Executive Order for More Transparency in Healthcare Pricing

June 25, 2019

President Donald Trump has signed an executive order that aims to lower healthcare costs by improving price transparency.

Here are seven things to know, as reported by the hospital news magazine Becker’s Hospital Review:

1. The order, signed June 24 at the White House, directs HHS to develop rules requiring hospitals to publish prices “that reflect what people actually pay for services in a way that’s clear, straightforward and accessible to all,” said President Trump.

2. It should also “require healthcare providers and insurers to provide patients with information about the out-of-pocket costs they’ll face before they receive healthcare services,” HHS Secretary Alex Azar said before the order was signed, according to NPR.

3. The overall thought behind the order is that price variation exists among healthcare facilities for the same service, and patients need information to find the cheapest and highest quality care. The administration expects the order to promote competition for health services and lower healthcare costs.

4. President Trump said: “For too long it’s been virtually impossible for Americans to know the real quality and price of healthcare services and the services they receive. As a result, patients face significant obstacles shopping for the best care at the best price, driving up healthcare costs for everyone. With today’s historic action, we are fundamentally changing the nature of the healthcare marketplace. This is bigger than anything we’ve done in this particular realm.”

5. Details about how the rules called for in the order would work remain unclear, but they could prompt healthcare to operate more in a way where patient behavior is driven by quality and price, NPR said.

6. CMS Administrator Seema Verma welcomed the order. Her statement says she is excited to implement reforms “that transform our healthcare system into one that delivers affordable and accessible healthcare and puts American patients first.”

7. However, hospital and health plan lobbyists say that  public disclosure of competitively negotiated, proprietary rates would lead to higher healthcare prices, according to NPR. America’s Health Insurance Plans is arguing the disclosure will reduce competition.

“Fountain of Youth” Doctor Convicted in Healthcare Fraud Scheme

June 18, 2019

Healthcare fraud

Healthcare fraud is a serious problem that impacts every American. As taxpayers, we all pay for it! That’s why cases like this are so important.

A Pittsburgh area cardiologist was found guilty of two counts of healthcare fraud, involving more than $13 million in falsified insurance billing. Dr. Samirkumar Shah submitted the fraudulent claims to Medicare, Medicaid and private insurance companies, receiving payments in excess of $3.5 million.

During an eight day trial, evidence was submitted to show that Dr. Shah, 56, offered External Counter Pulsation (ECP) treatments to patients in Pennsylvania, Ohio, New York and Florida for a variety of ailments, including obesity, migraines and erectile dysfunction. He advertised the ECP treatments as “the Fountain of Youth” and claimed they made patients “younger and smarter,” according to the Department of Justice.

ECP involves the use of a specialized bed equipped with pressure cuffs, which exert pressure upon patients’ lower extremities as a means to increase blood flow to the heart.  Insurers only reimburse for ECP treatments for patients who suffer from disabling angina—or chest pain caused by decreased blood flow to the heart—and only when a physician supervised the treatment.

FBI Pittsburgh Special Agent in Charge Robert Jones called healthcare fraud a serious problem that impacts every American. “It takes critical resources from our health care system and increases health care costs for everyone. Dr. Shah’s disregard for safe patient care goes against the medical ethics he was to uphold,” Jones said.

According to the DOJ, evidence showed that Shah instructed his employees to indicate that every patient had disabling angina on billing sheets that were used to support false insurance claims. In some cases, Shah never even met patients and never reviewed ultrasound imagery before approving new patients to begin ECP. In addition to billing for ECP treatments that were not medically necessary and were not provided under direct physician supervision, Shah also double-billed insurers.

Contrary to health insurance requirements, ECP treatments routinely occurred while neither Shah nor any other medical doctor was present at his various locations. On one occasion, a patient experienced an adverse event during his ECP treatment and had to be transported via ambulance to the hospital.

U.S. Attorney Scott Brady said, “Health care fraud threatens the safety and integrity of our entire health care system. Doctors and medical professionals like Dr. Shah who issue false diagnoses, order unnecessary testing and fraudulently bill Medicare and Medicaid in effect steal from the most vulnerable in our community.”

Shah faces a maximum sentence of 10 years in prison, a fine of $250,000, or both.  Click here to read more from the Department of Justice.

