Practice Fusion to pay $145M for taking kickbacks aimed at increasing opioid use
fiercehealthcare.com
fiercehealthcare.com
> Of that $118.6 million, $113.4 million will be paid to the federal government and up to $5.2 million to states that opt to participate in separate state agreements.
So, nothing was taken from the personal bank accounts of the people who made these decisions, and nobody went to jail. That is to say, nothing was done about this.
The takeaway here is that you can murder people for money and as long as you do it behind the paperwork of a large corporation, you can get away with it.
The only people who pay the consequences are shareholders. Sure this incentivizes shareholders to try not to invest in sociopathic execs, but I'm not sure how possible that even is.
why would you think these sham alerts rely on actual data that was “new”? these were probably as simple as some if statement that said “if patient over X age and in pain and lives in Y state then show alert”
Obviously none of us know how this was implemented, and it's possible PF had a slick CDS design tool that was super powerful and made these sorts of things easy. That's never been my experience though...
Most people come to work for a paycheck, and the perceived cost to them of shaking up that paycheck (even just to get a new job) is very high.
Shall we go down the list of horrible and unethical things engineers have built over millennia, so we settle this once in for all? If you quit, someone else will do it
Even if an individual engineer suspected the opioid recommendation alerts were medically unnecessary, medically unnecessary tests and treatments are very common [1], so it wouldn't exactly stand out as "probaby an illegal kickback scheme."
[1] https://www.propublica.org/article/unnecessary-medical-care-...
Let’s not be naive. The list is big. But elements are incriminating. If you implement them, you are morally—and eventually, legally—responsible.
I get a story that says, "As a user, when I press the H key I want a horn to play." And I go into the planning meeting and ask, "Is this like a bike horn?" And they say yeah! And I ask, okay, so when I press the key, do you want the horn to sound on key down, or key up? And they say, "How about it starts playing on key down, and stops playing on key up?" And then I say, "do you want different volumes, for let's say when they are on their bike and just want to politely let someone know they are there, versus when they're about to get hit by a truck?" And they say, "yes, eventually, but being able to play the horn at different notes is a higher priority." And then I ask, "wait, why is that useful for a bike horn?" And then they explain that they're going to be playing the horn as part of an orchestra. And then by the end of the conversation I realize the horn I'm implementing is a French horn midi keyboard, not a bicycle horn traffic signal, and the requirements are completely different.
I don't really buy this idea that people are just writing single, isolated requirements out of context.
From TFA
>in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products.
When and how the software would display the CDS alerts would be discussed in a planning meeting; the logic of each individual CDS alerts would not, those would be handed down from somewhere else. Software engineers are in no position to be suggesting or discussing individual clinical decisions. Software engineers aren't going into a planning meeting saying "hey, what about suggesting scheduling a pap test if the patient is a female between 21 and 60 and there's no record of a recent test?" That's not in the software engineer's purview.
So there's very little doubt in my mind that the "suggest opioids if XYZ" CDS alert came down in a list of other innocent CDS alerts like "suggest pap test if XYZ" or "suggest mammogram if XYZ" or "possible drug interaction detected" or "tetanus vaccine due."
Of course there's also the possibility that the system was engineered so that the person configuring the software builds all the CDS alerts themselves with a drag-and-drop interface.
But anyway, sometimes you, as an engineer implementing the system, don't get to personally participate in requirements gathering, planning meetings, or interfacing with the end users. Depending on a lot of factors, sometimes that's done by pointy haired bosses at a much higher level. Especially if you're just a contractor or a subcontractor. I once worked on a project as a short term subcontractor (around six months), I was literally handed detailed requirements, including mockups of all the screens, and told "implement this." Of course, everyone had their own opinion on how it should work, but it was not open for discussion.
So I have absolutely no reason to believe that the programmers of this software knew about this nefarious kickback scheme but I have reason to believe that they probably didn't.
Boy am I glad I work for an EHR that doesn't agree with you... If I was asked to implement a CDS rule that wasn't based on some reasonable clinical guideline (CMS quality measures, etc) you'd better believe I'd push back on it and want to understand where it was coming from.
Healthcare isn't some dark art that engineers couldn't possibly understand. These rules should be based on publicly available and widely agreed upon standards of care.
The impacts aren't nearly as harmful in tech as in pharmaceuticals, but there are a lot of practices in our industry which we all accept as normal procedure but would seem very ethically questionable to an outsider.
This is a sad event but definitely will be a good learning experience for those in the EHR design world.
in near future they will start to use AI and nobody would be able to tell where the specific opioid bias crawled in from, and even if the lineage of the biased decisions is successfully established it would be from some innocent facts/rules/data.
So where is jail time for the entire decision-making team?
Very first line: I dig: socially responsible company-building
Courts removed DOJ's legal tools they used to go after individuals (Skilling).
DOJ started allowing companies to hire law firms to investigate themselves for wrongdoing because it was easier than doing an investigation. Also, it created a revolving door between the white collar legal community.
Culture change at DOJ after a pushback from said white collar legal community after flattening Arthur Anderson hilariously punctuated by the hiring in Obama's first term of Denis McInerney as the DOJ Chief of Fraud after he represented Arthur Anderson.
Several high profile losses: Skilling (again), Bear Sterns execs, AIG execs.
Everyone should just read Chickenshit Club.