"Eat What You Kill"
propublica.org
propublica.org
A doctor was billing Medicare for seeing up to 70 patients a day - more 15-minute visits than any other doctor in the entire United States. No regulator noticed this or acted?
Multiple insurance companies paid for 11 years of Stage 4 lung cancer treatment without ever requiring proof the cancer existed. Not one claims adjuster or medical reviewer caught this.
Hospital administrators let him make himself both oncologist AND primary care physician for his patients, creating a closed system with no oversight. They let him take over end-of-life care despite concerns about suspicious deaths.
When hospital CEOs tried to question his practices, he organized campaigns to force them out. Hospital administrators chose protecting revenue over protecting patients.
The medical board failed. The DEA investigated but only pursued civil penalties. Law enforcement seems uninterested in investigating multiple suspicious deaths.
What's most disturbing - after all this came to light, his medical license was renewed in 2023. He can still practice medicine and prescribe drugs today.
The whole thing exposes how profit incentives in healthcare can override patient safety at every level and the regulatory framework that we pay to protect us is part of the problem.
How do we fix a regulatory system that fails at every level to protect patients?
But a journalist’s job is to weave those facts into an actual story, which they’ve excelled at.
This deserves Pulitzer consideration.
For all of the galling failures described in this story, I see it first and foremost as an indictment of the (non-)system. If a plane has a rough landing that results in so much as a sprained ankle, we expect everyone involved with that flight to be up to their eyeballs in an NTSB investigation that will produce a thorough and authoritative account of the failure. Alaska Airlines Flight 1282 (aka the 737 Max door plug blowout) officially resulted in 3 minor injuries, and that was a massive scandal that prompted a tidal wave of scrutiny against Boeing and perhaps a dozen high-profile pieces about how its engineering culture was undermined by McDonnell Douglas's management culture. At least as many people have evidently been fatally poisoned at St. Peter's.
But we apparently can't investigate medical failures with even a modest fraction of that level of robustness because... uh... reasons. The knee-jerk deflection is that medicine is messy and doctors are due a certain amount of deference for judgment calls in the context of the situation; are the same points not also true of aviation and pilots? Suppose that Dr. Wiener is entitled to walk away a free man because of a non-blame-oriented culture of dispassionate root cause analysis. In that case, we're due (and he's due, for that matter) a very detailed and public accounting of exactly where the failures occurred, whether they're his or others'. But maybe we're just not ready to look this shit in the eye.
(I'm also making a note to myself to double my usual donation to ProPublica this year; they've been kicking ass at the sort of muckraking that we haven't seen nearly enough of in the past 15-20 years)
By removing the profit incentive and making the medical system just a job.
No more shareholders or execs or CEOs or partners.
Doctors can work in government sponsored facilities for a salary. No itemized CPT codes with varying costs.
No incentive to cheat.
Like plenty of other circumstances where someone is able to build a cult of personality, it's not someone having such extraordinary charisma that they can convince people to reject reality; they might be above average in their persuasiveness, but their real skill is identifying situations where people are vulnerable and don't have any alternatives. In this case, being the only oncologist anywhere in the region gave both his patients _and_ the hospital where he worked no obvious alternative than continuing to buy into whatever he told them, until someone from the outside without circumstances making him susceptible was able to push hard enough to force action (at no insignificant personal cost; the outside doctor who came in and built up enough momentum to force the unscrupulous doctor out is still dealing with a personal lawsuit alleging defamation despite the case against the hospital for defamation and wrongful termination being thrown out).
I understand why it was posted here, and deserves upvotes.
There are bits I wanted to quote for comments but I genuinely believe it's better to read the article and let those parts meet you in the place and how the journalist wrote them.
This is often what people are scared about with US doctors, that the financial incentive will have them over-prescribe and tell you that treatments are needed that aren't.
Crazy Story!
Edit: I think one conclusion to take away, always get a second opinion, don't rely on just a single doctor/hospital's diagnosis.
That’s a crucial point. The "eat what you kill" compensation model, where doctors are paid based on volume of procedures and visits (RVUs) creates the environment for this to continue to happen again and again.
(2) Given how high his diagnosis rates were, I wonder if any population-level studies have been inadvertently thrown off by the "high" cancer rates in Montana, or otherwise tried to explain them. From the outside it might've looked like there was some kind of cancer cluster when in reality this guy was just a liar.
(3) I recently heard a similar story, albeit on a much smaller scale, of a woman who was wrongfully diagnosed with HIV and got so sick from the side effects of anti-HIV medication (this was in the late 80s/early 90s when treatment was nearly as bad as the disease) that she was on the verge of dying. Thankfully she sought last-ditch treatment with a doctor who ran some bloodwork and discovered that she was HIV negative.
In that case, the false positive came from a health department employee who'd deliberately lied to her about the results. The employee lied because they wanted the woman to come to their church, where she'd miraculously be "cured" of HIV (and of being gay). But the woman only realized this in hindsight.
https://www.thisamericanlife.org/123/high-cost-of-living/act...
Ultimately it seems like a story of a doctor's cult of personality, greed and buying loyalty, reckless malpractice, and a failure of multiple institutions to detect it or care about stopping it.
He wants money, but less out of greed and more because superhero doctors naturally earn a lot of money. There are plenty of easier ways to cheat money out of the system than maintaining that a man has stage 4 lung cancer for 11 years.