Monday, April 17, 2017

For Texas Legislators: MOC's Myriad Conflicts of Interest

The American Board of Medical Specialties' (ABMS) Maintenance of Certification (MOC) proprietary continuing education program has a myriad of conflicts of interest. I thought I would assemble a partial list of some of them below:

1) The American Board of Internal Medicine (ABIM), the largest ABMS member board responsible for credentialing one-quarter of all US physicians, is increasingly in debt thanks to high salaries and expenses. Its latest 2015 Form 990 shows a NEGATIVE asset and fund balance of balance of $50,642,980.

2) The cost of for participating in the proprietary ABMS MOC program has grown far in excess of the rate of inflation (16.3 to 17.2% annually), without adding any appreciable change to the product delivered to physicians or the public.

3) The ABIM Foundation, which was reported as being created in 1999 on federal tax forms from 2008-2013, has a POSITIVE balance of $77,255,188 on its 2015 Form 990. Much of this balance was secretly transferred from the ABIM physician testing fees from 1990-1999, ten years before the organization was reportedly "created." Furthermore, the Foundation is domiciled in PA, not Iowa, as it was claimed from 1999-2013. With some of those funds, the ABIM purchased a $2.3 million condominium that came complete with a chauffeur-driven Mercedes S-class town car for itself in December 2007.

4) Christine Cassel, MD not only worked as President and CEO of the ABIM and its Foundation from 2004-2014, she also secretly served on the Board of Kaiser Foundation and Hospitals, earning $1,683,221. From 2008 through 2013, she also served on the Board of Directors at Premier, Inc, the largest US hospital procurement firm, earning 230,000 in case and stock in 2013. (Here's the breakdown of her take). None of these conflicts were ever disclosed until she was investigated by Propublica before becoming the President and CEO of the National Quality Forum. From 2010-2014, the ABIM paid a little-known company, CECity, Inc., over $5.5 million to process physician patient survey/practice improvement survey data. Shortly after Dr. Cassel left the ABIM, CECity, Inc was bought by Premier, Inc for $400 million in 2015.

5) Robert Wachter, MD served as a consultant and board member for IPC Hospitalist Company while working as Chairman of the Board of the ABIM/ABIM Foundation in 2014. IPC Hospitalist company was investigated for overbilling Medicare and Medicaid patients and paid $60 million to settle Medicare/Medicaid false claims act violations with the DOJ February 6, 2017.

6) The ABIM has been lobbying Congress for years, but such lobbying has never been disclosed to the public via Form 990 tax forms.

7) The adverse effects of MOC on physicians and patients have never been studied. Yet the ABIM has been conducting research on physicians (see here and here) without their consent or Institutional Review Board oversight, potentially in violation of Protection of Human Subject statutes of the Department of Health and Human Services.

8) The American Board of Medical Specialties (ABMS) and the American Hospital Association (AHA) are both member organizations of the Accreditation Council on Graduate Medical Education (ACGME). Maintenance of Certification (MOC) favors hospitals eager to limit competition.

9) Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). Margaret E. O’Kane is founder and president of the National Committee for Quality Assurance (NCQA). The NCQA is responsible for credentialing insurance companies that must accept ABMS MOC as a condition if their credentialing under the Affordable Care Act. Ms. O'Kane is also a public board member of the American Board of Medical Specialties (ABMS) that actively promotes the ABMS MOC program that benefits the ABMS. In addition, Richard J. Baron, MD, the current President and CEO of the ABIM, served as member of the Standards Committee for the NCQA.

10) The ABMS sells credentialing information on physicians through its wholly-owned subsidiary, ABMS Solutions, LLC, a for-profit corporation based in Atlanta, Georgia.

11) The American Board of Family Medicine (ABFM), one of the ABMS member boards, holds ABFM Realty, LLC, a for-profit real estate company that manages commercial real estate and is funded almost entirely by physician testing fees.

