Tag Archives: grassley

ProPublica investigates ties between doc groups, industry

With an assist from Sen. Chuck Grassley, ProPublica senior reporters Tracy Weber and Charles Ornstein, AHCJ’s board president, have published their latest data-heavy investigation (USA Today version). This time, their journey into the myriad avenues pharmaceutical companies pursue to influence physicians has taken them into the world of professional societies and annual conferences. The duo writes that despite the power of these groups, their dependence upon millions and millions of dollars in industry funding has often slipped under the radar.

Professional groups … are a logical target for the makers of drugs and medical devices. They set national guidelines for patient treatments, lobby Congress about Medicare reimbursement issues, research funding and disease awareness, and are important sources of treatment information for the public.

Their strongest anecdote comes from the Heart Rhythm Society, a group which, in 2010, pulled in about $8 million – half their total income – directly from manufacturers of the drugs and devices their members specialize in prescribing for, or implanting in, patients. The society has started to disclose these relationships, but perhaps not to limit them, the reporters write. “’This is our business,’ said Dr. Bruce Wilkoff, the incoming society president. ‘We either get out of the business or we manage these relationships. That’s what we’ve chosen to do.’”

The companies also pay two-thirds of the society’s board members speaking or consulting fees, a situation Weber and Ornstein found is far from unusual. In addition to these financial conflicts, the reporters gathered some fascinating examples of just how deep industry influence can run. My personal favorite comes from the conference of a well-known collection of cardiologists.

Last month, the American College of Cardiology attached tracking devices to doctors’ conference ID badges. Many physicians were unaware that exhibitors had paid to receive real-time data about who visited their booths, including names, job titles and how much time they spent.

For more examples, I recommend Robert Durrell’s photographs from the 2011 Heart Rhythm Society annual conference, which show dozens of industry-sponsored objects alongside the amount of money each company paid for that particular privilege. Dan Nguyen and Nicolas Rapp put together an infographic that expands upon a similar theme.

Much of the disclosure data the ProPublica team depended on for their reports was released in response to a request for informationGrassley sent out in late 2009. His investigation has started to yield some preliminary results.

There are fledgling efforts to push medical societies toward stricter limits on industry funding: 34 groups have signed a voluntary code of conduct calling for public disclosure of funding and limits on how many people on guideline-writing panels have industry ties.

“The general feeling is that the societies need to be independent of the influence of companies,” said Dr. Norman B. Kahn Jr., chief executive of the Council of Medical Specialty Societies, which helped draft the code.

Senators join fight to open Medicare claims data

Two senators have joined the effort to open up the Medicare claims database that reveals what payments doctors get through the system.

Covering Health readers might remember that Dow Jones & Co. – parent company of The Wall Street Journalfiled a lawsuit in January in its attempt to overturn an injunction that “prevents the public from knowing how much taxpayer money individual doctors receive from the Medicare program,” according to a press release.

Republican Sen. Chuck Grassley of Iowa and Democrat Sen. Ron Wyden from Oregon are pushing legislation to overturn the same 1979 injunction.

Neither senator, nor Dow Jones, seek the release of private patient data. The Medicare claims data has proven useful in fighting fraud and abuse in the system, allowing journalists or investigators to identify anomalies.

Grassley said “he was prompted in part” by articles in The Wall Street Journal about the Medicare database and fraud. Wyden, who spoke at Health Journalism 2009, said he plans to discuss joining forces with Grassley, saying, “I believe we can have a bipartisan bill on this.”

Preventing health care fraud was the subject of a Senate finance committee hearing on Wednesday, where Grassley and Wyden heard from the director of the Center for Program Integrity, Centers for Medicare & Medicaid Services, and from Daniel Levinson, inspector general for the U.S. Department of Health and Human Services. Their statements, as well as video of the hearing, are available online.

Four states refuse to name hyper-prescribing docs

As part of his war against overprescription and fraud, Sen. Charles Grassley asked states to share data on doctors who  write colossal amounts of prescriptions for drugs covered by Medicaid. At this point, at least four states are holding out, and Pharmalot’s Ed Silverman is naming names. Montana, Alabama, Wisconsin and New Jersey have declined Grassley’s request, and a commenter says Michigan, which didn’t name names, belongs on the list as well.

Silverman attempted to contact the four holdouts he listed and gleaned what other information he could from other published sources. The reasons officials gave are, for the most part, well-worn: The data’s too expensive to collect, it doesn’t have enough context and, according to Alabama, might wrongly pinpoint physicians with legitimate reasons for prescribing all those drugs.

In reply, Silverman lets the already disclosed data speak for itself:

… in Florida, the top Zyprexa provider wrote 1,356 scrips for 309 patients in 2008 and 1,238 for 236 last year, compared to the 10th-highest prescriber each year who wrote 256 for 55 patients and 192 scrips for 30 people, respectively (more here). In Texas, one doc authorized 13,596 filled scrips for Xanax in 2008, and increased that to 14,170 filled in 2009. The doc who occupied the lowest ranking in the top 10 prescribers wrote just 1,444 and 1,696, respectively. The list goes on…


AHCJ members can read more about getting Medicaid prescribing data from states in this article by Christina Jewett. Jewett, now at CaliforniaWatch, requested Medicaid data from a number of states for an investigation for ProPublica.

Fraud-busting contractors slow to refer cases

Despite recent high-profile busts, the private contractors hired by Medicare to sniff out fraud cases and refer them to law enforcement seem to be lagging, according to recent government reports. The Associated Press’ Ricardo Alonso-Zaldivar reported on investigations that found that contractors took an average of 178 to refer fraud cases, and that the government was only able to recover a small fraction of the money identified as lost to fraudsters (OIG report | Testimony).

As this letter summarizing the congressional investigation shows, Iowa Sen. Chuck Grassley is on the case. He’s looking to figure out how much the fraud hunters are paid ($102 million in 2005) and how that balances with their benefit to taxpayers ($55 million recovered by the feds in 2007). The numbers are tricky, Alonso-Zaldivar writes, because fraudulent claimants have a habit of closing up shop and disappearing as soon as they’re notified of the pending investigation. Thus, the fraudbusters can’t be blamed entirely for the collection failures, though their tardy referrals are at least partially responsible.

The contractors have widely different track records. One identified $266 million in overpayments in 2007, while another found just $2.5 million, the Health and Human Services inspector general said in May.

Earlier, the inspector general found gaping differences in the number of new cases the contractors generate for law enforcement. Some had hundreds of cases, while others were in the single digits. Most were doing a poor job at spotting new fraud trends, with “minimal results from proactive data analysis,” the inspector general concluded.

The Obama administration says it’s aware of the problem and is close to completing a reorganization of the contractors, to consolidate their work, define their jurisdictions more clearly, and help them coordinate better with claims processors and law enforcement.

The new “Zone Program Integrity Contractors” will cast a somewhat wider net, and be more closely monitored by federal health officials.


(Hat tip to Ricardo-Alonzo Zaldivar for providing a copy of the Grassley letter)

Grassley digs into journal ghostwriting practices

Ben Comer of Medical Marketing & Media reports that Iowa Republican Senator Chuck Grassley sent a letter to eight prominent medical journals, asking them to share their editorial policies regarding the disclosure third parties involved in the creation of journal articles, as well as the penalties they have set for authors who don’t follow those policies. Grassley asked the journals to respond by July 22. Read the senator’s press release here.