Fentanyl Easy to Make; UnitedHealth’s Physician Empire; Is NP Training Sufficient?

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Investigation Reveals How Easy It Is to Make Fentanyl

A Reuters investigation found that making fentanyl from scratch is alarmingly cheap and easy — and it exposed holes in the regulatory framework.

With $3,600 and some internet research, Reuters reporters figured out how to purchase the supplies and ingredients to make nearly $3 million worth of the street drug. (Reuters did not make any fentanyl and safely destroyed the materials.) Most of the materials were paid for using cryptocurrency and reporters communicated with suppliers on encrypted messaging apps.

“It’s like making chicken soup,” one independent fentanyl producer in Mexico told Reuters. “It’s mega-easy making that drug.”

The Reuters team ordered precursor chemicals, which are also used in other key industries, like cosmetics and pharmaceuticals, from China, which used to be the primary supplier of fentanyl until a 2019 crackdown. They had materials shipped to New York, New Jersey, and Mexico City. Dye tablets, a pill mold, a full face respirator, and other miscellaneous supplies came from retailers like Amazon.

Independent testing found a few fakes, but many of the ingredients were legitimate, the investigation found.

“Anyone with a mailbox, an internet connection and digital currency to pay the tab can source these chemicals,” the article stated.

UnitedHealth Squeezes Its Physician Empire to Profit

UnitedHealth Group has stealthily grown its monopoly in healthcare in part by buying up physician practices and gaming the Medicare Advantage payment system, STAT reported.

UnitedHealth takeovers of physician practices often start with an influx of money that buys needed upgrades practices couldn’t previously afford. But then, the company would ramp up asking more and more from its employees, like seeing more patients per day and urge upcoding to increase profits.

One physician, Susan Baumgaertel, MD, said patients would ask her why their medical charts said they had conditions that weren’t discussed in the visit, to which she’d tell them the truth: that even if they didn’t have that condition, she was encouraged to code for it to increase profits.

“We were not truly caring for patients anymore,” Baumgaertel told STAT. “We were just micromanaging their care to bring in money. It just felt so unconscionable.”

A different employee retired soon after UnitedHealth took over and compared the work environment to an Amazon warehouse.

Plus, the insurance giant targets health centers in markets densely populated with Medicare Advantage patients. Upcoding is rampant in Medicare Advantage plans, and per STAT, overpayments from coding are expected to reach $50 billion this year alone.

UnitedHealth’s massive profits are on par with Apple, and STAT compared the company’s growth strategy to Standard Oil.

Is NP Training Sufficient?

While nurse practitioners (NPs) play a critical role supporting doctors, there’s huge variance in training quality which sometimes leads to dangerous situations, according to a Bloomberg investigation.

NPs are the fastest growing profession with thousands of people obtaining the advanced degree that affords them a higher level of responsibility, such as diagnosing and prescribing. Some of this work was traditionally done by doctors, but now with a growing NP workforce, patient wait times can be shorter and doctors’ time is freed up for other tasks.

“In important respects, [NPs are] now at the center of health care in the U.S.,” Bloomberg reported.

But NP education isn’t standardized and varies tremendously from program to program, according to the report. Many programs are completely online with very little in-person training.

Bloomberg spoke with some NPs who said they “wouldn’t entrust members of their own families to the care of some of the newly minted nurse practitioners they’ve observed.”

While some NPs have tried raising the alarm, most have experienced intense pushback, Bloomberg reported.

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