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Fraud and Anonymity: The Perils of Medical Care Bureaucracy

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October 8th, 2019   For Immediate Release

Contributor & author: Marilyn M. Singleton, MD, JD, (Oakland-California) board-certified anesthesiologist and President of Association of American Physicians and Surgeons (see bio at bottom of release)

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Preview:

  • After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance
  • Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments.
  • One amoral scheme recruits patients who unknowingly forgo curative treatment options by joining hospice.
  • In 2016 the government paid $160.8 million for drugs that hospice organizations should have paid for from its fixed daily fee. Our tax dollars paid for the drugs twice.
  • One typical victory is a Medicare patient whose neurologist prescribed a drug for his Parkinson’s disease symptoms. The government demanded testing that could not be done because of the patients debilitated condition. Despite a sympathetic ear and supporting research, the government arbiter could only parrot the party line: because the drug was not on the “list,” it was not covered by Medicare. In a fortunate twist of fate, with a Good Rx coupon the patient paid $34 per month cash instead of the drug’s $1,100 per month price with 20 percent patient co-pay that would have been charged through the Medicare Prescription Drug program.

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The high cost of medical care is on the lips of every politician and draining the pocketbooks of most Americans. After creating the Medicare/Medicaid monster, the government’s expanded intervention into the medical care marketplace with the inaptly named Affordable Care Act doubled the premiums and deductibles for both employer-sponsored and individual insurance. Piling on more laws, regulations, and agencies is not the answer.

Anonymity, complexity, and opacity invite shady behavior. Individuals, companies, and patients who defraud the massive federal “health system” would never dream of lifting money from their patients’ wallets or stealing from their doctors’ cash drawer.

The government’s track record does not bode well for imposing more bureaucracy to remedy a problem created by the layers of third-party payer bureaucracy. Waste, fraud, and abuse are so rampant that the government has a Medicare Strike Force to root out and recover lost federal funds. Medicare fraud—about $60 billion in 2016 alone—is about 10 percent of Medicare’s total payments. By contrast the typical private business loses 5 percent of its revenues to fraud. Unfortunately, since its inception in March 2007, the Medicare Strike Force has recouped less than $2 billion per year in misappropriated funds. More

Doctor Robot for You, Real Doctor for Me

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Contributor & author: Marilyn M. Singleton, MD, JD, (California) board-certified anesthesiologist and President of Association of American Physicians and Surgeons  (see bio at bottom of release)

Interview – Contact booking at dr.marilynsingleton@gmail.com, or call Dr. Singleton directly at 510-421-5800

 

Preview:  Medical technological aids have now jumped the shark. An unbelievable, but—thanks to cell phone video—verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles.

  We can certainly expect more medicine by proxy as larger corporations and the government takes more control of our medical care

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March 19th, 2019

Doctor Robot for You, Real Doctor for Me

by Marilyn M. Singleton, MD, JDl

A couple of years ago, computer programs, algorithms, and glorified Google searches were touted as the replacements for a physician’s analysis of a patient’s medical condition. Compressed medical research is quite useful for clinicians who are presented with novel situations and have no readily available colleagues with whom to discuss the case. However, the purpose of flow charts should not be to replace the brains of busy clinicians or, worse yet, be a cookbook for the practitioners at drugstore clinics.

Medical technological aids have now jumped the shark. An unbelievable, but—thanks to cell phone video—verifiably true news report detailed how a robot rolled into a patient’s Intensive Care Unit cubicle and a physician’s talking head appeared on the robot’s “face” and told the patient the sad news that he had a terminal illness. While remote medicine is reasonable in rural areas where access to medical care is limited, telling a patient he is going to die from a TV screen is a crime against all medical ethical principles. More

SOTU 2019 and American Medicine

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February 12th, 2019

SOTU 2019 and American Medicine

by: Jane M. Orient, M.D.

While President Trump called for unity and cooperation in his 2019 State of the Union address, the views of the audience showed a sharp and bitter divide, especially on issues affecting the health and medical care of Americans. Most striking was the solid bloc of Democrat “suffragettes” clad in white like Speaker Nancy Pelosi.

When the President congratulated women for their increased representation in Congress, this bloc rose to its feet to applaud uproariously, as if the home team had scored the winning touchdown in the high-school championship game.

