It has now been roughly 37 hours since I returned home from a vacation in Austin, TX.
A vacation is not usually a time of positive personal accomplishment. From this particular respite, I can say that the only net gains in my column were 4 1/2 pounds of buffet weight, the free beer I had bestowed upon me in an Irish bar on 6th Street from a friendly couple who enjoyed my musical interlude (thank you again, kind strangers) and the bodies of dead bugs from seven different states that now decorate my windshield in all of their Jackson Pollock-esque splendor.
When it comes to a permanent fix to the Sustainable Growth Rate formula (SGR) for Medicare payments, the U. S. Congress accomplished little more than I did during the same period of time.
Currently, there is a plan being floated by the Democrats in the House of Representatives that would delay a permanent fix to SGR until 2015. The plan would provide pay increases for a four-year period. This legislation would again need to advance prior to the latest deadline of June 1, 2010 to avoid the oft-delayed 21.3% cut that was set to originally take place at the beginning of this calendar year.
As with all past temporary fixes that have taken place, this legislation has the effect of kicking the larger problem down the road and feeding the vulture that is the pay cut, which by some estimates could be as high as 37% when 2015 rolls around.
Looking at the calendar, we are again faced with five working days to attend to the latest temporary fix before Congress takes a one-week recess for Memorial Day. This recess is expected to be spent knee-deep in the process of campaigning in an election year. If I had to make a prediction, I would begin to get comfortable with the idea of another CMS-induced delay of 10 business days for claims processing beginning on June 1st until either the legislation above or a different package offering a stay of execution of the current planned pay cut is implemented.
Also greeting me upon my return was another bit of news regarding a study published in the New England Journal of Medicine. The study was conducted jointly by scholars at Harvard Medical School and Tufts University School of Medicine among others, and focused on the effects felt by insiders who decide to file qui tam, or “whistleblower” lawsuits in the pharmaceutical industry. Despite the fact that $9 billion had been recovered due to qui tam lawsuits between 1996 and 2005, the study concluded that there is a high personal and professional toll felt by those who file qui tam lawsuits against their employer.
Twenty-six informants were interviewed for the study, which in addition to the above, led to a variety of findings:
- 82% were subjected to firing, intimidation or blackballing upon filing the lawsuit;
- The filing of lawsuits in most cases is precipitated by a job change, such as a promotion or other career change that makes the person privy to inside information about company operations;
- Most of the whistleblowers attempted in vain to find an internal remedy to the unethical behavior, but were either ignored, dismissed or given orders to continue the behavior unabated.
What jumped out at me was that last bullet. With 90% of fraud suits starting with the qui tam process, I find it amazing that after years of awareness of the consequences of non-compliance, the primary reaction of companies whose policies are questioned from the inside tends not to be “OK, let’s investigate and if necessary, fix this”, but instead defaults to “Don’t rock the boat”.
The study recommended several steps to improve the qui tam process, including better employee protections against retaliation, increased resources for the U. S. Justice Department for enforcement (over 1,000 qui tam cases are pending currently with the department) and rewards for insiders that are equitable based on the dollar amount of the fraud that is uncovered.
The co-authors also recommended that policymakers try to instill an ethical sense that encourages more people to come forward. While that is a noble endeavor, it is also up to the companies themselves to operate in an environment of ethics and integrity that encourages the solving of problems as they arise, rather than the time-honored tradition of sweeping the problem under the rug in hopes that problems disappear permanently.
To put it another way based on recent personal experience, if you’re driving the same road without windshield washer fluid and the bugs are continually hitting your windshield, there will come a time when you can’t see where you’re going and you lose direction.