'Rent-a-Patient' Fraud
Hundreds of patients from across the country underwent unnecessary and sometimes dangerous surgical procedures that resulted in the submission of tens of millions of dollars in fraudulent medical claims, according to a $30 million lawsuit filed by 12 Blue Cross and Blue Shield Plans.
The lawsuit was filed against nine California-based outpatient surgery clinics, seven medical management companies, and 34 individuals, in a Los Angeles federal district court.
The Blues Plans allege that paid recruiters enlisted patients to travel to the surgical centers and undergo "needless and sometimes hazardous" surgical procedures and treatments. In return, the patients allegedly received cash payments or cosmetic surgery, and the providers submitted fraudulent insurance claims. These "rent-a-patient" tactics have resulted in significant financial losses to insurance companies and employee benefit plans since 1999, according to the slawuit.
Conflict-of-Interest Rules Targeted
People with direct financial conflicts of interest should not be put on committees that advise the Food and Drug Administration, a coalition of public interest groups has recommended. Financial conflicts undermine "the public's faith in the fairness and credibility of the panel's work," the Center for Science in the Public Interest, the National Women's Health Network, the U.S. Cochrane Center Consumer Coalition, and eight other groups said in a letter to Acting FDA Commissioner Lester Crawford, D.V.M., Ph.D. The groups cited the FDA advisory committee that recently reviewed the safety of cyclooxygenase-2 (COX-2) inhibitors and noted that 10 of the committee's 32 members reported having direct financial conflicts.
In addition to prohibiting scientists, physicians, and clinicians with relevant conflicts of interest from serving on advisory committees, the groups also recommended that people with any industry ties should make up no more than half of a committee.