12) The American Board of Pediatrics (ABP) has numerous real estate holdings surrounding its North Carolina address and contracted with its retired CEO, James A Stockman, III, MD to work 8 hours per week for $793,438 in 2014.

These are just a few of the conflicts inherent to the ABMS MOC product. Sadly, there have been many more throughout the years, including cozy relationships with major US academic institutions.

-Wes

6 comments:

Anonymous said...


Dong, Dong, Dong, Dong - Hear that ABIM? The bell tolls for thee!

"ABIM accepts no outside money from the healthcare industry." Christine Cassel under oath to Congress. said...

ABIM and Christine Cassel, with their combined political and financial activities (conflicts of interest), gave unfair business advantage by favoring certain large healthcare corporations. They have gobbled up the market share through merger and acquisition and price-advantaged leverage and control. What we have witnessed in unbridled corporate healthcare corruption since 2004, 2008 and beyond has been mind boggling.

Christine Karen Cassel, MD, a key player and contributor to the corruption of the healthcare industry while CEO/President of ABIM and the ABIM Foundation, had no qualms about taking money from multiple sources in the corporate healthcare industry. This was in violation of ABIM's own rules to accept no outside money from the healthcare industry. In fact, Cassel worked little for the ABIM but accepted large sums totaling millions from the ABIM and every direction possible.

For Cassel (and the ABIM) there was a lucrative bright financial moon in every direction. Christine Cassel moonlighted and the ABIM clearly cheated. MOC is one of the ABIM's corrupt money making schemes. (MOC has been corporate-backed and physician-funded through mandates and regulatory capture from the get go.) For Cassel, Nora, and Baron and so many of the other executives at the ABMS it is "project moonlight".

The ABMS cannot exist currently without the MOC revenue. MOC was a scam from day one to control physicians and keep the executive over compensation going. The DOJ needs to shut "project moonlight" down immediately. State legislators need to act and end mandatory MOC to give relief to physicians and patients who continue to suffer sub-optimal treatment under ABMS' corrupt rule of the rigid iron thumb.

Consider the healthcare reform which Cassel was involved in for decades and helped pass in 2010. As a board member of Kaiser Hospitals and Health Plans Cassel gave an unfair business advantage to Kaiser Permanente. This is clearly documented by investigative journalists and ethical scholars.

We can see these conflicts of interest in action with many examples. One can browse the internet and they are everywhere as plain as the sun. Consider the recent acquisition of Kaiser Permanente when they bought out one of the oldest HMO's in the country - Group Health Cooperative based in Seattle.

This happened through Cassel and corporate/government cronies building up Kaiser into the gigantic national corporate powerhouse that it is today. With the largest private EHR electronic health record system. Cassel played a big part in that while on the boards of Kaiser, Premier, and others and while she was a presidential advisor, ABIM CEO, and NQF CEO. This was all kept fairly hidden from the public.

How does the public fight this kind of corruption when it is not so common knowledge that CEO/President/Chairman of Kaiser Permanente (Bernard Tyson) was groomed by Cassel and her political/financial backers and pumped up Bernard Tyson to her cronies as their 'man to be' while still in lower executive positions. Tyson started out as a medical records clerk.

Corrupt Times (because elites never do hard time) said...

For some background evidence on the Cassel/Kaiser conflicts of interests, see Cassel and Tyson presenting together as a team in 2010 starring in a federally funded PCAST presentation. At the DC presentation they are pushing Electronic Health Records together. Kaiser had a federally-funded head start on EHR (attempts to link VA with Kaiser EHR)thanks to Kaiser cultivating relationships (financial or otherwise) with highly placed medical politicians associated with Washington and the quality assurance cartel.