Company at Center of Opioid Crisis Sued for Claims about Drug

May 15, 2019

opioidcrisis-jpg-1-jpg-1


(Photo courtesy Times News)

Endo Pharmaceuticals, the same company which was at the center of a $193 million settlement with one of James Hoyer’s whistleblower clients, is now facing another major legal battle. The Tennessee Attorney General is suing Endo for making unlawful and false claims about the safety and benefits of its opioid products.

The AG’s office says Endo violated the Tennessee Consumer Protection Act and contributed to a devastating health crisis in Tennessee. Here are details from the news release by Attorney General Herbert Slatery’s office:

Attorney General Herbert H. Slatery III today sued Endo Pharmaceuticals and Endo Health Solutions Inc. (Endo) for making unlawful and false claims about the safety and benefits of its opioid products.

The State’s lawsuit, filed in Knoxville, alleges Endo violated the Tennessee Consumer Protection Act and contributed to a devastating public health crisis in Tennessee.

“Our Office has conducted an extensive investigation into Endo’s unlawful marketing practices which included targeting vulnerable populations like the elderly,” said Tennessee Attorney General Herbert H. Slatery III. “Endo has repeatedly refused to take responsibility for its unconscionable conduct, which is why we are taking this action.”

The allegations in the State’s 180-page complaint detail how Endo deceptively marketed its opioid products as being less addictive and more effective than others on the market. It did this despite evidence to the contrary, including the FDA’s explicit rejection of Endo’s claim that Opana ER was resistant to abuse as well as overwhelming evidence that Opana ER was being abused throughout Tennessee.

The Complaint alleges that Endo also knew the dangers of its opioid products, including increased risks of respiratory depression and death in elderly patients, and failed to clearly disclose those risks while it specifically targeted patients in that age group.

The State also has reason to believe Endo used the recommendations and educational materials of third-party groups like the American Pain Foundation without disclosing that Endo was by far the biggest donor to the Foundation and provided more than half of its total funding. Endo provided significant funding to other third-party groups and subsequently relied on material generated by those groups without disclosing the financial relationship.

The Attorney General requested the complaint be filed under a temporary seal because Endo claims the information produced during the State’s investigation is confidential. The order sealed by the judge allows the seal to expire in 10 days unless Endo acts to extend it.

The Attorney General believes the complaint should be made available to the public in its entirety and efforts to keep it confidential will only prolong and diminish Endo’s accountability for its conduct.

Don’t Take Your Employee Rights for Granted

April 25, 2019

Employee-Rights-1200x600The fight for worker rights took another blow this week.  The Supreme Court ruled employees at a California company could not band together in an effort to get compensation from their employer for a breach of their data.  The 5-4 decision put yet another limitation on the ability to use class arbitration and class actions to battle against bigger, more powerful opponents.

Attorney Dave Scher, head of the James Hoyer Employment Law Division, says the decision is disappointing but “really not surprising, given the conservative shift on the court.”  Recent rulings have chipped away at employee rights and, unfortunately, this will make it even more difficult for employees to tackle joint grievances in the workplace.

“It impacts any issues where employees band together to fight unfair circumstances in their workplace—not paying overtime, underpaying tips, break times, not getting benefits they’re entitled to—things like that,” Scher explained.

Forcing Individual Arbitration

The ruling allows companies to ban class action lawsuits and class arbitration proceedings to address disputes; instead, forcing employees to bring their cases on an individual basis.  It essentially creates a divide and conquer scenario for companies to take away the ‘strength in numbers’ individuals can get by working together.


Attorney Dave Scher

“It allows corporations to take advantage of low income employees and prevents them from being held accountable for improper practices,” Scher said.  “They do what they want, because they know there’s really nothing these employees can do about it.”

It’s cost prohibitive in most cases for employees to bring individual cases for claims that don’t amount to large sums, even if the collective damage to all employees is large.  Class actions and class arbitrations are supposed to help even the playing field for employees and consumers by spreading out the costs, but that gets harder now with this ruling.

“Companies can afford to fight, but an individual with a $1000 or $5000 claim can’t afford it.  They can’t pay a lawyer to help them, and the way it’s now structured, many lawyers can’t afford to bring the case, because they won’t recoup their costs.”

According to the Economic Policy Institute, nearly 54-percent of non-union, private sector employers require mandatory arbitration clauses and 65-percent of large companies with more than 1000 employees have them.  These arbitration agreements require workers to give up their rights to have disputes settled in a court of law. They are often a take-it-or-leave-it deal, where if you don’t sign, you don’t get the job. Unfortunately, many don’t even realize the rights they are giving up and that it puts them at a significant disadvantage should a dispute arise.

