The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry

Oppression that is clearly inexorable and invincible does not give rise to revolt but to submission. Simone Weil

The AMA Code of Medical Ethics opinion 8.032 states:

“Physicians should disclose their investment interest to their patients when making a referral, provide a list of effective alternative facilities if they are available, inform their patients that they have free choice to obtain the medical services elsewhere, and assure their patients that they will not be treated differently if they do not choose the physician-owned facility.”

There are three ways a person can pay for health services: 1.) government Health Plans ; 2.) private health plans; and 3.) out-of-pocket

Government and private heal plans have regulations that are consistent with the AMA Code of Medical Ethics opinion 8.032 and the key concepts are: 1)  No taking money for referrals 2) Referrals should be based on medical necessity  3) Referrals should be based on the best providers.   Government regulations are the most restrictive. Stark Law and the Anti-kickback Statute provide very detailed “safe harbor” rules which must be followed.   Congress enacted a physician self-referral law in 1993 after learning the incidence of radiology procedures and physical therapy greatly increased when the patient’s physician had an ownership interest in the facility or clinic. This law is the result of legislation introduced by Representative Fortney (Pete) Stark (D-CA), then Chairman of the U.S. House Ways and Means Health Subcommittee.  An earlier self-referral law (“Stark I”) had been enacted for clinical laboratory services only.  The self-referral law prohibits Medicare and Medicaid payments when a physician refers any of ten “designated health services” (DHS) to an entity where the physician has a financial relationship including clinical laboratory services and inpatient hospital services.    Physician Self-Referral Law [42 U.S.C. § 1395nn]    Anti-kickback regulations apply to anyone who “knowingly and willfully offers, pays, solicits, or receives remuneration in order to induce business reimbursed under the Medicare or Medicaid programs.”  Anti-Kickback Statute [42 U.S.C. § 1320a-7b(b)] makes it a crime to pay for referrals in the Federal healthcare system. ( Section 1128B(b) of the Social Security Act ).  False Claims Act [31 U.S.C. § § 3729-3733] makes it illegal to submit claims for payment to Medicare or Medicaid that you know or should know are false or fraudulent.   Private health plans (including “self-funded” health plans) also have a restrictive set of rules and private-pay restrictions may mirror Stark Law or the Anti-kickback Statute, and will either be set forth in a provider agreement, or in a claims processing manual; compliance with which the physician may be asked to certify.   Patient out-of-pocket (where the patient is solely responsible and pays out of pocket for an ancillary service) have no meaningful restrictions and this opens the door for abuse.  The physician health program model is based on a simple coercive extortion scheme.  In a paradigmatic case of coercion—the mugger who demands “your money or your life” the victim is better off handing over the money than losing their life. Coercion characteristically involves threats by which the coercer proposes to make the victim worse off unless they do as the coercer demands.  In the 1990s some entrepreneurs within the “impaired physicians movement” discovered they could demand “your money or your medical license” and coerce doctors into paying for unneeded assessment and treatment that lasted three-times longer than normal folks and needed to be paid out-of-pocket.  With no regulation from government or private insurers they could do whatever they want and they did.

money1-richdoctorThe simple extortion scheme from the 1990s has now grown to around two dozen “PHP-approved” assessment and treatment centers and state boards require that only “PHP-approved” facilities be used and specifically excludes non “PHP-approved” facilities.   The preferred facilities engage in “diagnosis rigging” and false diagnoses to warrant unneeded treatment.  The labs are willing to  engage in laboratory misconduct and will create a falsely positive test at client request.    It is a closed incestuous system in which the  PHP serves as the Axis of Control and everything is kept not just close-to-the-cuff” but up the sleeve.  This has led to pathological opportunism and  promiscuous interaction between the PHPs-assessment center-lab conglomerate, regulators and medical boards and the legal profession which includes attorneys ostensibly representing doctors who will not bite the hand that feeds them-mostly carpetbagger board attorneys and former AAGs who hopped over to the more lucrative side  doctors who are actually carpetbaggers who hopped over to the other side after proving to the racket they had no scruples and the current pseudosymbiosis damages everyone but the psychopaths, bullies and clowns lining their pockets from the racket.

Source: The Regulatory Capture of American Medicine by the Drug and Alcohol Testing, Assessment and Treatment Industry

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