Cassel has been a central figure figure in this corruption and now partner in Kaiser's future landscape participating in the new medical school as FOUNDING dean. It is not publicly available what Kaiser is paying Cassel for her participation from her longstanding mo operating from her residence in New Mexico or secondary luxury residence in Philadelphia provided by the ABIM Foundation while she lobbied for healthcare reform in Washington DC.

http://www.modernhealthcare.com/article/20151217/NEWS/151219868

This acquisition of GHC by Kaiser was a huge deal made possible by the merger/acquisition environment since 2008 and the healthcare reform agendas propagated by Cassel, Baron, Wachter, and the ABIM/ABMS certification cartel. There was disappointment for those patients and physicians at GHC who already saw a decline in health care and coverage after the passage of the ACA. Kaiser has been notorious for giving their patients the short-ended stick. Nurses have also been repeatedly having to fight for their needs.

http://www.latimes.com/business/la-fi-kaiser-permanente-20151204-story.html

Christine Cassel's revolving door with Kaiser Permanente is a multi-year scandal that has not been investigated fully enough. Scroll to Cassel followed by Tyson. Summed up by David Blumenthal. HIT in medicine. The conflicts of interest involving healthcare technology companies and the benefits they experienced has gone largely untalked about in the press. We get press releases of fraud and corruption but the corruption and surrounding issues continue. The federal government has given away taxpayers dollars in funding a lot of this corruption via corporate/government revolving-door mouthpieces like Cassel and Baron with the ABIM. The ABMS has served a s conduit for much of these corporate/government revolving door initiatives, policies and legislation.

MOC money has paid for a great deal of these back-channel deals and the self-enrichment programs for professional medical politicians. MOC money not only creates unnecessary and harmful physician mandates, the MOC pays for/aids and abets a large part of the corruption.
The quality assurance cartel (NCQA and others) by controlling insurance and hospital credentialing requirements sustains the ABMS MOC Ponzi scheme.

https://www.c-span.org/video/?296980-1/presidents-council-advisors-science-technology-report

FZ said...

For the ABMS certification cartel MOC is the "mother of corruption". When will patients and physicians be free of this violatory "mother of corruption"?

Having conflicts of interest is like having a PHD from Harvard. Helen Darling of the NQF said...

Citing ‘Distraction,’ Quality Forum (NQF) CEO Christine Cassel Resigns Board Seats
(2014 Flashback to the NQF COI and Safety Committee Kickback Scandal)

With the DOJ investigating a kickback scandal at the NQF in walks ABIM's former CEO Christine Cassel with her egregious conflicts of interest to be the new NQF CEO.

Putting a PR spin to Cassel's egregious conflicts of interest after getting caught with feathers in the mouth, Helen Darling, of the National Quality Forum and NCQA, dropped the "mother of all bombs" on the 'Quality Forum' and Dr. Cassel's integrity by making the most inane and deceptive statements possible.

While being confronted with DOJ accusations of NQF corruption (NQF Safety Committee kickback scandal) and Dr. Cassel's egregious coi (getting large concurrent paychecks from NQF, Premier and Kaiser) Helen Darling said about Cassel's extracurricular board seats:

"It’s like saying you’ve got a Ph.D. from Harvard. This is something you’d be proud of."

The PR spin only worsened matters for Dr. Cassel and Helen Darling--two scandalous foxes caught with fluff on their noses. Why wasn't Darling forced to resign from the NCQA at the time? There are more conflicts to list about the NQF, NCQA, and ABMS than there are stars in the DC sky. In fact the CEO of the NCQA, Ms. O'Kane, who gets $800k per-year and multiple retirement accounts sits on the ABMS board of directors. Helen Darling, Christine Cassel and Margaret O'Kane had direct roles to play creating and maintaining ABMS MOC insurance/hospital requirements, which patients and physicians unlawfully suffer from.

The DOJ needs to get back to their investigation of this quality assurance cartel and actually put some of the most egregious offenders behind bars. Some of these Ponzi-style NGO's are so corrupt and broken beyond repair that they need to be shut down. Even a cursory study of the corruption and coi at the NQF, NCQA, and ABMS puts them on the short list for shuttering.

If physicians don't wake up and actively put an end to the certification cartel's racketeering and lobbying scams, then the status quo of corruption will continue and healthcare quality and working conditions will continue to decline.

