more of an administrator, who never sets foot in your clinic, is expensed to you. There may be others that you have never met.
 
again, apples to oranges. not my point at all. and a diversion argument, has nothing at all to do with my point.

please feel free to post about hospital employed docs are being arrested for excessive opioid prescribing, and compare that to the number of private practice docs in the same situation...
 
again, apples to oranges. not my point at all. and a diversion argument, has nothing at all to do with my point.

please feel free to post about hospital employed docs are being arrested for excessive opioid prescribing, and compare that to the number of private practice docs in the same situation...

University Hospitals sued over Wickliffe man’s opioid overdose death
By Tracey Read, The News-Herald

POSTED: 01/03/18, 6:09 PM EST | UPDATED: ON 01/03/2018

0

A wrongful death lawsuit has been filed against University Hospitals Health System over a Wickliffe man’s overdose death from prescribed medications.

David Skisano, a divorced father of one son, died suddenly on June 28, 2015, at the age of 66 while under the care of UH Bedford Medical Center doctors Ghassan Haddad and Haitham Azem.

The suit was filed Dec. 22 in Cuyahoga County Common Pleas Court by attorney Francis Sweeney Jr. Skisano’s estate seeks unspecified damages from the Shaker Heights-based hospital, UH Bedford Medical Center and the two doctors.

Skisano first sought treatment at UH in 2005 for various pain-related complaints.

The doctors negligently prescribed him hydrocodone and Xanax for a decade with no specific diagnosis until his death in 2015 —despite the fact they were aware he had issues with substance abuse and mental illness, and had been referred to addiction rehabilitation, according to the suit.

“Defendants broke the rules in place for reasonable prescribing and were complicit not only in causing (Skisano’s) death, but their individual and related acts have contributed to the epidemic of overprescribing, dispensing and use of narcotics and controlled substances with deadly consequences,” Sweeney stated in the lawsuit.

Sweeney also accused University Hospitals of turning a “blind eye” to “overprescribers” like Haddad and Azem to “dramatically increase revenue” at the risk of patients.

Sweeney added that opiate prescribing by UH physicians has essentially been unregulated.


“Between 2007 and 2017, at least nine University Hospitals patients have died from opiate narcotic overdoses from medication prescribed by University Hospitals doctors,” he said. “From at least as early as 2007, University Hospitals has had ... notice that improper, excessive, medically unnecessary prescribing of opiates and benzodiazepines existed with many of its employed physicians.”

The estate, via temporary administrator Kevin Lipman, is also seeking reimbursement for Skisano’s medical, funeral and burial expenses.

“Healthcare providers, doctors and pharmacies should never place their desire for profit above the health and well-being of their patients or the communities in which their patients live,” said Sweeney.

Kim Fatica, a UH spokesman, said it was the hospital’s policy not to discuss pending litigation. .

A receptionist at UH Bedford Medical Center said Haddad and Azem were unavailable for comment.

The case has been assigned to Judge Kelly Ann Gallagher.

Sweeney filed a similar case last year against Lake Hospital System over a Parma man’s accidental drug overdose. That case remains pending in Cuyahoga County Common Pleas Court.
 
Lawsuit.

Holds no weight.

Any action by DEA or DOH?

Looking for easy money. Guy had been getting opioids for over 10 years without dying...

So these “horrible” docs... in 2015, one did write for 1182 opioid scripts... which was 8.8% of the 13391 total scripts he wrote. Only 47 extended release scripts. The other wrote 2892 scripts which was 5% of the 57,432 scripts he wrote. 43 long acting.

Compare that to xiulu Ryan who wrote for 5486 opioid scripts out of 10561 scripts (52%) with 1213 long acting opioids.

These numbers do not look like they are prescribing a ton of opioids compared to the bad actors...


That’s a pretty bad example.
 
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