番茄社区

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

Doctor's Company Billed for Bogus Consults, Faked COVID Test Results

Los Angeles city and county officials sued Sameday Health for facilitating "medically unnecessary consults," faking COVID test results, and wrongly profiting off insurers and patients, according to the .

Sameday Health was a startup run by Felix Huettenbach, who said he wanted to "disrupt the American healthcare system." He partnered with Jeff Toll, MD, who recruited other physicians to perform the "consults" at Sameday sites.

Toll said his company "gave medical advice about COVID-19 symptoms and exposure and educated patients about quarantining and vaccines," according to the article. But Sameday billed insurers $450 for the 2-3 minute consults, some of which never happened, or were done over the phone.

When insurers wouldn't pay Toll's company, some patients were stuck with hefty bills, and had no idea who the listed doctor, "Jeff Toll, MD," was.

The company also allegedly partnered with COVID testing labs and promised 24-hour result turnarounds that the labs had never agreed to. Sameday ended up falsifying over 500 test results by using PDFs from previous customers' negative results, changing the name and date.

Los Angeles city and county attorneys said the scheme took advantage of CARES Act laws that compelled insurers to cover COVID-related services. It seems as though "they just took advantage of the weaknesses in the oversight and monitoring of these activities," Glenn Melnick, PhD, a healthcare economics expert at the University of Southern California, told the Los Angeles Times.

Huettenbach has now settled city and district attorney claims for nearly $22 million, and Toll will pay nearly $4 million in a separate settlement.

Sexism Lawsuit Speaks to More Pervasive Healthcare Problem

Deborah Keller, MD, filed a lawsuit in December against NewYork-Presbyterian/Columbia University Irving Medical Center after filing numerous complaints about discrimination against her as a female colorectal surgeon, .

"The last thing I wanted to do was speak out. I just wanted to go to work," Keller told NBC News. But "it's time for a change," she said.

Keller knew she was hired at a lower salary than the men on her team. Her boss, Pokala Ravi Kiran, MD, the division chief of colorectal surgery, would speak more harshly to her about cases, humiliating her in front of coworkers. He'd comment on her appearance and give her administrative work that none of her male coworkers had to do, she alleged.

After she filed complaints with the hospital system, Keller's employer took away her office, didn't renew her contract, put her on administrative leave, cut her pay, and "sabotaged" a grant she had received, in acts of retaliation, she alleged.

These sexism allegations are part of a larger issue that's only been made worse by the pandemic, NBC News reported. For example, fewer manuscripts were submitted by women after childcare options narrowed. Women now make up more than half of U.S. medical students, the outlet reported, but better pay, grant funding, and promotions to leadership positions are still skewed heavily toward male physicians.

Pringl Miller, MD, founder of an organization that helped Keller face the problems at work and that helps other physicians experiencing discrimination, told NBC News, "Most of the people are so turned inside out, thinking that they're crazy, that they did this to themselves, when these are very intelligent, skilled people."

Hospitals Seek Huge Reimbursement Increases

The reported that hospital chains like HCA Healthcare and Universal Health Services are asking insurers to reimburse them at higher rates than usual, citing unusually high labor costs as salaries for travel nurses and full-time staff have risen with demand for their services during the pandemic.

People familiar with the negotiations say the hospital chains are asking for increases of 7.5% to 15% -- far beyond the typical 4% to 6% increases they seek each year. They usually win increases of about 3%, according to the Journal.

Insurers say there's no reason to ask for higher reimbursement rates when the priciest hospitals can make more than five times Medicare pay rates for the same services. If insurers do agree to higher rate increases, premiums for employers and workers will likely go up.

"Most of the employers have been unable to increase the wages of their workers for years primarily because of the increasing cost of healthcare," Karen van Caulil, CEO of the employer coalition Florida Alliance for Healthcare Value, told the Journal.

Though HCA said on an earnings call that labor costs were $500 million more than expected, insurers say they won't budge. "It looks like we're overpaying to begin with," Cheryl DeMars, CEO of The Alliance, which represents self-funded employers, told the Journal.

Comment