Every choice has a consequence. How often have I said that and in how many settings? Yet, some people and even professions believe it always applies to the other guy. Big shots think that unethical behavior is the domain, for example, of automobile mechanics. Truth is, I have known many, extremely ethical automobile mechanics. Poor ethics is not determined by income, nor class, education or profession. Proof in point is what has just occurred in Modesto, California. Seems that medical ethics has gone bad!
Medical Ethics
Modesto is a lovely community in the middle of the California’s Central Valley. It is surrounded by agriculture; almonds, fruit trees, dairy farming and grapes. This case of bad medical ethics involving five medical doctors plus medical billing businesses and pharmacies smells more like the substance that farmers put on their fields.
California prosecutors have uncovered worker compensation fraud running into millions of dollars. In all, the huge case (with unethical tentacles throughout Southern California), has robbed the taxpayers of California of more than $23 million.
Behind the Scenes
Behind the unethical scam are the husband and wife team of Christopher and Tanya King, who were owners of three medical billing companies, namely Monarch Medical Group Inc., King Medical Management Inc. and One Source Laboratories Inc. They worked with the pharmacies and physicians to commit fraud. Fraud is killer especially in the sensitive arena of medical ethics. The Kings live in Beverly Hills (I’ll get to that in a minute).
The owners of the medical billing companies set up an illegal “partnership” with Modesto compounding druggists and physicians to prescribe unnecessary drugs to patients, then they intentionally overbilled insurance carriers. In addition, they excessively charged insurance agencies for pain drugs and the doctors ordered unnecessary medical tests. Apparently they felt medical ethics be damned.
This underhanded, unethical abuse of the system took place over four years, from 2011 to 2015, affected thousands of patients and about 25 insurance carriers.
The doctors, in some cases, partnered with the medical billing companies to split profits – a medical ethics no no! In essence, the medical billing service bought the drugs and then “sold them” to the insurance providers at more than 10 times cost. This was especially true when expensive creams were ordered where the patients were kept in the dark as to what they were being given – or why.
Obamacare? Trump care? Who cares?
At the time of this writing, our nation is sharply divided on the topic of healthcare. The issue is highly politicized and there is no lack of opinions. What amazes me is that people are so bound up in the politics and ignoring the ethical components of the entire medical system. And when a system is in such controversy it becomes easy to look past medical ethics and look the other way.
In this one case from Modesto and vicinity, $23 million was defrauded by physicians, pharmacies and medical billing agencies. It is the tip of the iceberg. Who knows how many hundreds of millions, if not billions of dollars are defrauded annually at every level of the system?
We can debate the politics of health care in America for hours or even weeks, but we cannot allow ourselves to overlook bad medical ethics. I wonder, just in the State of California alone, how many medical conventions led off with a keynote speech on the topic of ethics? How many major healthcare industry tradeshows addressed ethical issues? How often do ethical discussions take place in the insurance industry, pharmaceutical industry or even medical equipment manufacturers?
What are the true penalties for poor ethics in healthcare? Jail time? Hefty fines? While those are consequences to be sure, the real consequence is poor care. Millions of dollars drained from the healthcare system in one area, translates into inadequate care in other areas or ever increasing costs.
I would like to end this post with an illustration. The physicians, druggists and billing agencies in this case are all well-off. They are Upper Middle Class and higher. They live in nice homes and in more expensive communities. Yet, they are unethical and frankly, they are crooks. They deserve their punishments. Bad choices should never be confused with location, class or profession. The physicians, especially, may be brilliant diagnosticians, but ethically and morally they are corrupt.
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