Go Broke Or Break The Law
An old boyfriend, a doctor who's on an elite liver transplant team in Manhattan, makes $30 an hour when he has to wake up at 3 a.m. to do a transplant on a Medicare patient. (Seen the rents and cost of living lately in Manhattan?)
I was reminded of that by a case in which a doctor used an "unapproved IUD," which doesn't mean that he fashioned it himself out of some bits of plastic or copper, but that he imported one from Canada that had not been approved by the FDA. Rob Lowes writes on Medscape:
Ob/gyns such as Dr. Shrum typically buy the IUDs they implant in patients. If a patient is insured, an ob/gyn then bills the insurer to recoup what he or she paid for the IUD. It often is not a break-even proposition. When Arkansas ob/gyns, for example, implant a levonorgestrel-releasing Mirena IUD (Bayer Healthcare Pharmaceuticals) in a Medicaid recipient, the state reimburses them roughly $448 for the device. Ob/gyns lose money on the procedure because they have to pay $700 to $800 for the IUD, assuming it is the FDA-approved version, which is the only legal version to use in this country.However, they can buy a Mirena IUD that lacks FDA approval from Canadian pharmacies for a little more than $200. By going with the less-expensive version, these physicians avoid losing money on the IUD procedure and instead earn a modest profit that subsidizes their care of Medicaid patients. After all, Medicaid programs across the country pay so little that many physicians turn away such patients, lest they go broke.
Conviction on Criminal Charges Could Mean Prison
The Canadian price break comes with a big risk. In June 2009, FDA agents found unapproved Mirena IUDs in Dr. Shrum's office -- a discovery that triggered criminal and civil charges.
Last October, a federal grand jury indicted Dr. Shrum with drug misbranding, healthcare fraud (for billing the state Medicaid program for unapproved IUDs), and 3 counts of money laundering (for depositing money from an allegedly illegal activity in his bank account). Dr. Shrum faces a maximum penalty of 3 years in prison and a $10,000 fine for misbranding, and a maximum of 10 years in prison and a $250,000 fine for healthcare fraud and for each count of money laundering, according to federal prosecutors.
..."Dr. Shrum wants his patients to know that they are not in any danger and he never risked their safety," Hicks said. "There is no threat to the public safety, and instead, the only conceivable harm is to Bayer's profits."
He noted that all Mirena IUDs are manufactured in a plant in Finland. What made Dr. Shrum's IUDs "unapproved," Hicks said, was that they were purchased at a lower price than what Bayer distributors sold them for in the United States and were packaged differently.
"It is unfortunate that the government is using our criminal justice system to line the pockets of a multinational, for-profit company," he said.
Maybe being just a few years older pays off on this one, but I remember that some horrible things happened to women using IUDs back in the day (early 70's). The lawsuits were outlandish. I can understand why a regulatory agency would be extra fussy about them.
Crid [CridComment at gmail] at July 31, 2010 12:12 AM
Why not just insist paitents purchase the IUD themselves and file their own medicare reimbursment forms
lujlp at July 31, 2010 12:57 AM
You want to see something funny?
http://www.usatoday.com/news/nation/2010-07-28-doomsday28_ST_N.htm?csp=obnetwork
End of the world insurance.
Given the billion dollar biodome never worked how do they expect these thing to work?
And who are you going to sue for your refund if it doesnt work, or the guards to the bigger facilites wont let you in?
And its not like any of the worlds governments would advertise a world killing asteroid or comet as doing so would lead to the break down of society long before it ever hit
lujlp at July 31, 2010 1:39 AM
Crap, worng thread
Delete it if you want to
lujlp at July 31, 2010 1:40 AM
I wonder if Obamacare will simply advise women to keep their legs shut, in order to save money on IUDs.
mpetrie98 at July 31, 2010 2:31 AM
Amy Alkon
http://www.advicegoddess.com/archives/2010/07/31/go_broke_or_bre.html#comment-1738579">comment from Crid [CridComment at gmail]Maybe being just a few years older pays off on this one, but I remember that some horrible things happened to women using IUDs back in the day (early 70's).
That was the Dalkon Shield.
http://en.wikipedia.org/wiki/Dalkon_Shield
Amy Alkon at July 31, 2010 5:04 AM
Conan joke via Cato's @DanMitchell:
Q: Heard about McDonald’s’ new Obama Value Meal?
A: Order anything you like & guy behind you has to pay for it.
–Conan O’Brien
Amy Alkon at July 31, 2010 6:12 AM
Not to pile on the doctor, but the Canadian government might wanna get in on this, since he also stole from the taxpayers of Canada.
See, the REAL reason that the IUD (and all other pharmaceutical products) are cheaper in Canada is that they are both price-controlled and subsidized by the government.
Which is also the reason why drug prices are so high in the US.
Someone's gotta pay for the research, right?
Won't matter in a few years though, there won't BE any pharma companies left because there won't be any markets where they can recover costs.
brian at July 31, 2010 6:22 AM
An old boyfriend, a doctor who's on an elite liver transplant team in Manhattan, makes $30 an hour when he has to wake up at 3 a.m. to do a transplant on a Medicare patient.
