Little Punishment for Misinformation; Hidden Fees Hit Docs; Dubious Charity Spending

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

Maine Medical Boards Rarely Punish Misinformation

In Maine, cases of medical misinformation related to COVID-19 made up less than 1% of the state’s medical and osteopathic licensure boards’ disciplinary actions since March 2020, according to a report in The Maine Monitor.

Of more than 70 public actions (in 65 disciplinary cases) taken by both boards during that time period, only four cases involving three doctors dealt directly with COVID-related matters, such as prescribing unapproved medication or issuing improper medical exemptions for the COVID-19 vaccines, the Monitor found.

Those three doctors were Meryl Nass, MD, Paul Gosselin, MD, and an unnamed pediatric cardiologist.

Despite the lack of disciplinary action from the boards related to COVID-19 misinformation, medical professionals and experts in the state reportedly believe punishments are warranted.

A former chair of one of the medical boards emphasized that there is a line between trying to treat patients in an “unknown situation” early in the pandemic and the physicians who continued to use unapproved drugs, such as ivermectin, later on.

“The line is that the board doesn’t want to squelch people trying to treat people early on, but on the other hand doesn’t want people then fleecing individuals by giving them medications,” Louisa Barnhart, MD, a psychiatrist and former chair, told the Monitor.

Hidden Fees Cost Doctors Millions

Health insurers are routinely charging doctors kickback fees as high as 5% for electing to receive payments electronically, according to a new ProPublica investigation.

These fees likely add up to billions of dollars per year, given that more than $2 trillion in medical claims are paid electronically each year — and they can cost larger practices $1 million per year, according to the report.

ProPublica revealed a power struggle between CMS and a payment industry lobbyist who fought to preserve such fees. In August 2017, CMS posted a notice on its website informing insurance companies they couldn’t charge physicians a fee when paying them for their services.

But 6 months later, the posted rule had vanished without explanation. ProPublica discovered an extensive back-and-forth between CMS officials and Matthew Albright — a former CMS employee deeply involved with drafting the standards for paying doctors electronically who was ultimately recruited to payment company Zelis. Not long after Albright brought in a law firm to put additional pressure on the agency, the posted rule was taken down.

Despite complaints about this practice from physicians and health systems, insurers and payment processors refuse to relent. AdventHealth, which operates 53 hospitals in nine states, claimed it had to pay $1.8 million in expenses, in a 2020 complaint to CMS. A senior executive said that money could have been used “on PPE for our employees, or setting up testing sites, or providing charity care, or covering other community benefits.”

Even smaller clinics face fees over $100,000, which would cover the salary of a registered nurse, the report stated.

One physician, Terence Gray, DO, an anesthesiologist in Scarborough, Maine, told ProPublica that “[a]ll these additional fees are the reason why you see small practices folding up on a regular basis, or at least contributing to it.”

Questionable Charity Spending at Hospitals

Two hospitals in the small Colorado town of Pueblo have come under scrutiny from local residents for falling short of their obligations to provide charity care, a stipulation of their tax-exempt status, according to CBS News.

Centura St. Mary-Corwin reportedly contributed $2.3 million in charity care — free care provided to patients who can’t afford their medical bills — in fiscal year 2022, and Parkview Medical Center reported spending $4.2 million that year, or 0.75% of its operating expenses.

The hospitals claim other forms of community benefit spending. For example, Parkview reported $100 million of such spending in 2022, on a total revenue of $593 million. But more than $77 million of that represented the difference between the hospital’s cost of providing care, and what Medicaid paid for it, according to the article. In contrast, the hospital spent $58 million on a new orthopedic facility and $43 million on a new cancer center.

Critics claimed that the low levels of charity care mean that residents in towns like Pueblo are taking on more medical debt. A total of 15% of people in Pueblo county have some medical debt in collections, compared with 13% nationally and 11% statewide, CBS News reported, citing 2022 data.

Theresa Trujillo, co-executive director of the Pueblo office of the Center for Health Progress, told the news outlet, “[o]nce you understand that there are tens of millions of dollars every single year that hospitals are extracting from our communities that are meant to be reinvested in our communities, you can’t go back from that without saying, ‘Oh my gosh, that is a thread we need to pull on.'”

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