Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative healthcare reporting each week.
Prominent doctor charged with sexual assault
According to New York Times.
The two women accused Cahill of performing an intrusive physical examination on dates in 2006, 2009 and 2019. Wesko and Mauro both claimed he penetrated them “anally with his finger or an object.” , according to the article.
After first meeting in 2009, Wesko also claimed that Cahill tried to pursue a romantic relationship with her for nearly a decade, according to “hundreds of emails and dozens of handwritten cards and voicemails from Dr. Cahill to Ms. Wesko” which were reviewed by the Time. Then in 2018, Wesko was diagnosed with endometriosis.
According to the article, she lacked effective treatment options and ultimately sought Cahill’s medical advice. The Time The report says Cahill took the opportunity to arrange for Wesko’s care, including surgery, at Lenox Hill Hospital in New York City.
Wesko agreed to receive the treatment only to be told by Cahill that he would ask her to see him for two preoperative exams before the operation could take place. During these examinations, Wesko testified that Cahill sexually assaulted her again. The Time reported that Wesko claimed that “Cahill again penetrated her anally, and on the second examination, [he] fondled her breasts, tore her paper dress, touched her stomach and pelvic area and kissed her on the mouth.”
Wesko filed a lawsuit accusing Cahill of these offenses. His attorney denied the seriousness of the encounters and claimed that Cahill was only pursuing a friendship with Wesko.
Mauro did not press charges against Cahill, but agreed to share his meeting with him in 2006 with the Time. She told the Time that “he came in – there was no nurse – and immediately approached me and tore the front of my blouse” to examine her breasts even though she had scheduled the visit due to gastro issues -intestinal.
She told the Time that after the visit she recalled saying to her boyfriend, “I feel like I was raped by a 70-year-old doctor.”
Cahill is being investigated by the New York State Health Department in addition to Wesko’s lawsuit. He did not answer the Time‘ request for comment.
Billion dollar bounty for AARP
The American Association of Retired Persons (AARP) entered into an exclusive promotional agreement in September with Oak Street Health, which operates 100 primary care clinics in a dozen states, according to Kaiser Health News.
The agreement allows Oak Street Health to use AARP in its marketing for an undisclosed fee, according to the report.
This arrangement is part of a lucrative practice of AARP, where the organization collects “royalties” in exchange for exclusive marketing deals with healthcare companies willing to promote themselves to AARP members.
In total, AARP collects $1 billion from such royalties, according to its 2020 financials. KHN reported. About two-thirds, or $752 million, of those royalties come from “health products and services,” according to the article. For comparison, AARP raised about $300 million in membership dues in 2020.
There are questions about whether these partnerships are chosen because they benefit AARP members or because they are so profitable for the organization, according to the report. Marilyn Moon, a health policy analyst with AARP since the 1980s, said KHN that it’s “definitely a problem,” as the organization takes advantage of these Medicare-focused marketing partnerships while lobbying Medicare issues in Washington, D.C.
The partnership with Oak Street Health highlighted these concerns when the company was investigated by the US Department of Justice for its marketing tactics, KHN reported.
“It’s unclear whether they’re representing their business interests or those of the seniors they’re supposed to represent,” said Joshua Gordon, director of health policy for the Committee for a Responsible Federal Budget, a nonpartisan group. KHN.
DOJ Targets Medicare Advantage Billing Systems
The US Department of Justice is prioritizing the investigation of widespread fraud related to a false diagnosis program designed to raise Medicare Advantage fees, according to the Washington Post.
The government considers the practice of adding diagnoses to patients’ medical records to be fraudulent and has taken legal action against several companies, including UnitedHealth Group, Cigna and Anthem, according to the Job. The DOJ announced in February that these investigations are an “important priority,” according to the Job.
The Job reported that the fraud was made possible by incentives built into the Medicare Advantage program. The program paid companies a fixed fee for patient care as well as a “risk-adjusted” pay scale to reimburse health systems for longer, more expensive patients. By adding more unnecessary or previously resolved conditions, companies can increase the payments they receive for patients without using patient resources.
Critics said a side effect of this fraud is that it leads to inaccurate medical records, full of false diagnoses, “which could unnecessarily stigmatize patients who have been wrongly judged to be obese, malnourished or mentally ill”. said the Job reported. These false records could lead to “phantom influences” on the future medical care of these patients, according to the report.
The fraud was initially uncovered when a whistleblower, Kathy Ormsby, discovered the scheme designed to make patients sicker during an audit of her former employer, the Palo Alto Medical Foundation. The foundation and its parent subsidiary, Sutter Health, a Northern California health system made up of 24 hospitals, settled the lawsuit with the government in August 2021 for $90 million. They admitted no wrongdoing.
Ormsby discovered that his former employer was adding diagnoses to patient records without their knowledge to inflate Medicare billings. According to the government lawsuit, Ormsby audited hundreds of cases and found that 90% of cancer diagnoses were invalid. It also found that 96% of strokes and 66% of fractures were also not valid diagnoses.
Ormsby told the Job that “as we continued to audit, I started to see more things. I couldn’t believe how bad it was.”