The Annals of Greed teem with humdrum rapaciousness. The Medicare scams, like the pain clinics in California and Oregon, evoke a blasé ho-hum. Medicare and Medicaid are not the only marks. When 18 former NBA players were accused of defrauding their union’s health plan, billing for fictitious dental and office visits, the story evoked another blasé nod. The Inspector Generals, the forensic accountants, the investigators, determined to uproot these frauds, are much like gardeners tackling kudzu.
This entry in the Greed Annals, though, is horrendous.
The cruelty begins with a benign facade. Wondrous medical devices — wires with blades or lasers — enable physicians to clear away the plaque around the arteries in patients’ legs. Approximately 12 million Americans suffer from peripheral artery disease. Some people have no symptoms; some, mild symptoms; others, severe pain. Treatment for some patients can include exercise and medication. For more severe cases, physicians may insert stents or balloons. And then there are the devices which physicians insert to perform artherectomies.
The New York Times (July 15) analyzed the data for artherectomies: in the past decade the number has soared. In 2011 Medicare paid $86 million for the procedures; in 2021, $612 million.
The reason lies in the confluence of Medicare billing procedures with the greed of the manufacturers, abetted by the greed of surgeons.
Begin with the manufacturers. With so many potential patients, those labs (e.g., Abbott and Boston Surgical) saw so many procedures. Then came Medicare’s decision to reimburse these procedures not only in hospitals, but in outpatient clinics. On the surface, that was a cost-conscious decision on the part of Medicare: why reimburse for a costly hospitalization when a surgeon can operate at an outpatient clinic.
That decision opened up the road-to-riches. Physicians who operate in a hospital keep a fraction of the insurance payout. A physician who owns a “vascular clinic” can keep it all.
Enter the equipment manufacturers, eager to help these outpatient clinics grow. The New York Times looked at the 200 surgeons who performed the most procedures: three-quarters had received loans from the manufacturers to fund their clinics.
With a per-procedure payout of $10,000, the profits surged. The more procedures, the more income for the manufacturers, the more income for the physicians. An aggressive surgeon might threaten the patient: if we don’t do the artherectomy, you may lose your leg, though ironically the artherectomy increased the risk of amputation.
At the same time, the data showed a spike in amputations. Too many procedures given in a short period of time (one patient had 18 procedures in 18 months), patients who might have fared better in a hospital, patients whose diabetes or heart disease made them especially risky — all contributed to a frightening number of amputations. In Michigan over four years, 45 patients lost limbs.
ProPublica, in “Arterial Motives,” cast a spotlight on Dr. James McGuckin who spawned a network of clinics (with transportation provided). He promised to unclog those clogged arteries, relieving patients of pain.
He left a record of amputations that alarmed both Medicare and state departments of health, which license physicians. In 12 states he lost hospital privileges; several state departments of health sanctioned him; Medicare levied fines.
ProPublica asks: How is he still practicing?
The alarm did not stanch his enthusiasm for these profitable procedures.
State health boards’ sanctions do not necessarily disbar a physician. The five-figure fines are trivial compared to the physicians’ income. Lawyers can generally forestall harsh bureaucratic measures. And the procedure does work for millions of patients — though, arguably, some patients might have benefited from less invasive treatment.
At first glance, the safety net seems unable to protect patients.
But beyond fines and sanctions, there is shame. We accept commonplace greed that doesn’t overtly hurt patients; but the greed that leaves patients without legs deserves more than a blasé nod. Kudos to the New York Times and Pro-
Publica for shining a spotlight on abject cruelty. In the best of all worlds, shame should stop this egregious scamming of sick vulnerable patients.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.
From The Progressive Populist, September 15, 2023
Blog | Current Issue | Back Issues | Essays | Links
About the Progressive Populist | How to Subscribe | How to Contact Us