Otherwise, the women mostly sat sullenly with arms crossed, or even displayed overt and in-your-face derision. They sat, as did Speaker Pelosi, while Sen. Bernie Sanders scowled eloquently, during the standing ovation for the President’s promise that America would never become a socialist country. The President had just observed that Venezuela, once the richest country in South America, had become a pit of abject poverty and despair under socialist rule. No sign of compassion have Democratic Socialists shown for women rooting through trash seeking food for their children, and no trace of concern about the refugees fleeing into Colombia and other neighboring countries.

These congresswomen in white are blind to the White Ladies of Havana, Cuba, who march in silence every Sunday after church to protest the communist regime on behalf of their fathers, brothers, and sons who were jailed and tortured by the Castro brothers’ totalitarian regime for their anti-communist beliefs. A naturalized American citizen (a legal immigrant) who grew up in Communist Romania, Ileana Johnson, is dismayed that Americans have elected socialists to rule over our lives. Bernie Sanders, Ocasio-Cortez’s mentor, has praised Fidel Castro for educating and bringing healthcare to Cuban children, and “totally transforming” society. More

SCOTUS, the Constitution, Freedom and Your Health

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by Elizabeth Lee Vliet, M.D.

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We stand at the crossroads of liberty or despotism. Each day the news brings examples of assaults on life and liberty. These include:

The multifaceted assault on individual freedom is by design, as outlined in the teachings of Karl Marx, Saul Alinsky, and other radical leftists whose goal is to tear down the principles and institutions that made America the quantum leap in the history of humankind, based on the exceptional idea that Life and Liberty are natural rights that come from our Creator, not from government. More

Danger: Interstate Compact Could “Fundamentally Transform” Medicine

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Jane M. Orient, M.D.

While Americans are preoccupied with the political theater of the Presidential race, special interest groups toil to pass legislation that could radically transform your medical care. One example is the Interstate Medical Licensure Compact, which has passed in 11 states. Pennsylvania has joined a number of others in proposing it.

The proposal promises to provide “remote communities with access to high-quality care through telemedicine” and “address a shortage of medical personnel in underserved rural and urban regions,” according to an article in the Pennsylvania Business Daily.

Americans need to remember three things about proposed legislation:

  • Its real purpose is likely to be very different from the stated one, and the result may be the opposite of the one that is promised.
  • Especially when the same law is surfacing simultaneously in a number of states, some vested interest wants to make money from it. A lot of money—getting laws passed can be very expensive.
  • There may be no way back, as the law empowers and funds interest groups that will oppose repeal.

So what does the Compact do to bring telemedicine to underserved areas? By itself, nothing. It’s about a bypass to state control of licensure, not about providing care. If telemedicine were the real object, the way to expedite it would be to define the location of medical care as the location of the doctor, not the patient. The doctor would need a license in only one state. Compact proponents oppose a telemedicine bill in Congress that would do just that.

Some physicians already hold a license in several states—they just apply to each state. Under the Compact, they would apply to a private interstate commission, which would have its own rules, possibly overriding rules of the states, and which would have no public accountability. This would add costs, not eliminate them. It could also allow doctors to evade state laws meant to protect patients. For example, a carpetbagger abortionist could fly in to do late-term abortions forbidden by the state, under his Compact license. More

Announcing Guardianship Shield Program

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 PPJ supports  Guardianship Shield Program

To join the Guardianship Shield Program please send an email with the header “Shield” to ShieldCoordinator@live.com  This e-mail address is being protected from spambots. You need JavaScript enabled to view it  

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Guardianship abuse has reached the level of a national epidemic. Those whose family members have been abused by a guardian quickly find that there is often no legal redress. The Guardianship Shield program is designed to actívate a national network of human rights members who will take constructive action to protect the vulnerable person.

The Guardianship Shield  is a proactive, grassroots program which issues human rights alerts concerning individuals at risk for problematic or coercive guardianship practices.  These alerts go out to all the GS members and to human rights groups. The GS members agree to contact the parties and institutions involved in initiating the actions in question and advise these parties of their concerns.  The GS members also agree to contact local media in an effort to raise public awareness of specific incidents of guardianship abuse. 

The issues that the Shield program addresses : More

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