My boss was pre-med, but decided against medical school. Instead, he took his degree in Chemistry and went to work... selling fine wine to wholesalers. Today, he is the VP of Marketing for a distributor of wine and spirits. Whenever someone is sick, he likes to say, "Take the day off. There's nothing that can't wait; we're not saving lives here."
Ironic, considering that he makes out better financially as a booze marketer than he would have as an elite transplant physician who actually does save lives (at least the lives of the elderly and/or poor).
Guess we know where this country's priorities lie!
Beth at July 31, 2010 7:01 AM
Hey, wine has been more effective than medicine on many occasions. Or so I hear.
MonicaP at July 31, 2010 7:42 AM
Amy Alkon
http://www.advicegoddess.com/archives/2010/07/31/go_broke_or_bre.html#comment-1738605">comment from MonicaPHey, wine has been more effective than medicine on many occasions.
I try not to whine, but if I moan a little that I'm sick, and ask Gregg nicely, he'll bring me a big thing of Cantor's chicken soup, the best chicken soup I've ever had.
I did find it cute that somebody, last week or so, suggested I make my own. I kinda do. I pour it in a mug and put it in the microwave and push the button to heat it.
Amy Alkon at July 31, 2010 8:46 AM
The doctor knew he was importing illegal IUDs and could have simply refused to do the procedure because he wouldn't get fully reimbursed for the legal IUDs.
Instead he chose to knowingly break the law (yes, a silly law) and must now pay the price.
I hope the law gets changed.
US Grant: "I know no method to secure the repeal of bad or obnoxious laws so effective as their stringent execution."
Conan the Grammarian at July 31, 2010 9:43 AM
No one seems to have explicitly explained this, so for clarity: it is entirely normal for drug companies to market the identical product in different countries, using different packaging different names. This allows them to charge different prices for the same product, and have the government help them enforce these price differences for them.
They are gaming the system, and the government is a patsy, letting itself be abused in this way. Actually being stupid enough to charge the doctor with and prosecute him? I suppose the bureaucrats have to justify their existence...
bradley13 at July 31, 2010 10:57 AM
Government Management of Doctors
Doctor: I dreamed of being a doctor, and earned my M.D.
Mike: I'm puzzled. Why are you managing a government department?
Doctor: As a doctor, I realized I was mostly managing a government department. This way, I get paid to do it, and I go home at 4:00.
Medicare has degraded to the point where reimbursements minus imposed costs are not enough to support doctors. The true, awful promise of Obamacare is to make this worse. Medical prices have been grossly distorted along the way, with more distortions to come.
Doctors are moving away from Medicare just as Obamacare tries to provide all services as in Medicare.
Intrusive laws and "free-care" requirements are changing medicine from a vocation to just a job. Do we want doctors, or bureaucrats who don't mind practicing medicine on the side?
Andrew_M_Garland at July 31, 2010 11:09 AM
Madness.
The thing is, if Doctors wanted this idiocy to stop, all they'd have to do is react to it.
Simply announce that unless certain idiocies are revoked and eliminated by a given date, they will refuse to practice on that day.
Government action is slowly enslaving the medical practice. The result will be the destruction of quality medical care.
Robert at July 31, 2010 11:51 AM
But if doctors refuse to practice, people who really need their help could be in serious trouble. For that reason, I don't think that will help.
Remember the "gas out" days where people were urged not to buy gas on a particular day? Did that make any difference.
What we need to do is get it through to Washington that we want them to stop making medical stuff worse. And if they don't get it, we vote in someone new.
I'm also really sick of politicians and celebrities who want to raise our taxes "for the good of all". Yeah, right. Why don't they use their own money? And how come stuff that sounds noble when they talk about it ends up making things worse.
Want to make things better for poor people? Make sure their kids can get decent educations and don't have to be afraid walking home from school or running an errand. Offer scholarships so that adults can learn a vocation or skill or something where they can get better jobs. Sure, make sure they have enough to eat and someplace to stay, but the beauracracy needs to be streamlined.
Kris L at July 31, 2010 3:57 PM
There are many honest,ethical lawyers practising today. Unfortunately the sleeze bag ones give the other 2% a bad name.
Jay at July 31, 2010 5:39 PM
Very good Jay.
-----------------------------
The more a government (or bureaucracy) gets involved in individual issues the more the individual or group is fucked.
My last company and current company both have employees complain about the insurance. And that is a 5K or less crowd.
When you look at trying the same crap across millions -- we are so fucked.
Jim P. at August 1, 2010 5:45 AM
The problem is that the government can do a few things really well.
Everything else, it'll fuck up.
We need to realize that there are very few things that the government can do to make people's lives better, but a whole lot it can do to make them worse.
The federal government should focus on its strengths, and leave the rest to state and local governments, NGOs, and private citizens.
Robert at August 2, 2010 1:35 PM
Leave a comment