Saturday, May 23, 2015

The ABIM, Its Finances, and the Great Collusion

Yesterday, Newsweek Pulitzer-prize finalist and reporter Kurt Eichenwald pulled back the curtain on the Great and Powerful Oz of medical credentialing, the American Board of Internal Medicine (ABIM) when he meticulously dissected the organization's most recent financials. In his piece, Eichenwald laid bare the "trickery," cronyism, and greed that has come to define the ABIM that has been led by a few self-selected "Untouchables" of our profession.  The details are outrageous for a non-profit espousing "medical professionalism:" $1,712,846 million to the outgoing President and CEO Christine Cassel, MD, an estimated $860,926 to the current Present and CEO Richard Baron, MD, lack of disclosure of lobbying efforts, tax filing discrepancies, to name a few. The story is so disturbing on so many levels, yet so important, that I encourage all to read it.

In response, Richard Baron, MD sent an emotional  e-mail to all ABIM diplomats yesterday that was in large part a rehash of his disagreements with Mr. Eichenwald's reporting.  He also attempted to dispute two of the allegations made by the most recent Newsweek story:
First, we have never made any effort to obfuscate, hide or delay ABIM's financial information. It's publicly available on our website. Second, no one is trying to hide salaries. I earned $688,000 in compensation in 2014 and $55,000 in deferred compensation (payment of which is contingent upon completion of my five-year contract). That is more than I ever made in 30 years of independent community practice of internal medicine and geriatrics, but it is set by my Board to be comparable to what CEOs of similar-sized health-related organizations earn.
By now it is almost silly for Dr Baron to claim they "never made any effort to obfuscate, hide, or delay ABIM's financial information." No where does the ABIM website discuss its transfer of $30.66 million of physician testing fees to the suspect ABIM Foundation from 1998-2007, the purchase of a $2.3 million condominium complete with a chauffeur-driven Mercedes S class town car in December 2007, the continued contradiction in the ABIM Foundation's creation date (1999) that  conflicts with public record (1989), why the condominium's depreciation was lumped in with "condo expenses" and classified under "program service expenses", nor that the "rent" that the ABIM pays the Foundation for the condo's use does not show up on tax forms as such. I asked him to explain these issues in December of 2014 and only received world class obfuscation of the facts. (Update: And then there was the stunt where they tried to withhold six key schedules from their consolidated financials with Foundation, only to publish them after public ridicule). Was he aware of his actions? Given what we've repeatedly observed regarding his inability to address ABIM diplomats financial concerns regarding the ABIM, it's hard to think otherwise.

More telling was Dr. Baron's pitiful disclosure of his salary and "deferred benefits." It is clear that Dr. Baron is so far removed from the realities of patient care today that he has no concept how entitled he sounds, especially for someone running a non-profit organization that has crushed 139 physicians' professional lives with the past Arora test-preparation scandal to protect their monopoly while they enjoy their lavish salaries and creature comforts all provided with tax exempt status.

Mr. Eichenwald learned of Dr. Baron's follow-up e-mail to ABIM members and broadcast his rebuttal via Twitter. In that thread he gave details on his interaction with the ABIM and their avoidance of the issues. (Details can be read on Jay Schloss's Storify of the tweets.) I'd like to think Baron will accept and offer to be interviewed by Eichenwald, but I know it will never happen - the ABIM's lawyers won't let him.

It's Not Just the ABIM

As twisted, deceptive, corrupt and disappointing the financial story of the ABIM and its Foundation has become, it's only the tip of the iceberg. We should recall that the American Board of Medical Specialties (ABMS - a separate 501(c)(6) non-profit) owns the trademarked Maintenance of Certification® program which the ABIM as one such member board helps administer. The ABMS serves effectively as a "business league" for its 24 member boards, much like the NFL lobbies for its football franchises (in fact, the NFL has the same tax-exempt designation). The ABMS lobbied Congress about the self-proclaimed merits of their branded MOC® program while paying their director,  Lois Nora, MD, JD $779,487 to earn government contracts and to assure the ABMS (with the ABIM as a testing entity) remained in the Affordable Care Act as a physician quality registry (see Social Security Act 1848, Section (k)(4)). The monopoly power of the ABMS regarding physician credentials prompted a pending suit alleging possible anti-trust violations. The fact that the ABMS or the ABIM has never studied the socioeconomic, psychological or physical toll upon physicians (and their patients) who fail the trademarked MOC® re-certification examination is telling and speaks to the blatant disregard of those tested.

