UPMC, the Justice Department, and “Justice”

Nothing shows that the private, “non”-profit health care system is an abysmal failure like the recent whistleblower, false-claims suit brought against University of Pittsburgh Medical Center (UPMC) in Federal Court. While the wimpish Justice Department agreed to a settlement of only $2.5 million and failed to secure any admission of guilt, the exposure of appalling practices brought some credence to the fears and suspicions that swirl around UPMC patient care.

The public is indebted to the two doctors and a surgical technician, former employees of UPMC, for fearlessly standing up to the area’s largest employer and notorious bully. Drs. William Bookwalter and Robert Sciabassi and technician Anna Mitina have a commitment to patient health and well-being, a commitment uncommon in this era of health-care profiteering. I would gladly trust my health to them; others, I’m not so sure.

And kudos to the Pittsburgh Post-Gazette for giving the story more than a perfunctory news announcement. In follow-ups by writer Kris Mamula, many of the allegations that served as a basis for the suit were aired. Examples of overbilling, double-billing, unnecessary surgery, billing for unperformed surgery, and botched surgery were drawn from testimony. Patterns of incentivizing medical care through cost-cutting, short-cutting, and bill inflation were alleged. Others have documented that these practices are deeply embedded in the entire profit-driven private insurance and medical industry.

Given the enormous amount of advertising revenue (extracted ultimately from consumers) that UPMC passes through the media, the Post-Gazette assumed some risk in shedding light on UPMC sins.

Even more kudos to Tribune-Review columnist Kevin Heyl who scoffed at the paltry settlement concluded by the Justice Department:

UMPC suffered a barely perceptible bruise after being slapped on the wrist by the U.S. Attorney’s Office in Pittsburgh. To settle some claims in the lawsuit alleging the hospital network overbilled Medicare, Medicaid and Tricare, UPMC agreed to pay the federal government $2.5 million. (August 1, 2016)

Effectively employing satire, Heyl wrote:

“To come up with $2.5 million, they might have to search for the change underneath every cushion in (UPMC CEO) Jeff Romoff’s executive office couch,” the [fictional] observer said. “That could take seconds, perhaps even as long as a minute.”

Heyl went on to speculate that “the financial settlement likely distracted people from mediocre evaluations several UPMC hospitals received Wednesday in the latest federal government quality ratings. UPMC Mercy received two out of a possible four stars, as did UPMC Presbyterian and UPMC Shadyside, which were combined into one entity in the Centers for Medicare & Medicaid Services ratings.”

Reminding us that overbilling is not a new charge against UPMC, Heyl recalled that the health care/insurance behemoth “rebounded quickly from a similar injury suffered in 1998, when it paid the government $17 million after auditors uncovered another overbilling scheme.”

The “Justice” Department

Of course, no one should be surprised that the spineless Justice Department has shown such little enthusiasm in pressing UPMC. It was the Justice Department, after all, that could find no serious criminality in Wall Street moguls bringing the US economy to the edge of collapse.

And our local US Attorney, David L. Hickton, showed a similar timidity in choosing not to pursue a criminal case against the police who mugged a high school student, Jordan Miles. Instead, he told the Post-Gazette (November 9, 2013) that he’d prefer to address other issues: “‘Can we assemble 20, 30, 50 people who will look at the future?’ he asked, rather than dwell on past slights. ‘Are we going to develop a community intolerance for illegal guns? Are we going to develop a recognition that violence against police officers is as endemic as community violence?’” Hickton continues to “look at the future” well beyond police violence against African-Americans.

As for addressing the police violence that now draws widespread attention in the media, don’t expect much help from Attorney Hickton: “‘I’m trying to help,’ he cautioned, ‘but the communities are really going to be masters of their own fates.’” (P-G, 11-9-13)

Hickton reminds us again in a recent op-ed piece in the P-G (7-24-16) that his concept of civil rights is a little one-sided. He subjects the reader to a long diatribe on how police-community relations begin with respect for the police “who risk their lives every day to protect and serve the public and ensure the rule of law.” In a season of mass awareness of police violence against Black people, surely this focus  is a little misplaced, especially since cops commit one out of twelve of all killings in the US and the homicide rate for police (killings per 100,000 officers) is approximately the same as it is for the rest of the population.

It should not be surprising– since Hickton and the Justice Department have so little enthusiasm for making the police color between the lines–that they would be equally deferential to a powerful mega-corporation like UPMC.

Hopefully, there will be more legal actions addressing the grievances exposed by the settled whistle-blower lawsuit. However, it is difficult to have much confidence in the hesitant Justice Department. Some may experience even less confidence when they learn that the Justice Department’s representative in Western Pennsylvania is scheduled to speak on “Law Enforcement Meets Public Health” as part of a panel on opioid abuse at the UPMC’s fall conclave in late September at the luxurious Nemacolin Woodlands Resort. While a bit more law enforcement might be a welcome presence among UPMC’s top executives, some may wish for a less cozy relationship. No doubt Hickton will use the opportunity to deliver a searing rebuke of UPMC’s practices.

Well, maybe not.

Greg Godels

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