scholarly journals Bajakajian: New Hope for Escaping Excessive Fines under the Civil False Claims Act

1999 ◽  
Vol 27 (4) ◽  
pp. 366-379
Author(s):  
Melissa Ballengee

Ever since the U.S. Attorney General named health care fraud as the government's second highest priority after violent crime, the government has cracked down on health care fraud and abuse. Some of this crackdown has been needed. The General Accounting Office (GAO) estimates that as much as 10 percent of all government expenditures on health care are being siphoned out of the system because of fraud or abuse.The extreme measures taken to curb health care abuse have raised eyebrows, however. The American Medical Association and the American Hospital Association both have been vocal in their disapproval, describing the current enforcement initiative as “absolutely out of control.” The associations even went so far as to file suit to enjoin the government's actions.

PEDIATRICS ◽  
1962 ◽  
Vol 30 (2) ◽  
pp. 340-340

Nursery Sepsis: 16 mm., color, sound, showing time 28 minutes. Produced in 1961 by Churchill Wexler Film Productions, Los Angeles, for the American Academy of Pediatrics, American Hospital Association and American Medical Association, with the cooperation of Johnson and Johnson. Procurable on loan (no service charge) from American Medical Association, Motion Picture Library, 535 N. Dearborn St., Chicago 10. The story of this film is that of a newborn nursery that felt secure in having sepsis under control. Then within a period of 2 months, skin infections began to develop in nursery infants and infants after discharge. This was traced to breast abscesses in mothers. No breaks in nursing practices were found as they related to nursery techniques cleaning, laundry, infant general care, and so forth. Upon culture of a mother's breast abscess, a specific staphylococci was found, and 7 of the nursery staff were found to have positive cultures. . . . Evidence is given that the bacterial colonization of a newborn in a nursery is from 3% on the first day to 47% by the tenth day. This is a superb film on nursery sepsis. By actual photography of nursery procedures and by illustrative drawings, it portrays all of the problems of a newborn nursery and how best to solve them. All the modern techniques that should prevail in a newborn nursery are amply demonstrated. The photography and sound in this film are excellent. The material presented represents the best medical approach to the problems of a newborn nursery, whether small or large.


2021 ◽  
Vol 35 (S1) ◽  
pp. 25-44 ◽  
Author(s):  
Claire D. Johnson ◽  
Bart N. Green

Objective This paper is the second in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated anti-trust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of how the AMA rose to dominate health care in the United States, and within this social context, how the chiropractic profession fought to survive in the first half of the 20th century. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the second of the series that explores the growth of medicine and the chiropractic profession. Results The AMA's code of ethics established in 1847 continued to direct organized medicine's actions to exclude other health professions. During the early 1900s, the AMA established itself as “regular medicine.” They labeled other types of medicine and health care professions, such as chiropractic, as “irregulars” claiming that they were cultists and quacks. In addition to the rise in power of the AMA, a report written by Abraham Flexner helped to solidify the AMA's control over health care. Chiropractic as a profession was emerging and developing in practice, education, and science. The few resources available to chiropractors were used to defend their profession against attacks from organized medicine and to secure legislation to legalize the practice of chiropractic. After years of struggle, the last state in the US legalized chiropractic 79 years after the birth of the profession. Conclusion In the first part of the 20th century, the AMA was amassing power as chiropractic was just emerging as a profession. Events such as publication of Flexner's report and development of the medical basic science laws helped to entrench the AMA's monopoly on health care. The health care environment shaped how chiropractic grew as a profession. Chiropractic practice, education, and science were challenged by trying to develop outside of the medical establishment. These events added to the tensions between the professions that ultimately resulted in the Wilk v AMA lawsuit.


PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 731-731
Author(s):  
R. J. McKay

Fellows of the American Academy of Pediatrics should be proud of the effective way their organization has recently "spoken up for children." Thanks to the well-coordinated team efforts of our elected officers, especially our immediate Past-President, Don Blim; of our Washington office led by Jackie Noyes; and of the Government Affairs Committee, chaired by Birt Harvey, the chance has greatly diminished that children will be forgotten or shortchanged by the block-grant approach to reducing federal expenditures for health care. Although support was given by such organizations as the Association of Maternal and Child Health-Crippled Children (MCH-CC) Directors, the Children's Defense Fund, and the American Medical Association, it was AAP initiative, strategy, and implementation from start to finish that carried the day.


2021 ◽  
Vol 35 (S1) ◽  
pp. 97-116 ◽  
Author(s):  
Claire D. Johnson ◽  
Bart N. Green

Objective This is the seventh paper in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to provide a summary of the lawsuit that was first filed in 1976 and concluded with the final denial of appeal in 1990. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive time line. This paper, the seventh of the series, considers the information of the 2 trials and the judge's decision. Results By the time the first trial began in 1980, the AMA had already changed its anti-chiropractic stance to allow medical doctors to associate with chiropractors if they wished. In the first trial, the chiropractors were not able to overcome the very stigma that organized medicine worked so hard to create over many decades, which resulted in the jury voting in favor of the AMA and other defendants. The plaintiffs, Drs Patricia Arthur, James Bryden, Michael Pedigo, and Chester Wilk, continued with their pursuit of justice. Their lawyer, Mr George McAndrews, fought for an appeal and was allowed a second trial. The second trial was a bench trial in which Judge Susan Getzendanner declared her final judgment that “the American Medical Association (AMA) and its members participated in a conspiracy against chiropractors in violation of the nation's antitrust laws.” After the AMA's appeal was denied by the Court of Appeals for the Seventh Circuit in 1990, the decision was declared permanent. The injunction that was ordered by the judge was published in the January 1, 1988, issue of the Journal of the American Medical Association. Conclusion The efforts by Mr McAndrews and his legal team and the persistence of the plaintiffs and countless others in the chiropractic profession concluded in Judge Getzendanner's decision, which prevented the AMA from rebuilding barriers or developing another boycott. The chiropractic profession was ready to move into its next century.


2011 ◽  
Vol 69 (3) ◽  
pp. 316-338 ◽  
Author(s):  
Melissa M. Garrido ◽  
Kirk C. Allison ◽  
Mark J. Bergeron ◽  
Bryan Dowd

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.


2005 ◽  
Vol 23 (34) ◽  
pp. 8894-8905 ◽  
Author(s):  
June M. McKoy ◽  
E. Allison Lyons ◽  
Eniola Obadina ◽  
Kenneth Carson ◽  
A. Simon Pickard ◽  
...  

In the course of recent health care fraud investigations against TAP Pharmaceuticals (Lake Forest, IL) and AstraZeneca International (London, United Kingdom), each pled guilty to one violation of the Prescription Drug Marketing Act, settled claims related to alleged violations of the False Claims Act without admitting guilt, and paid fines, settlements for liabilities, and reimbursements of $850 million and $355 million, respectively. In a unique aspect of these cases, federal investigators brought criminal charges against 14 TAP employees and investigated the billing practices of several urologists. These investigations resulted in guilty pleas from both urologists and industry employees relative to the Prescription Drug Marketing Act or the False Claims Act and probationary sentences with payments of fines and restitution to the government for urologists who cooperated with federal investigations. One uncooperative urologist was found guilty of violating the Federal False Claims Act and sentenced to 6 months of home arrest, excluded from Medicare for 5 years, required to provide 600 hours of free medical care to indigent patients and patients covered by Medicare or Medicaid, and paid fines and restitution to the government. The cases against TAP and AstraZeneca have been followed by federal and state investigations of allegedly illegal marketing practices of other pharmaceutical firms and have resulted in negotiated settlements of $3.8 billion and $71.5 million, respectively. Believing that an Average Wholesale Price–based reimbursement system was an important driving factor for these marketing activities, Medicare has shifted to an Average Sales Price–based reimbursement system. This is expected to greatly impact the practice of outpatient oncology nationwide.


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