What can you do about it?

Some employment attorneys are developing a head-on approach to tackle ‘class’ bans by filing large numbers of arbitration cases, one by one.

“Creative employment lawyers are saying—‘Fine, instead of having a class, I’ll find a thousand workers who fit into this category, and I’ll represent each of them. And I’ll bring a separate arbitration claim for each of them, and you’re going to have to pay for the cost of each of those arbitrations.’ And that is having some degree of affect,” Scher explained.

In other words, in the world of unintended consequences, class bans could end up backfiring on some employers.

“Essentially employers are coming back and saying, ‘Well, wait a minute, that’s completely inefficient. It’s all the same issue’—which is the whole point of having a class action,” Scher explained. “So ultimately, we can put them all together in a class or you can oppose class actions. Which do you want? You’re making me do this.”

If you find yourself facing an unfair workplace issue, click here to contact attorney Dave Scher for an evaluation.

Home Sale Preps that Get More Money at Closing

April 3, 2019

Angie -CWN- Home Sale TipsPutting in a little effort BEFORE you put your home on the market can help you get more money at closing.  In this CWN video, Managing Editor Angie Moreschi shows us what preps pay off and which ones aren’t worth the time and money.

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DO DARK WEB SCANS REALLY WORK?

March 20, 2019

Angie Moreschi CWN Managing Editor

Internet based identity theft can create serious problems if you get hacked and your information is sold on the dark web. Some companies are promoting dark web scans as a way to protect yourself, but do they really work?

Consumer Warning Network Managing Editor Angie Moreschi checks out whether getting a dark web scan is really worth it and looks at other ways to protect yourself.  Click below to see what she found out.

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The Riskiest Scams of 2018: Don’t be a Victim!

March 6, 2019

BBB 2018 Scam ReportTech savvy scammers are working hard to scam more consumers. Employment scams were the riskiest scams in 2018, according to the latest report from the Better Business Bureau.

The reported employment scams had more instances and higher losses than in previous years when they ranked the third riskiest. The report is based on data supplied by consumers to BBB Scam Tracker and is based on the BBB Risk Index, which is a unique algorithm that calculates exposure, susceptibility, and monetary loss to offer a more accurate assessment of scam risk.

“This was a surprise,” said Melissa Lanning Trumpower, executive director of the BBB Institute for Marketplace Trust, which produced the report. “It’s the first time since we began this report three years ago that one scam dominated across so many demographic subgroups. It was the riskiest scam in three of the six age groups, and for both men and women. It was also the riskiest scam for military families and veterans, and students.”

The BBB says digging into the Risk Report shows one possible answer: Amazon was in the news a lot in 2018 with its high profile search for a second headquarters. It was also the 6th most impersonated organization mentioned in BBB Scam Tracker reports, after not even making the top 15 in previous years. In 2017, only 24 BBB Scam Tracker reports were employment scams that mentioned Amazon. In 2018, that jumped to 564.

“Scammers are opportunists,” says Trumpower. “Whatever is in the news or being talked about on social media, they see as an opening to imposter a recognizable and respected organization or brand.”

The Internal Revenue Service is the leading impersonated organization, and other government agencies together rank second. Other leading brands that scammers impersonate include Publishers Clearing House, Microsoft, Apple… and the Better Business Bureau.

Amazon, a BBB Accredited Business, has only one authorized job application site: amazon.jobs. Any other link is a scam, said Trumpower.

“Employment scams are particularly egregious because they prey on people who are already feeling pinched and may be desperate for work,” she said. “If the scam gets far enough, scammers collect the same information that real employers do – address, birth date, Social Security number, bank account – everything needed for identity theft.”

The ten riskiest scams of 2018 were: employment, online purchase, fake checks/money orders, home improvement, advance fee loans, romance, tech support, investment, travel/vacation, and government grant.

Click here to check out a report on the findings on CBS Morning News.

To report a scam, go to BBB.org/ScamTracker.

To learn more about different scam types, go to BBB.org/ScamTips.

Shopping Behavior: Tricks used to get you to buy more

March 1, 2019

Shopping picIn this CWN report– learn to understand the psychology of shopping. Angie Moreschi looks at what retailers do to get you to buy more.

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