For weeks, Senate Democrats have been taking to the floor to give speeches highlighting a "victim of the day"-average people they say were injured by substandard care from an HMO. But now they are looking to bring some star power to their cause.
Legislators who support managed-care regulation are fond of quoting actress Helen Hunt in the recent hit movie "As Good as It Gets." Hunt plays a single mother who rails against an HMO she says won't cover her son's asthma condition. Her expletive-filled tirade can't be printed in MODERN HEALTHCARE, even in Outliers, but it gets big cheers at the movie theaters.
Now the Democrats are trying to get Hunt to visit Capitol Hill to speak on behalf of their managed-care regulation bill, a spokesman says. If Hunt signs on, it would give some Hollywood pizazz to an issue that has been dominated by exciting topics like ERISA exemptions and multiple-employer welfare arrangements.
Pass the hat. The Roman Catholic parent company of a physician recruitment firm that illegally paid $500,000 in kickbacks to two physicians is now seeking donations to build a clinic for the indigent.
South Bend, Ind.-based St. Joseph's Care Group, which owns Horizon Group Enterprises and 289-bed St. Joseph's Medical Center, has begun the campaign to raise money to continue construction of the new off-campus facility.
Horizon pleaded guilty last month to offering financial perks to two physicians in exchange for their referrals to the hospital (May 4, p. 2). Horizon's punishment will be determined at its sentencing hearing, expected in June.
"The center . . . has reached a critical point in its development and we need your help," reads the letter, which is signed by Robert Beyer, St. Joseph's Care Group's chief executive officer.
The group and its charitable development arm, St. Joseph's Foundation, hope to raise $250,000 through the campaign.
Hmmm. Maybe they should have thought about that before shelling out twice as much for patient referrals.
An alternative way to defraud. When it comes to healthcare fraud, alternative medicine can look a lot like traditional medicine.
Acupuncture clinic operator Miriam Yedvab of Tarzana, Calif., pleaded guilty last week to mail fraud charges related to a scheme that improperly billed insurance companies for services that weren't medically necessary or were never performed.
The scheme, which went on for four years, cost private insurers as much as $350,000, according to the U.S. attorney's office in Los Angeles.
Yedvab, 49, the owner and operator of Alpha Acupuncture Center in Sherman Oaks, Calif., admitted she submitted bills that falsely stated certain services had been performed. The bills included "certificates of medical necessity" or "prescriptions for physical therapy" issued to patients by a licensed physician. However, Yedvab knew the physician who issued those certificates had not examined the patients.
Mordehai Zaray-Mizrahi, M.D., pleaded guilty in August 1997 to helping Yedvab in the scheme. He was sentenced last November to three years' probation and was ordered to pay an insurance company $42,500 in restitution.
Yedvab will be sentenced Aug. 19. The mail fraud charge carries a maximum penalty of five years in prison and a $250,000 fine.
Rapid rise. In a further indication that impotence wonder drug Viagra has gone mainstream, the share of prescriptions written by primary-care doctors has quickly overtaken those penned by urologists, the specialists principally responsible for treating impotency.
For the week ended May 1, a phenomenal 286,300 prescriptions were dispensed for Viagra, according to IMS America, a Plymouth Meeting, Pa.-based research firm. That torrid tally for the little blue pills from Pfizer is up nearly eightfold from 36,700 prescriptions written during the week ended April 10, the first full week Viagra was available. Dollar figures weren't available.
Primary-care doctors now account for more than half of all Viagra prescriptions, compared with one-third by urologists. The remainder were written by a variety of specialists, with psychiatrists accounting for only 1% of the total. Those numbers are a flip-flop from the first two weeks of experience with Viagra, according to IMS, when urologists accounted for the vast majority of prescriptions.
Stamping out cancer. The American Association of Health Plans has teamed up with the U.S. Postal Service to raise money for breast cancer research. The postal service will issue a special stamp, the first of its kind, in August, with net sale proceeds to be allocated to cancer research institutions.
The AAHP will help promote the stamp by disseminating information through publications and other communications to its more than 1,000 member health plans.
The stamp will sell for 40 cents, but it will be valid for postage at the first-class rate of 32 cents. Through the additional 8 cents per stamp, the campaign hopes to raise $8 million, with 70% of net proceeds to be donated to the breast cancer research efforts of the National Institutes of Health and 30% to be donated to research efforts by the U.S. Defense Department.
The campaign is the brainchild of Ernie Bodai, M.D., of Kaiser Permanente in Sacramento, Calif., who worked with Betsy Mullen, founder of Women's Information Network Against Breast Cancer, to win legislative approval for the stamp.
Quotable. "If they were all guilty, they wouldn't be so angry. I have been around a long time, and I have never seen my members so upset about something."- American Hospital Association President Richard Davidson, on the estimated 4,000 hospitals exposed to potential federal probes over their billing activities.