(Click to enlarge)

The interconnected relationships of Christine Cassel, MD, Richard Baron, MD, the National Quality Forum, the ironically named "Seamless Care Models Group" in the Center for Medicare and Medicaid Innovation, a component of the Centers for Medicare and Medicaid Services (CMS), reeks of a sophisticated kickback scheme using doctors and their requirement to pay MOC® fees every two years to the ABIM (and other member boards of ABMS) that assures their largess and perpetual cozy employment opportunities. Why else are doctors increasingly required to  participate in MOC® to remain credentialed with their hospital employer? Might this have been the reason the ABIM board felt Dr. Cassel warranted her $1.7 million take from the ABIM for working just a thirty-five hour work week and serving as a consultant to Premier, Inc and Kaiser Foundation Health Plans and Hospitals?

Because of the revolving door between the members of ABIM, the American College of Physicians (ACP), the Accreditation Council for Graduate Medical Education (ACGME), Joint Commission on Accreditation of Hospital Organizations (JCAHO), ABMS, and the American Medical Association (AMA), (with the exception of ABIM, all of these organizations are located in downtown Chicago) is it any wonder that program directors in hospitals must participate in MOC?  Likewise, is it any surprise that our most vulnerable newly minted physicians must enroll in the unproven and heavily marketed  Maintenance of Certification® program before they are even "board certified" for the first time?

Mr. Eichenwald is correct when suggesting that it is time for the "Federal Trade Commission and the Justice Department to investigate whether the ABIM is engaged in a restraint of trade by driving doctors out of business if they don’t pay up. It is time for the IRS to investigate whether the ABIM is a nonprofit or a business." I would add that the ABMS and ABIM should be investigated by the OIG of the Department of Health and Human Services to determine if the MOC program is a carefully contrived pay-to-play scheme using the US government as imprimatur.

Irrespective of the legal plays that are now likely to take place,  US physicians must immediately stop paying for MOC® and insist their local medical executive committees remove MOC® as a condition for hospital credentialing or, at the very least, make enrollment in an alternative to the corrupt ABMS MOC® credential. Otherwise, practicing physicians will be working to potentiate the existence of this very broken program.



Anonymous said...

Also add to the list a class action lawsuit against ABIM for all the patients who were injured or killed by the Choose Wisely recommendation to only revascularize the infarct related artery during an acute MI.


Calling all trial lawyers! The ABIM injured patients with their ineptitude. Dr. Baron and Dr. Cassell are innocent until proven guilty of negligent homicide. said...

Recently Bob Doherty,VP of ACP for govt.affairs and public policy,on his blog declared that internists and the ACP were the conscience of medicine.As audacious and baseless as that claim may be,it would seem appropriate for ACP to finally comment on what is going on at ABIM.Wonder why they have not.

Anonymous said...

ABIM should also refund the money that we submitted for this MOC testing that never came to pass. I sent them $208 last year, received an email within 24 hrs informing me that I was now MOC certified, although I had taken no exam. I have been trying to obtain a refund and cannot get a reply. After getting Dr. Baron's letter I replied to him. It will be interesting to see if he answers.

birgit said...

Thanks for your tireless muckraking. When I first had to recertify for ABIM in 2003 I swore "never again"as the testing was so demeaning. I chose to let my certification expire last year, and it is such a relief to know I am not alone. It feels dangerous yet liberating to take a stand against the powers that be.

Anonymous said...

Hi Birgit: I am considering the same, what has been your experience with insurance company reimbursement ?

Anonymous said...

Free Sarah Von Muller !!!!!

birgit said...

Hi Anon:
I have gone into solo practice so I could go direct pay when I'm brave enough. I have taken CMS ' "adjustments" in rate since I won't do Meaningful Use nonsense either, and my local hospital privileges are OK since I'm "just primary care. " So far my insurance payments are rock bottom (35 % below Medicare) since I'm in solo practice, but no one has cut me off. Of course, I'm unemployable without a Board Certificate.

x said...

without fighting/ exposing the American hospital association, all efforts of targeting non-profits is useless. the devil lives in the bureaucratic corridors of our hospitals. abim and all other cronies cant be curtailed if we cannot fight AHA. by merely trying to cure the symptoms cant treat the sick system. if the physicians of a few top universities can send notifications asking their administrations to explain the allegiance to all these no-good evils and seek a response in the lawful way (eg within a time free) and suggest a lawful opposition in the absence of satisfactory answer, the individaual CEOs will speak.

Anonymous said...

These reports of possible abuses of the tax exempt status and Form 990 appear to deserve IRS investigation and/or Grand Jury investigation -- has either been requested? These investigative techniques worked when I accused various university teaching hospitals of double-billing several years ago. Is it time for ABIM diplomats who feel that wrong doing has been done to do the same?

Robert L. Weinmann, MD, Editor, The Weinmann Report (

Unknown said...

Wes, I just wanted to thank you for what you're doing. You have played a major role in exposing the ABIM and ABMS and without your vocal stance I'm not sure Eichenwald and others would have picked up the story. We physicians owe you a lot. Thank you.

K Murray Leisure MD Infectious diseases MA USA said...

