Provider Conflicts of Interest in US Healthcare

2020 ◽  
Author(s):  
Richard S. Saver
Keyword(s):  
Empirical Evidence ◽  
Clinical Judgment ◽  
Conflicts Of Interest ◽  
Common Law ◽  
Third Party ◽  
Health Law ◽  
Legal Response ◽  
Drug Companies ◽  
Insufficient Response ◽  
Financial Arrangements

This chapter focuses on provider conflicts of interest (COIs) in US healthcare. Physicians practice within a turbulent US healthcare system featuring expanding complexity and commercialization. Potential COIs abound, including financial arrangements with drug companies and third-party payers that threaten to undermine clinical judgment and steadfast devotion to the patient. The chapter explores how the obligation to avoid or manage COIs is not always clear and uniform under US law; instead, it arises from a confusing patchwork of overlapping legal sources, including common law doctrines and regulatory provisions that are often limited in application or impose difficult procedural and proof burdens. The typical legal response to COIs has been required disclosure, but disclosure proves a necessary yet insufficient response with potentially unintended results. The chapter then explains why regulation of provider COIs remains particularly challenging for US health law, including limited empirical evidence about the effect of COIs on healthcare, difficulties in developing proportionate responses, and uncertainty in how to address secondary interests that advance important societal goals beyond the immediate patient's welfare.

Death, taxes and uncertainty: Economic motivations in end-of-life decision making

2021 ◽  
pp. 147775092110114
Author(s):  
George Slade Mellgard ◽  
Jacob M Appel
Keyword(s):  
End Of Life ◽  
Ethical Issues ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Third Party ◽  
Ethical Conflicts ◽  
Financial Interests ◽  
End Of Life Decision ◽  
Death Taxes

Economic motivations are key drivers of human behavior. Unfortunately, they are largely overlooked in literature related to medical decisionmaking, particularly with regard to end-of-life care. It is widely understood that the directions of a proxy acting in bad faith can be overridden. But what of cases in which the proxy or surrogate appears to be acting in good faith to effectuate the patient’s values, yet doing so directly serves the decision-maker’s financial interests? Such situations are not uncommon. Many patients care as deeply about economic wellbeing of their families as they do for their own lives and health. This brief work examines three scenarios that raise ethical issues regarding the role of pecuniary motives in making critical medical decisions. Each scenario presents a potential financial conflict of interest between an incapacitated patient and a third-party decision-maker and offers a framework for integrating ethical and legal concerns into clinical care. It is our hope that this work prepares physicians for unexpected ethical conflicts of interest and enables them to further the interests of his or her patients.

scholarly journals Adolescent Depression Screening: Not So Fast

2020 ◽  
Vol 10 (1) ◽  
pp. 59-69
Author(s):  
Edmund C. Levin
Keyword(s):  
Pharmaceutical Industry ◽  
Adolescent Depression ◽  
Conflicts Of Interest ◽  
Task Force ◽  
Third Party ◽  
Screening Tools ◽  
Depression Screening ◽  
The Us ◽  
National Organizations ◽  
The Uk

Background: Screening adolescents for depression has recently been advocated by two major national organizations. However, this practice is not without controversy. Objective: To review diagnostic, clinical, and conflict of interest issues associated with the calls for routine depression screening in adolescents. Method: The evaluation of depression screening by the US Preventive Services Task Force is compared and contrasted with those of comparable agencies in the UK and Canada, and articles arguing for and against screening are reviewed. Internal pharmaceutical industry documents declassified through litigation are examined for conflicts of interest. A case is presented that illustrates the substantial diagnostic limitations of self-administered mental health screening tools. Discussion: The value of screening adolescents for psychiatric illness is questionable, as is the validity of the screening tools that have been developed for this purpose. Furthermore, many of those advocating depression screening are key opinion leaders, who are in effect acting as third-party advocates for the pharmaceutical industry. The evidence suggests that a commitment to marketing rather than to science is behind their recommendations, although their conflicts of interest are hidden in what seem to be impartial third-party recommendations.

scholarly journals A hidden web of policy influence: The pharmaceutical industry’s engagement with UK’s All-Party Parliamentary Groups

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252551
Author(s):  
Emily Rickard ◽  
Piotr Ozieranski
Keyword(s):  
Pharmaceutical Industry ◽  
Conflicts Of Interest ◽  
Pharmaceutical Companies ◽  
Total Drug ◽  
Conflicts Of Interests ◽  
Policy Influence ◽  
Patient Organisations ◽  
Drug Companies ◽  
Health Related ◽  
Industry Needs

