Squeezing Out Healthcare Profits Squeezes Patients
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Insurance Company Fraud
Humana has agreed to pay $90 million to settle a whistleblower lawsuit by one of its former actuaries accusing the health insurer of overcharging the U.S. government for prescription drugs, the whistleblower's lawyers announced on Friday.
The whistleblower, Steven Scott, said that Humana, which contracts with the federal Medicare program to administer prescription drug benefits, misrepresented its true costs in order to get a more lucrative contract. It is the first settlement with any insurer over allegations of fraud tied to Medicare's prescription drug contracting process, according to the law firm Phillips & Cohen, which represents Scott. (Reuters)
Childhood Vaccines
It’s August and school starts pretty soon. Doctors are urging parents to check that kids' routine vaccines are up-to-date before their first day of school.
Children should begin vaccinations against 15 potentially serious diseases before they turn 2, according to the Centers for Disease Control and Prevention. This includes annual shots against influenza and COVID-19. (USA Today)
While kids receive most of these shots during routine checkups, doctors say some pediatric patients are still behind after the pandemic interrupted wellness visits. Physicians encourage parents to make sure their kids are up to date before they head to class.
The Vaccines for Children program has brought about a record increase in vaccinations since it was established in 1994, although the pandemic hindered some of that progress.
Most vaccines are delivered in multiple doses on a schedule. They protect against diseases such as hepatitis B, rotavirus, diphtheria, pertussis (whooping cough), tetanus (lockjaw), Hib (haemophilus influenza type b), pneumococcal disease, polio, measles, mumps, rubella, chickenpox and hepatitis A.
Vaccines are sometimes lumped together in a single vial, making it possible to protect against multiple viruses in one series of shots. For example, children only need one series of doses to protect against measles, mumps and rubella; and diphtheria, tetanus and pertussis are also targeted jointly in a single series of shots.
Recent outbreaks of measles, a highly transmissible disease that can be prevented with vaccines, show the importance of high vaccination coverage. For every 10,000 children infected with measles, 2,000 will be hospitalized; 1,000 will develop ear infections with the potential for permanent hearing loss; 500 will develop pneumonia; and 10 to 30 will die, said the dean of the National School of Tropical Medicine at Baylor College of Medicine. (NBC)
At least 13 measles outbreaks have been reported in 2024, according to the CDC, including one that occurred earlier this year in a Florida elementary school. Of the 219 cases reported this year, 40% were in children younger than 5, and 87% were among adults and children who were unvaccinated or whose vaccination status was unknown.
While childhood vaccinations are typically mandated for public school attendance, they are not always required for private schools and many localities offer waivers for a variety of reasons such as religious objection. Of course, thanks to wide, disinformation campaigns, many are hesitant to vaccinate.
Here is the CDC list of vaccines recommended by age and on this CDC page you can see the full schedule , 0-6 years old, and then older children. Don’t forget COVID, Flu and RSV.
When Profits and Patients Collide
We have covered private equity investments in healthcare and it rarely results in any improvement for the patient. Techniques are employed that involve short staffing, breaking the facility into separate paying companies and profit centers, front loading the facility with debt. These techniques work well to squeeze out high dividends to investors quickly. Of course you don’t have to be a private equity fund, many of these techniques are employed by publicly traded for profit entities, like, HCA.
A new working draft study out of Wake Forest University is the most comprehensive analysis of the personnel crisis at Mission Hospital in North Carolina to date, using hundreds of interviews, documents and media reports to tell the story of a mass exodus of doctors, a poor working environment for nurses and a dangerous situation for patients, all brought on by profit-centered management. (Asheville Watchdog)
The 49-page report, titled “Changes in Patient Care Following HCA’s Purchase of Mission Hospital,” and its accompanying 30-page appendix of sources comprise the first academic summary of Mission’s staffing tumult since HCA Healthcare bought the Mission Health system for $1.5 billion in 2019.
The report, written by professor Mark Hall, an independent academic researcher and a member of the National Academy of Medicine, reaches three conclusions about what happened after HCA’’s purchase:
Doctors left Mission because of quality-of-care and financial issues and have been replaced by less experienced staff. Today some specialties are severely depleted or gone, including otolaryngology (ear, nose, and throat), urology, rheumatology, orthopedics and neurology, according to the report.
HCA’s management slashed staffing among nurses and other personnel vital to patient care.
Understaffing has caused “a multi-faceted debacle” in Mission’s emergency department, one that in 2024 drew federal scrutiny, which threatened the hospital’s Medicare and Medicaid funding.
These adverse developments have been driven by HCA’s financially-focused management decisions, which have been enabled by Mission’s market position as the only hospital in the area’s largest county and the only tertiary care hospital in western North Carolina.
When the patient is the vehicle for profit the patient suffers. We can ask Congress to Change the Rules so patients are treated more fairly. The legislation should prohibit hospitals that take federal funds putting patients at risk while they squeeze out profits. They should also have to create an escrow account with enough money to cover 5 more years of operations so they can’t just close and leave patients high and dry.
Let’s let Congress know.
ACTION
Let’s let our members of Congress and senators know that patients are hurt when profits are more important than patient outcomes in healthcare. We need legislation that stops management short staffing and eliminating care or functions at patient expense. They should also set up an escrow account with enough money to continue care for 5 years in the event of financial hardship of the facility. You can reach them here, https://www.usa.gov/elected-officials.
Or Or use RESISTBOT via [Apple Messages / WHATSAPP / MESSENGER] or by texting SIGN PJUQZKto 50409 on your cell phone to send this message.
“I am your constituent and I want you to know that HCA Healthcare, one of the biggest for profit hospital operators, is busy squeezing money out of one of their recent purchases, Mission Hospital in North Carolina, at patient expense. You can read the report written by a member of the National Academy of Medicine here, https://hlp.law.wfu.edu/wp-content/uploads/sites/11/2024/08/HCA-Mission-Changes-in-Patient-Care-Following-HCAs-Purchase-working-draft-WFU.pdf.
I bring this up for a reason. While making a profit is fine, this company, is following some of the same techniques that private equity firms use when they buy medical facilities and squeeze them dry. The bottom line is that patients suffer.
I want you to have a look at the Health Over Wealth Act in Congress and modify it so that it applies to any commercial entity that purchases a healthcare facility or hospital. It demands an escrow account with sufficient funds to operate for 5 years in the event of failure to protect patients, it prohibits shady real estate transactions that bleed new purchases dry. It prohibits stripping out assets to reap profits while patients suffer - think about eliminating staff and leaving patients untreated.
This is a lot to ask but this is one of the ways hospitals are forced to close, when the are captured by for profit ventures that squeeze out every nickel and then declare bankruptcy. Here is a link to a summary of Senator Markey and Representative Jayapal’s Health Over Wealth Act for reference, https://www.markey.senate.gov/healthoverwealth.
Please take action on this.
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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