Accountable Strategies blog

A blog about accountability issues in the public, private, and nonprofit sectors

Posts Tagged ‘health care’

On polls about government and health care

Posted by David Kassel on September 8, 2009

The trouble with basing political decisions on polls, as many elected officials and politicians do these days, is that most polls don’t seem to be very good at measuring people’s real opinions. 

The reason may be that those opinions are likely to be mixed–even among the same people on the same issues.

For instance, a New York Times  poll in July found “a nation torn by conflicting impulses and confusion”  about health care reform.  In the poll, 75 percent of the respondents said they were concerned health care costs would skyrocket if the government didn’t step in to provide a health care system for all Americans.  Yet the same poll also found that 77 percent were concerned costs would go up if government did create such as system.

How do you base political and policy decisions on results like that?

That same confusion and ambivalence appears to characterize American’s feelings about government in general.   PA Times, a monthly publication of the American Society for Public Administration,  reported that 79 percent of Americans say they would encourage young people to work for the federal government.  This finding came out of a George Washington University Battleground Poll, conducted in July.  

Yet, according to the same poll, only 21 percent of the respondents had a great deal or a lot of confidence in federal civilian employees.

But before getting too discouraged about government, big business, newspapers, and HMOs fared as badly or worse in a similar poll conducted by Gallup in June, according to PA Times.  In June, Gallup asked a similar question about confidence in employees of several professions.  Among the following institutions, the level of confidence held by respondants was:

Newspapers (25 percent), TV news (23 percent), banks (22 percent), organized labor (19 percent), HMOs (18 percent), Congress (17 percent), and big business (16 percent).  On the other end of the spectrum were the military (82 percent), small business (67 percent), the police (59 percent), and organized religion (52 percent).

The question Gallup asked was:  “Thinking about the civilian employees of the federal government and your view of them, would you say that you have a great deal of confidence, a lot of confidence, some confidence, or very little confidence in these employees?”   The George Washington University poll excluded the military, which tends to draw higher public confidence than other institutions.

This type of question and the responses to it illustrate some inherent weaknesses in polling.  People’s feelings and beliefs about these issues are clearly mixed.  They are based on presumptions that may not always be examined or questioned.  On the one hand, the George Washington University poll shows that people have little confidence in the federal workforce.  Yet, they endorse it as a profession for young people.

Similarly, polls, such as the Gallup poll, show people hold Congress in the lowest esteem among practially all institutions.  Yet, late last month, we saw an  outpouring of public emotion at the passing of Senator Ted Kennedy,  albeit a famous and unusually productive member of Congress.

Like statistics, polls can be made to say just about whatever you want them to.  We should pay far less attention to them than we do.


Posted in Governance, Public | Tagged: , , | Comments Off on On polls about government and health care

Health care fraud and whistleblowers

Posted by David Kassel on November 25, 2007

Cynthia Fitzgerald filed one of the largest whistleblower lawsuits on record—a suit, which names companies such as Johnson & Johnson, Becton Dickinson, and Merck as participants in massive health care overcharges, The New York Times reported last week.

Yet, in a full-page editorial in The Times yesterday on the reasons for the high cost of health care, health care fraud isn’t even mentioned.  The editorial argues that the main driver of high medical spending is our wealth, which causes us to rely on costly specialists who overuse advanced technologies.  The editoral goes on to recommend several solutions, never once suggesting that we make an effort to control fraud, starting with better protections for whistleblowers and better auditing.

Why does health care fraud go so unrecognized as a driver of health care costs?  Not only do papers such as The Times ignore fraud as a factor even as they print stories about it, but Congress appears uninterested as well. 

Like many whistleblowers, Fitzgerald lost her job after she complained to company higher-ups about sales practices she came to believe were draining millions of dollars out of public programs such as Medicare through overcharges and other unauthorized uses.  Her subsequent suit alleges systematic fraud across a network of companies and more than 7,000 health care institutions.

Fitzgerald worked for a company called Novation, which helps hospitals, rehabilitation centers, home health agencies and doctors’ offices negotiate prices for medical supplies.  Novation is the nation’s largest group purchasing organizations for hospitals, buying more than $25 billion in supplies and services each year.

Fitzgerald’s case points up the need for new legislation, including the Private Sector Whistleblower Protection Streamlining Act of 2007 (H.R. 4047), and a second bill that would close loopholes under the False Claims Act (S. 2041).  It’s one of many pieces of whistleblower-protection legislation that appear to be going nowhere in Congress, according to the National Whistleblower Legal Defense & Education Fund.  

Fitzgerald’s suit was filed under the False Claims Act, which allows private citizens to sue on behalf of the federal government, if they believe fraud has occurred, and share in the financial recovery.

 A spokesperson for Novation alleges that Fitzgerald:

 …is rehashing old rumors and suspicions.  These allegations have been examined in depth by a variety of different authorities, and no one has proven any of them to be true.

In other words, calm down everybody, there’s no such thing as health care fraud.

But the existence of health care fraud is not a rumor or suspicion.  Malcolm Sparrow of the Kennedy School of Government argues that fraud may well be a “hidden factor” in the growth of Medicaid, Medicare, and health care spending in general.  The problem is that government and the medical establishment, in particular, are largely uninterested even in measuring it, he maintains. 

The Times article last week provided a good account of how health care fraud is allegedly committed in the medical supply industry.  The artice reported that in 1998, a few months into her job at Novation, Fitzgerald and her boss attended a meeting with a Johnson & Johnson sales team seeking an exclusive three-year  contract to sell $130 million worth of IV equipment to Novation’s clients.  The bids for the contract had already been received, and Fitzgerald contends it was her understanding that she was not supposed to meet individually with any of the vying bidders.  During the meeting, the Johnson & Johnson team allegedly sought inside information on how they could get the contract. 

Fitzgerald says she brought the meeting to a halt and later notified her company’s legal department and the company president about the situation and got little satisfaction.  The same dynamic happened with other companies.  After she asked her supervisor to be taken off a contract in which a bidder had said he would “take care of her,” she was fired for nonperformance of duties.

When companies submitted bids to Novation, there were frequently offers thrown in for things such as shares of stock and sometimes even cash, Fitzgerald alleges.  These “rewards” and rebates would get passed through to hospitals, which would then pass through the charges to Medicare, she contends.

A recent survey by PricewaterhouseCoopers shows that whistleblowers are one of the most effective means of exposing these practices.  Yet, health care fraud and the protection of whistleblowers, in particular, don’t seem to be on the radar screen.  Why? 

Posted in Oversight, Private, Public | Tagged: , , , , | 2 Comments »