Our objective was to examine conflicts of interest between the UK’s health-focused All-Party Parliamentary Groups (APPGs) and the pharmaceutical industry between 2012 and 2018. APPGs are informal cross-party groups revolving around a particular topic run by and for Members of the UK’s Houses of Commons and Lords. They facilitate engagement between parliamentarians and external organisations, disseminate knowledge, and generate debate through meetings, publications, and events. We identified APPGs focusing on physical or mental health, wellbeing, health care, or treatment and extracted details of their payments from external donors disclosed on the Register for All-Party Parliamentary Groups. We identified all donors which were pharmaceutical companies and pharmaceutical industry-funded patient organisations. We established that sixteen of 146 (11%) health-related APPGs had conflicts of interest indicated by reporting payments from thirty-five pharmaceutical companies worth £1,211,345.81 (16.6% of the £7,283,414.90 received by all health-related APPGs). Two APPGs (Health and Cancer) received more than half of the total value provided by drug companies. Fifty APPGs also had received payments from patient organisations with conflicts of interest, indicated by reporting 304 payments worth £986,054.94 from 57 (of 84) patient organisations which had received £27,883,556.3 from pharmaceutical companies across the same period. In total, drug companies and drug industry-funded patient organisations provided a combined total of £2,197,400.75 (30.2% of all funding received by health-related APPGs) and 468 (of 1,177–39.7%) payments to 58 (of 146–39.7%) health-related APPGs, with the APPG for Cancer receiving the most funding. In conclusion, we found evidence of conflicts of interests through APPGs receiving substantial income from pharmaceutical companies. Policy influence exerted by the pharmaceutical industry needs to be examined holistically, with an emphasis on relationships between actors potentially playing part in its lobbying campaigns. We also suggest ways of improving transparency of payment reporting by APPGs and pharmaceutical companies.

scholarly journals Pharmaceutical Phonies: The Entanglement of Fraud, Third-Party Payors, and Proximate Cause in Civil RICO Cases

2021 ◽  
Vol 9 (4) ◽  
pp. 1-11
Author(s):  
Merrick Max Dillard Hayashi
Keyword(s):  
Health Risks ◽  
Case Law ◽  
Case Note ◽  
Third Party ◽  
Pharmaceutical Companies ◽  
Related Case ◽  
Proximate Cause ◽  
Drug Companies ◽  
District Council ◽  
Health Care Fund

This Case Note analyzes the Ninth Circuit’s approach to the issue of whether patients and doctors destroy proximate cause in cases where third-party payors (“TPPs”) sue drug companies for fraudulently misrepresenting the health risks associated with their products. In the 2019 case Painters & Allied Trades District Council 82 Health Care Fund v. Takeda Pharmaceuticals Co., the Ninth Circuit held that TPPs suing to recover damages from a pharmaceutical company for the fraudulent omission of a drug’s health risks could satisfy the proximate cause requirement for a civil cause of action under § 1964(c) of the Racketeer Influenced and Corrupt Organizations Act (“RICO”). The Ninth Circuit’s decision is satisfactory in that it faithfully (1) observes the Supreme Court’s direct relation test and (2) follows precedent establishing that a plaintiff satisfies the proximate cause requirement when their alleged injury is a foreseeable and natural consequence of the defendant’s fraud. As a matter of public policy, this holding is positive because it hamstrings pharmaceutical companies’ ability to escape liability by hiding behind patients, doctors, and other actors inhabiting the chain of causation. Additionally, the Ninth Circuit’s holding is positive in that it adheres to Supreme Court precedent and helps deter future injurious conduct. In support of these assertions, this Case Note begins by examining the factual background and procedural posture of Painters. The Note continues by analyzing the majority’s opinion with respect to related case law and closes by suggesting ways to address some of the potential problems that could stem from the Ninth Circuit’s decision.

scholarly journals Empirical Evidence of Overbidding in M&A Contests

2018 ◽  
Vol 53 (4) ◽  
pp. 1547-1579 ◽  
Author(s):  
Eric de Bodt ◽  
Jean-Gabriel Cousin ◽  
Richard Roll
Keyword(s):  
Empirical Evidence ◽  
Conflicts Of Interest ◽  
Empirical Test ◽  
Indirect Evidence ◽  
Merger And Acquisition ◽  
Necessary Condition ◽  
Bidding Behavior ◽  
Winner’S Curse ◽  
For Profit ◽  
Profit Maximizing

Surprisingly few papers have attempted to develop a direct empirical test for overbidding in merger and acquisition contests. We develop such a test grounded on a necessary condition for profit-maximizing bidding behavior. The test is not subject to endogeneity concerns. Our results strongly support the existence of overbidding. We provide evidence that overbidding is related to conflicts of interest, but also some indirect evidence that it arises from failing to fully account for the winner’s curse.

Third Party Beneficiary: A Comparative Analysis

1976 ◽  
Vol 11 (3) ◽  
pp. 315-338 ◽  
Author(s):  
Gabriela Shalev
Keyword(s):  
Comparative Analysis ◽  
Legal System ◽  
Common Law ◽  
Third Party ◽  
Critical Examination ◽  
Legal Research ◽  
General Part ◽  
The Common ◽  
Comparative Survey ◽  
The Right

Chapter 4 of the new Israeli Contracts (General Part) Law, 1973, introduces the concept of a contract in favour of a third party, while granting express recognition to the right of a third party beneficiary. Even those, (including the author) who maintain, that the right of a third party beneficiary could and should be derived, even before the commencement of the new Law, from the general principles and premises of the old Israeli law of contract, cannot fail to see in the above-mentioned chapter an important innovation in the Israeli legal system.This paper is a comparative analysis of the institution of third party beneficiary. The analysis will consist of a presentation and critical examination of the central concepts and doctrines involved in the institution under discussion, and it will be combined with a comparative survey of the arrangements adopted in various legal systems. The choice of this approach stems from the particular circumstances of the new legislation.While in most countries, comparative legal research is a luxury, in Israel it is a necessity. The new legislation in private law is inspired to a great extent by Continental codifications. As far as the law of contract is concerned, Israel is now in the process of becoming a “mixed jurisdiction”: departing from the common law tradition and technique, and heading towards an independent body of law, derived from various sources, mainly Continental in both substance and form.

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