Thank you, Dr Wes, and Mr Kurt Eichenwald, NEWSWEEK. Excellent work.

Anonymous said...

Thank you so much for you you do sir. Someone needs to speak truth to power and you are doing an amazing job.

FYI: I am a board certified physician and I know that I should use my real name but I am scared of possible repercussions from the ABIM later down the road for speaking up. Thank you for being brave enough to have a public voice!

Anonymous said...

If these allegations are true, the once thought rabbit hole might just be an enormous black hole that has sucked the light and life out of a physician's souls and pockets. Where there is smoke a combustible source should be detected and extinguished. With these revelations, it is conceivable that the alleged treachery is not just isolated to the ABIM, but ubiquitous across the board realm. Every speciality board might need to reexamine their certification and recertification process. The first question: EVIDENCE BASED MEDICINE

The thought of a mid-level performing, at my hospital, the same tasks as I. However, if I am not board-certified I am denied privileges at my hospital while the mid-level keeps seeing patients. So basically they are stating that the years at university, medical school, residency, and published research alone do not make me qualified to practice family medicine? I need a board to provide a costly certification tag to an honored education? Something,just doesn't appear transparent.

A Famous scene from the Outlaw Joey Wales:
Senator: The war's over. Our side won the war. Now we must busy ourselves winning the peace. And Fletcher, there's an old saying: To the victors belong the spoils.

Fletcher: There's another old saying, Senator: Don't piss down my back and tell me it's raining.

Anonymous said...

FYI: Many of us are board certified physicians and scared of possible repercussions from the ABIM later down the road for speaking up. Thank you for being brave enough to have a public voice!

DrWes said...

Anony 11:35 PM-

You say: "With these revelations, it is conceivable that the alleged treachery is not just isolated to the ABIM, but ubiquitous across the board realm. Every speciality board might need to reexamine their certification and recertification process. The first question: EVIDENCE BASED MEDICINE."

I agree with your first sentence here, but the second sentence is simply not the issue. It is very convenient to think that the whole issue of board certification and recertification is the problem. It is not as simple as this.

Doctors are the goose that lays the golden egg for all of medicine. As such, the question now becomes: if the corruption and money that flows from board certification and re-certification aren't for physicians' benefit, but rather for the benefit of the specialty boards and insurance lobbyists, who is protecting the interests of the practicing physician? Is it the federal government? No. The state governments? No. The AMA? No. The ABMS, ABIM, or all of the 24-member specialty boards who have co-opted the trademarked MOC program as their mark of excellence and ongoing education? Absolutely not.

It is time for a new paradigm - a new organization. One that protects the practicing physician and doctor-patient relationship above all else. Might it be the American Association of Physicians and Surgeons? I'm not so sure about them, but they were first to recognize the monopoly that the ABMS and their member boards has become. Perhaps it will be another separate organization that will serve as a serious watchdog for practicing physicians' interests. There are a growing number of physicians who have awakened this this reality (thanks in large part to the ABIM scandal, the EMR and its wasteful "meaningful use" requirements, and the like) as health care "reform" continues. The transformation is gaining steam as more and more practicing physicians realize the growing reality before us.

Change must come and its coming. And I plan to be part of that revolution, because my patients and our profession (if it is to survive) demand nothing less.

Exhausted professional ABIM taker said...

Thank you, Thank you, Thank you!
I had similar experience and my life was placed on hold for over 2 years and thousands of dollars. My job depended on me passing the test and I had to quit my job because I did not pass. I took it a year in advance and it took me 5 times to pass. My boards expired in Dec 2013. I started taking the test Oct 2012 and passed Oct 2014. No rest for over 2 years! All vacations spent studying, CME for board review. Many nights, evening, early mornings and weekends doing questions and I accumulated over 300 CME hours. That is ridiculous. I am not doing that again! I know of a few physicians personally escorted out of their position (30 min to clear their office) just for not passing the ABIM. I quit because I knew that would be the next step. My current job also requires maintaining certification so....Yes still anxiety provoking and I have 9 years to figure something else out! Too young to retire!

Anonymous said...

Replying to "x," yes, the AHA is intensely evil. I left a large healthcare corporation, that took me to court to enforce my non-compete. The AHA filed a deposition against me. Can you imagine, the AHA against one tiny little physician? They are bullies, but "Anon" is also correct, that we are the goose that laid the golden egg. Now that we know for certain that the AMA not only does not represent us, but in fact is against us, we need to get organized and stand up for our rights.

Anonymous said...

There should now be enough evidence to support a class action litigation against the ABIM. It is an organization that no longer protects the interests of physicians and the public; rather, the facts show that it functions as a secret society, accountable to no one, fueled by the funds it extorts from hardworking physicians, and, by skillful lobbying using fees it collects from us, working to ensure its existence in perpetuity as a government sanctioned monopoly.

Kfg said...


Anonymous said...