It sometimes only takes one person at the head of a healthcare union to change the calculus. But if there are no sustained efforts to build on that change coming from the vast healthcare professional community dark corporate money will trump your hand every time. Understanding that the ABMS is not anybody's friend has opened a lot of eyes already.
The ABMS and their corporate cronies will sully the legislators mind and sour a good pot whenever you let your guard down.

Citing ‘Distraction,’ Quality Forum CEO Resigns Board Seats
https://www.propublica.org/article/citing-distraction-quality-forum-ceo-resigns-board-seats

"Isn't that Darling" greasing the wheels of Teladoc said...

Just like Rich Baron, his NQF friend, Helen Darling, comes with a plurality of coi

Helen Darling - NQF director (former interim CEO), NCQA Committee on Perforamance Measurement, Medical Advisory Panel of the Blue Cross Blue Shield Association’s Technology Evaluation Center (now the Center for Clinical Effectiveness), the Advisory Board for the Peter G. Peterson Foundation and the Board of the Reagan Udall Foundation for the FDA - earns herself some big bucks.

Let me get this right, according to Helen Darling, those lucrative positions do not represent coi, but are equivalent to a medical degree or PHD from Harvard!

"Helen Darling Joins Teladoc Board of Directors

June 27, 2016 LEWISVILLE, Texas--(BUSINESS WIRE)--Teladoc, Inc. (NYSE: TDOC), the nation’s leading provider of telehealth services, today announced that Helen Darling, past president and CEO of the National Business Group on Health (NBGH) and current interim president and CEO of the National Quality Forum, has joined its board of directors. Darling will serve on the board’s Quality of Care and Patient Safety Committee.

“As Teladoc continues to expand in participation and scope, Helen’s breadth and depth of experience – particularly in the areas of quality of care and affordable access – will be invaluable to our leadership team and a great asset to our clients and partners”
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Ms. Darling, who has spent her career working to find practical solutions to address the mounting obstacles to affordable care, was named one of the “most powerful People in Healthcare” in the U.S. by Modern Healthcare five consecutive years from 2003-2007. For the past two decades, she has held various positions, including president and CEO with NBGH, a non-profit organization that promotes affordable, high quality health benefits, and represents large employers – including 300 of the Fortune 500 – on national health policy.

“As Teladoc continues to expand in participation and scope, Helen’s breadth and depth of experience – particularly in the areas of quality of care and affordable access – will be invaluable to our leadership team and a great asset to our clients and partners,” said Jason Gorevic, Teladoc chief executive officer. “Her contributions as a board member will further enhance Teladoc’s growing ability to break down the barriers to implementing telehealth and bridging the gap in health care access.”

Previously in her career, Ms. Darling directed the purchasing of health and disability benefits at Xerox Corporation for 55,000 U.S. employees. She also served as a principal at William W. Mercer and a practice leader at Watson Wyatt.

“I was attracted to Teladoc because, as the clear leader in its industry, it is a transformative force in the health care system,” said Ms. Darling. “I look forward to working with Teladoc, as finding ways to provide increased – and convenient – access to quality health care at a lower cost has never been more important.”


Ms. Darling holds a master’s degree in Demography and Sociology and a bachelor’s of science degree in History and English, cum laude, from the University of Memphis.

About Teladoc

Teladoc, Inc. (NYSE:TDOC) is the nation’s leading provider of telehealth services and a pioneering force in bringing the virtual care visit into the mainstream of today’s health care ecosystem. Serving some 6,000 clients — including health plans, health systems, employers and other organizations — more than 15 million members can use phone, mobile devices and secure online video to connect within minutes to Teladoc’s network of more than 3,000 board-certified, state-licensed physicians and behavioral health specialists, 24/7. With national coverage, a robust, scalable platform and a Lewisville, Texas-based member services center staffed by 400 employees, Teladoc offers the industry’s most comprehensive and complete telehealth solution including primary care, behavioral health care, dermatology, tobacco cessation and more. For additional information, please visit www.teladoc.com."