In July 1997, HHS' inspector general's office issued a report that found massive problems in Medicare home health billing largely due to what the office termed "problem providers."
Several months after the report was released, a list of nearly 700 home health agencies found by the inspector general to be "problem providers" began circulating in Washington.
Now the inspector general is apologizing to at least seven of the agencies that appeared on the list, including Olsten Health Services, the nation's largest home healthcare provider.
The inspector general stresses that "there may be other inaccuracies, as well" in the list.
The mix-up occurred, according to the inspector general's office, because it used a list "developed elsewhere in (HHS) subsequent to the report, which was based on sources never part of nor used in the office of the inspector general study."
The inspector general further points out that the list was "never intended to be, nor did it, produce a `hit list' of providers to be investigated by the Office of the Inspector General."
Nevertheless, Outliers smells some legal action brewing.
Watch out, Ira. House Ways and Means Committee Chairman Bill Archer (R-Texas) wants Ira Magaziner's head on a platter.
In case you've already forgotten, Magaziner is the White House policy wonk who, along with first lady Hillary Rodham Clinton, headed the supersecret White House healthcare task force that created the president's ill-fated Health Security Act.
Magaziner again is in the news. After nearly four years of legal wrangling, a federal district judge last month ordered the White House to pay nearly $300,000 in sanctions for what the judge called "dishonest" and "reprehensible" conduct in keeping the proceedings of the task force under wraps. The administration had been sued by a conservative physicians group that claimed the deliberations of the task force should have been open to the public.
Now Archer wants President Clinton to fire Magaziner. In a letter sent last week, Archer also called on Clinton to "protect taxpayers from paying the court-ordered $285,864 sanction in this case."
Though no longer the administration's healthcare guru, Magaziner still is employed as a White House senior adviser. His last project was a review of Internet regulation.
After Archer's letter was made public, Clinton came to Magaziner's defense: "I am quite confident that Mr. Magaziner acted appropriately. Any suggestion to the contrary is unfair and unsupported by the facts."
Archer wasn't sold. "Where in this administration does the buck stop?" Archer asks. "If not with Mr. Magaziner, with whom?"
FDA on speed. In what has become an annual rite, drugmakers celebrated the end of 1997 with a flurry of approvals from the Food and Drug Administration.
An unofficial count by Outliers late last month, showed seven new drugs, or about one-sixth of the year's expected total, were approved in the year's final month. An FDA spokeswoman says an official tally on drugs approved this year, including December's whirlwind, won't be available until later this month.
It seems the FDA, like almost everyone, works best under deadline. "Each December for the past several years it seems to me (approvals) have been up," says Jeff Trewhitt, a spokesman for the Pharmaceutical Research and Manufacturers of America, a Washington trade group.
As of just before Christmas, the FDA had racked up approvals for 38 new drugs. "That's not too shabby," Trewhitt says, adding the expected total wouldn't be far behind "last year's blockbuster," when the FDA approved 53 new drugs-the most ever. The previous high mark of 30 was set in 1991.
"You can connect the fact they've done well to the continued success of the user-fee law," Trewhitt says. Since 1992 drugmakers have paid the FDA to review their applications for new drugs. By law, the fees are earmarked to fund drug assessments and have been used to beef up the FDA's reviewer ranks. This year, the agency will charge companies $251,000 to review a new drug.
"We estimate that more than 11 million Americans received a newly marketed drug this year that would not have been available until 1998" without user fees, said lead deputy FDA commissioner Michael Friedman, M.D., at a conference in Washington last month.
Conflicted. The New England Journal of Medicine prides itself not only on the quality of its peer-reviewed articles but also on a conflict-of-interest policy that its editor calls "the tightest in the business."
But late last month, and for the third time in eight years, the Journal found itself backpedaling from an article whose author had a clear conflict. A review in the Nov. 20 issue of the Journal panned a book alleging environmental chemicals are fueling an epidemic of cancers. The reviewer, it turns out, is the medical director at chemical giant W.R. Grace & Co., but readers were not told that.
"We should have recognized that W.R. Grace was a conflict of interest, but unfortunately the person who handled it didn't recognize that," Jerome Kassirer, M.D., the Journal's editor-in-chief, told the Boston Globe. "There will be a complete explanation in the journal in the next three to four weeks."
The author of the piece, Jerry Berke, M.D., says the Journal knew of the W.R. Grace affiliation before the article was published.
In 1989 the Journal ran an article downplaying the risks from environmental exposure to asbestos but failed to note the authors' past ties to asbestos makers.
In 1996 it ran an editorial saying the benefits of diet drugs outweigh the risks. It failed to note that the two authors had been paid consultants for firms that made or marketed one of those drugs, Redux.
Makes you wonder. One of the best healthcare bloopers of 1997 came just as the year ended.
Patrick Hays, president and chief executive officer of the national Blue Cross and Blue Shield Association, told Bloomberg business wire service that Blues premiums could rise 10% to 15% in 1998. In the interview, he said: "Can the Blues sustain 15% rate increases? We can, because the Aetna's, the United's (HealthCare Corp.) are going to have to do the same thing, and already have begun to do so." Hays repeated the assertion three times in the interview, with a Blues press spokesman in attendance.
Two days later, the association decided to amend the estimate. "He should've said 5% to 10%," said Bill Pierce, a Blues spokesman.