Feds Allege Mass Forest Park Medical Center Kickback Scheme; 21 Indicted

Feds Allege Mass Forest Park Medical Center Kickback Scheme; 21 Indicted

(Credit: Justin Clemons)

A federal grand jury has returned indictments on 21 individuals allegedly involved in a massive kickback scheme through the defunct Forest Park Medical Center chain of luxury hospitals, which resulted in “well over half a billion dollars” in billed claims due to illegal bribes.

The 44-page indictment, unsealed Thursday, describes a vast, four-year conspiracy, fueled by $40 million in kickbacks funneled through a number of shell companies—consulting firms, commercial real estate firms, business services organizations—into the pockets of high-powered surgeons, some of whom have their faces on billboards throughout Dallas-Fort Worth.

The 21 suspects include two of the four physician founders of the hospital chain, including Dr. Richard Toussaint, the anesthesiologist who is awaiting sentencing on a separate fraud conviction; and Wade Barker, the bariatric surgeon who helped develop the idea for Forest Park. Other early adopters indicted in the scheme include Wilton ‘Mac’ Burt, a consultant who helped run the chain’s affiliated management company until he and his colleague, Alan Beauchamp, were bought out in 2015. Beauchamp was also indicted.

But the bribery scheme sailed far outside the doors of Forest Park’s grey and blue flagship at the corner of U.S. 75 and Interstate 635. Also indicted were prominent bariatric surgeons Drs. David Kim and William Nicholson as well as the minimally invasive spine surgeons Drs. Michael Rimlawi, Douglas Won, and Shawn Henry. Won, the DOJ alleges, was paid $7 million for his referrals. Rimlawi is accused of accepting $3.8 million. The feds argue that Kim and Nicholson, both of whom were investors in Forest Park, were paid $4.595 million and $3.8 million respectively. Reads the indictment: “The surgeons spent the vast majority of the bribe payments marketing their personal medical practices—which benefitted them financially—or on personal expenses such as cars, diamonds, and payments to family members.”

In all, the feds say Forest Park collected “in excess of two hundred million dollars in tainted and unlawful claims.” None of those named in the indictment have returned requests for comment. Sheryl Zapata, the chief development officer for the Texas Back Institute where Nicholson currently practices, said “TBI is not a part of this and we will not be commenting.”

“Medical providers who enrich themselves through bribes and kickbacks are not only perverting our critical health care system, but they are committing a serious crime,” read a statement from U.S. Attorney John Parker. “Massive, multi-faceted schemes such as this one, built on illegal financial relationships, drive up the cost of healthcare for everyone and must be stopped.”

Forest Park Medical Center was a chain of luxury hospitals that sprouted in Dallas, Fort Worth, Southlake, Frisco, and San Antonio. One in Austin was built but never opened, kneecapped due to nearly two dozen construction liens.

The model collapsed in on itself due to its reliance on high out-of-network charges that it would bill to insurance companies. The payers eventually balked, and the patient volumes dried up. The hospitals died one by one, each eventually entering bankruptcy and sold off to a health system. Because they were physician owned, they were barred by the Affordable Care Act from billing any public health insurance plan, such as Medicare, for fear of conflicts of interest regarding referrals. And despite this, it twice had to settle claims with the DOJ for paying kickbacks for Tricare patients and Department of Labor employees. The indictment alleges that this is exactly what happened: Beauchamp, Barker, and Kim, among others, “also attempted to refer patients with lower-reimbursing insurance coverage, namely Medicare and Medicaid beneficiaries, to other facilities in exchange for cash.”

Lax Ambulance Rules Put Paramedics, Patients at Risk

http://www.realclearhealth.com/articles/2016/12/01/lax_ambulance_rules_put_paramedics_patients_at_risk_110293.html?utm_source=RealClearHealth+Morning+Scan&utm_campaign=e55112c10f-EMAIL_CAMPAIGN_2016_12_01&utm_medium=email&utm_term=0_b4baf6b587-e55112c10f-84752421

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When an ambulance driver using her phone’s GPS got distracted and crashed through a guardrail, rolling off an embankment in north-central Ohio in August 2014, the consequences were dire: A 56-year-old patient was ejected and killed, and an EMS worker was injured.

The emergency medical service worker was not strapped in, and the patient was only partially restrained, a situation that is all too common in ambulances across the nation.

Unlike school buses, ambulances are not regulated by the federal government. While states set minimum standards for how they operate, it’s usually up to local EMS agencies or fire departments to purchase the vehicles and decide whether to require their crew to undergo more stringent education and training.

Some agencies demand that crew members in the back of an ambulance use lap and shoulder restraints for their patients and themselves, but many agencies don’t. In some places, ambulance drivers don’t receive any special training before they get behind the wheel, even though they must speed through traffic under tremendous pressure.

“One agency will make them take a course before they can drive. Another will just say, ‘here are the keys,’ ” said Bruce Cheeseman, Idaho’s EMS operations manager.

Ambulances have been involved in 4,500 crashes a year on average over a 20-year period, a third of which resulted in injuries, according to the National Highway Traffic Safety Administration (NHTSA). About 2,600 people a year were injured and 33 were killed. Some were drivers or ambulance crew members, some were patients and some were pedestrians, bicyclists or occupants of other vehicles.

Safety and EMS experts say ambulances should be safer than cars and more like school buses, given that they’re transporting sick or injured people and workers caring for them. While the number of injuries and fatalities may seem small compared to the number of people transported, the experts say state and local agencies need to do a better job overseeing ambulance safety.

“These are vehicles carrying cargo that’s human and vulnerable and fragile because they’re already injured or experiencing a medical emergency,” said Dia Gainor, executive director of the National Association of State EMS Officials, whose members license ambulance services and personnel. “It’s unconscionable that the public is placed at risk when being put in the back of an ambulance.”

What happens when you don’t price-regulate drugs? Just look at the United States.

http://www.vox.com/science-and-health/2016/11/30/12945756/prescription-drug-prices-explained

Americans aren’t buying lots more drugs. We’re just spending more on the ones we do buy.

There isn’t much evidence that Americans use an inordinately high amount of prescription drugs. It’s just that when we buy prescription medications, we pay more for the exact same product.

Should a Simple Fitness Check Be Part of Your Checkup?

Aerobic fitness should be considered a vital sign, just as body temperature, blood pressure, pulse and breathing rates are now, according to a new scientific statement from the American Heart Association.

The statement points out that fitness can be a better indicator of someone’s risk for heart disease and early death than such standard risk factors as smoking, obesity and high blood pressure. The authors recommend that each of us should have our aerobic fitness assessed as part of medical examinations and, if our fitness is on the low side, we should be advised and helped to start exercising.

The authors also suggest that if your physician does not begin to determine your aerobic fitness in the near future, you should do so yourself, using any of several scientifically validated online tools.

Aerobic, or cardiorespiratory, fitness is a measure of how well your body can deliver oxygen to tissues. Because that process is pervasive and essential within our bodies, it is also a “reflection of overall physiological health and function, especially of the cardiovascular system,” according to the report.

Many past studies have found that relatively low aerobic fitness is linked with a significantly increased risk for heart disease and premature death and that being out of shape may, in fact, represent a greater risk for developing heart disease than if you have a poor cholesterol profile, Type 2 diabetes, a history of smoking or a high body mass index.