The American Board of Anesthesiology employs a similar form of dictatorship and cronyism.

"Grandfathered in" anesthesia providers, without historical requirement for continuous medical CME, safety assessment, knowledge assessment, and excluded from recurring "Board Certification" testing fees ... under the new MOCA 2.0 continue to retain their elitist title of "Board Certified" without any requirement of younger physicians. In essence a two tiered system of "Board Certified" Anesthesiologists exists ... with some practicing 30 year old medicine and paying no fees, remain "Board Certified".

Furthermore, as offered by the ASA, I took my re-certification examination 3 years early; paid my $2100, studied a year, and successfully passed my examination. 3 months later MOCA 2.0 was released, and I will not be receiving a refund, and will begin be to changed an annual fees of $210 per year. (Keep in mind that my colleagues who achieved board certification the same year as myself, will never have to pay the $2100, nor study, nor pass another examination).

I have communicated with Michelle Pore regarding the illegality of both matters. She now will no longer return my phone calls, nor my email requests to resolve these important issues.

I have included Michele Pore's contact information for my colleagues with similar concerns. Seems a Class Action lawsuit, for these, and other serious grievances may be building.

Michele Pore

Director, Marketing and Communications Services

The American Board of Anesthesiology, Inc.

4208 Six Forks Road, Suite 1500

Raleigh, NC 27609-5765

P: (919) 745-2283

F: (919) 745-2201



Thoughts In Retrospect said...

In the Case of ABIM vs Arora it is interesting to discover and take note that there was no court response ever given to the ABIM's complaint by Arora's legal team.

And therefore there was no counterclaim. Was it not his right to sue them for the harm they did to all of our (US citizens and residents) civil liberties?

Privately he said his rights were violated and that he could have won.

I am beginning to think very differently about life, truth, justice and how to live more fully.

To live more fully. That may be the victory enough to carry with us each day.

The ABIM was let in the door by Arora and just like to the residents who came to prepare for an evil unjust test, he gave all he had to give generously.

Why did he not just respond to what is, in kind. He said anger is not worth it.
Rich Baron sent an email later, maybe a general letter, I don't know, but Arora said Rich was just a monkey and the ABIM was not worth it.

Arora said if he lives to be 90, that's a million minutes or so. The ABIM is not worth even a single minute.

Why was there not ACLU lawyer crying foul? I often wonder this. It is an obvious case of abuse and violation of all that were harmed and hurt - 'duped' by everyone.

The lawyer(s) that Arora used advised him to fold and not even play the game.
He was bullied and intimidated to quit, especially because of his old age.

All in all the ABIM has an arsenal of dirty tricks. That is what gives them away more than anything.

Here's to Arora's beautiful legal team!

ABIM, Get Out of My House! said...

I'm Dreaming of a White Christmas
with every Senator I write
may the day's be merry and bright
and may all your Christmas' be white.

"I am beginning to think very differently about life, truth, justice and how to live more fully. To live more fully. That may be the victory enough to carry with us each day."


...but when all you can see in your head is the Cassel-Langdon duo perpetrating more harm, more fresh young flesh to eat, I go berserk.

I just learned today of more treachery and how they plan to win.

They battle to win taking no prisoners.

Trust me, there will be no White Christmas for anyone as long as the ABIM exists.

The ABIM has not only broken trust with phycians and the public, they have destroyed people's lives.

That is unacceptable and can't be tolerated.

"Yes, Arjuna you can live more fully everyday, but it is your duty to pick up the sword of truth and fight."

The path to victory is in the small details and understanding them to find the Achilles heel.

The 1965 articles changed everything with the stroke of Myers and Brem's corrupt pen.

A board of 9 was now allowed to have a czar and appointees "independent of the board" to make part time charitable giving a thing of the past.

From now on it would be...the control of medicine by...

"Sing a song of sixpence, a pocket full of rye.
Four and twenty black birds baked in a pie.
And when the pie was open the birds began to sing,
Wasn't that a dainty dish to set before the king."

With the executive position, the ABIM would become a full-time menace having sway in every way.

Profit and politics entered the ABIM and ruled with an iron hand. Deceived everyone.

Destroy the beast if you can.

If our corrupt society is too fossilized to change and still insists that we need the beast, then cut off its political head. Banish that evil lust for easy money and the political force it gives as a boon forever.

Render the monster and liar powerless. Cut off the money flow. Make it shed the stolen wealth taken from you and everyone's house.

Amend the bylaws to send them all packing and take the payday away. It was non-profit in the beginning, make it so again. There is no taxation without representation; this is where the burdensome tax will end today.

Good Penelope is in the midst of profiteers, freeloading politicians and corrupt Wall Street scum.

Her oak bed is in danger of horrible nightmares without end.

Odysseus, string the bow, pull back your hood and take good aim with full knowledge of how, what and who!