La Guillotine: Oui ou Non?

La Guillotine: Oui ou Non? podcast 1/31/14

Since we live in an age where daring and greed matter almost more than anything else, certainly more than common virtue and affection, we are reading daily more and more stories that not only make us angry but that also make us think of punishments neither meted out nor handed down. This one in particular, as reported recently, in the New York Times.

Health Management Associates, a for-profit hospital chain based in Naples, Florida, is being investigated by the Justice Department for eight instances of what basically amounts to fraud in six states.
The whistle-blower suits involve an internal strategy that regulators say was intended to increase admissions, regardless of whether a patient needed hospital care, and pressure the doctors who worked at the hospital to go along with this policy.

One kind of example of this practice involved an infant who had a normal 98.7 degree “temperature” but who was quickly admitted “for fever” and observation, and for whose care afterwards the hospital billed Medicare or Medicaid. HMA allegedly used a mix of sophisticated software, financial incentives, and threats to its own staff to be able to bilk the US government – that’s us, folks – out of millions of dollars each year.

What else this policy may do is bankrupt a family who is blind-sided not just by the hospital, in which they place their trust, but also who have been charged stupendous fees for normal items like aspirin, sheets, medicines, and technical tests which are unnecessary but costly and somehow made to seem related to the child’s fever, or non-existent fever.

The accusations reach upwards to the former chief executive’s office, identified by many as the driving force behind the scheme. The architect of the strategy to raise admissions, as per several of the lawsuits, was the company’s former chief executive, Gary Newsome. In what may well be the slippriest and most transparent of departures, Newsome resigned from HMA last summer to head a religious mission in Uruguay. We suspect Uruguay has no reciprocal extradition treaty with the US.

Naturally, the hospital denies everything. “HMA associates and physicians who practice at our facilities are focused on providing the highest quality patient care in all of our hospitals.” You betcha.

Which would account for the firings of personnel who refused to go along with the bilking of us all.
Ralph Williams, an accountant with 30 years’ experience in hospital management, was hired as the chief financial officer of an HMA hospital in Monroe, Georgia. He asked an outside firm to conduct an audit of the hospital’s in-patient admission rate. When the report arrived, Williams was told by his bosses to “burn it,” and was soon thereafter fired.

Jacqueline Meyers, a regional manager for EMCare which provides emergency room physicians to a number of HMA hospitals, refused to follow HMA directives and fire doctors who admitted fewer patients than HMA wanted She, too, was fired.

In another instances of every day fraud as perpetrated by the medical profession itself, a professor of history at the University of Central Arkansas, had the most common of skin cancers biopsied and treated by a hospital 30 miles away from her doctor’s offices that involved a dermatologist, an anesthesiologist, and an ophthalmologist who practiced plastic surgery. The combined bill was more $25,000. The professor had been told she might need a few stitches after the excision.

“If you freeze off 18 lesions and bill separately for surgery for each, it can be very lucrative,” admitted Dr. Steven Shroeder, the chairman of the National Commission on Physician Payment Reform. Add to this the number of entrepreneurial physicians who own their own rehabilitation sites or their own laboratories, and one can begin to see the pattern in its complexity.

For our money, this amounts to another class of criminals – much like those who, in banking, brought the country to its knees in 2006 – and who have yet to repay the government, be sentenced for fraud, or imprisoned for wrong-doing.

Sooner rather than later this begins to make us think of the communards in France in the late eighteenth century who chose whom to decapitate for their so-called “crimes” and whom to imprison in the Bastille.

Which leads us directly to what may seem an outlandish, but also certainly effective, idea.

We propose a law that makes men and women who purposely defraud others, bankrupt and destroy the lives of adults and children – all for the sake of building their own fortunes greater – liable to instant punishment and disbarment from their professions. The most egregious of outlaws would be subject to the guillotine.
Is this too extreme? Perhaps. But a national committee, or series of them organized by profession, could judiciously investigate and expose the malfesances of these hot-shot high-flying financiers – for that is what many professional have become – and mete out an appropriate punishment, or settlement, or at the least censure. Publicity is NOT always good.

It would not only be just, it would be relieving to see men and women of ill-conceived ambition in the dock, finally, and to imagine the coming to an end of the milking not only of the government, but also of all its citizens, poor and rich alike, who have come to believe and depend on the advice of just such kinds of “professionals.”

We’re certainly open to other suggestions than the blade, but we might want to keep it on hand just in case.