Wednesday, October 18, 2017

Why the IRS Needs to Investigate the ABIM

Monday, the bureaucratic side of the House of Medicine, via the American Board of Internal Medicine, announced their new-and-improved fee structure for Maintenance of Certification®. Lots of fancy corporate spin was used to justify the need for cash, with even some "discounts" (that failed to include the test facility fee as before) were promised for those silly enough to pre-pay for their strongarmed fees.

According to ABIM's publicly reported mission statement:
"THE AMERICAN BOARD OF INTERNAL MEDICINE (ABIM) SEEKS TO ENHANCE THE QUALITY OF HEALTH CARE BY CERTIFYING INTERNISTS AND SUBSPECIALISTS WHO DEMONSTRATE THE KNOWLEDGE, SKILLS AND ATTITUDES ESSENTIAL FOR EXCELLENT PATIENT CARE...MOST DIPLOMATES CERTIFIED PRIOR TO 1990 ARE STRONGLY URGED TO PARTICIPATE IN MOC BUT ARE NOT REQUIRED TO DO SO TO REMAIN CERTIFIED.FOR ALL DIPLOMATES, IN ADDITION TO REPORTING BOARD CERTIFICATION, ABIM WILL REPORT IF THEY ARE PARTICIPATING IN THE MOC PROGRAM (I.E., ENGAGING IN MOC ACTIVITIES FREQUENTLY)." (From their IRS Form 990)

Board certificaiton, and MOC® in particular, are no longer voluntary for US physicians. I believe (and I do not say this lightly) placing such a statement on an IRS form in this day and age constitutes fraud. MOC® has been cleverly incorporated into hospital bylaws and insurance panel requirements thanks to (1) the public sharing of Margaret O'Kane on the National Quality Forum and the American Board of Medical Specialties board and (2) Richard Baron, MD's work at the Seamless Care Model Group of CMS. Clever corporate inner dealings have benefitted their self-proclaimed corporate partners at FigMD, Kaiser Foundation and Hospital Group, the now defunct IPC The Hospitalist Company, Premier, Inc,, CECity, Inc., ABMS Solutions, LLC, the NEJM Group, Wolters Kluwer, and Pearson Education. As such, ABIM is no longer a charity organization, it is a for profit business. They have never shown improved quality of care no prevented injury to the public (state medical boards address poor quality and behavior by physicians). Rather, like many successful for-profit companies, the organization has promoted the self-inurement of its leadership, board of directors, and academic affilitates through political influence and self-dealing. It is now well-documented that at LEAST $78 million dollars from ABIM diplomates were secretly funneled to the ABIM Foundation for their benefit. Condominium purchases, health club memberships, spousal travel, Cayman Island Investments, a lavish $1.2 million golden parachute for Christine Cassel, MD and an annual salary from Richard Baron that approached $850,000 in fiscal year 2016 are realities and not usually the hallmark of a legitimate charitable organization that provides voluntary benefit to the public. Neither is the repeated convenient misreporting on tax forms from 2008 through 2013 that has occurred, including (at a minimum) misreported dates and place of origin of the ABIM Foundation, lack of disclosure of depreciation of the condominium or the disclosure of lobbying of Congress on those forms either.

At the very least, it is time for the Internal Revenue Service to reevaluate the non-profit status of the ABIM. Taxpayers (and physicians who have no choice but to participate in this costly charade) deserve no less.

-Wes

8 comments:

  1. Wes,

    Might want to look at the 990 returns of the charitable entity you work for. Non profits are rife with these princely payments because "this is what the market demands we pay for these talented people that are in such short supply." The last time I looked, the CEO at Northshore was clearing close to 1.5 mil for his great guidance (and willingness to battle the FTC every 10 years or so over monopolistic mergers and behavior.) Many organizations are skirting these tax exempt laws for profit going to a few well placed individuals. Another reason we have such economic equality in the US of A.

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  2. "Why the IRS Needs to Investigate the ABIM".

    More importantly, why ISN'T the IRS investigating the ABIM? While we're at it, why do the federal courts drag their feet regarding litigation directed at the ABMS? And why did Congress pass the ACA which legitimized the ABMS gangsters? Federal complicity in all three branches is the common thread. The near total control of physicians and their practice behaviors have been outsourced to the private sector. We are now surveilled by EMR systems, and can look forward to life long exams that are shrouded in secrecy and can even introduce unvetted standards of practice (Choosing Wisely comes to mind). Our very careers are also being threatened. Only those who have nothing left to lose rebel. Physicians have too much to lose and will likely remain submissive for the foreseeable future.

    There may be a glimmer of MOC reform hopes at the State level, where competition may be heating up to retain physicians, as a shortage purportedly looms. This has already been witnessed in a handful of states. Rest assured, however, that the ABMS already has its beady eyes set on influencing the State Boards as well. Pay attention to Ohio.

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  3. "Laws catch flies, but let hornets go free."



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  4. We agree the IRS should take a look at the ABIM and other boards; they should be able to recover some money. Somebody could guide them through the process and get a recovery reward. It is ridiculous that ABIM and the others do not pay any tax. It's obvious to most physicians that the ABIM/ABMS are dodging taxes; crystal clear when this abusive business franchise has docs by the nose ring. Branded with the trademark MOC. It all hurts. Just look at all their business partners listed above ready to jump in the game like Wolter Kluwer, the UpTodate parent company. I don't see any of their for-profit partners mentioned on the tax forms, except the multi-million dollar payments to CeCity, the former ABIM CEO's acquisition target for Premier, Inc.

    The for-profit list of the ABIM partners is growing all the time. A great deal of money is flowing through the ABIM. Over a quarter of a billion $$$,$$$,$$$ in program related revenues every 4 years. And a whole lot more than that is changing hands between them and their partners.

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  5. Docs are owned by the ABMS' Chicago MoC®antile Exchange. Docs are bought and sold in a neat tidy line with their tails pinned up high. Mandated to stand waiting for a buyer right next to the pork bellies.

    "Don't you try to run away in the land of the free, we need your MOCfees."

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  6. ABIM hired this man, Chris Jennings and his firm in DC paying $120,000 in 2010. What for? ABIM says "no" to the question of lobbying on their tax forms.
    http://healthaffairs.org/blog/author/jennings/

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  7. Why did ABIM hire this lobbyist in 2010?

    "Mr. Jennings, 52, was President Clinton’s chief health policy adviser from 1995 to January 2001. He is known and trusted by Obama administration officials and has close ties to Democrats and some Republicans in Congress. In 2001, he established a lobbying and consulting concern, Jennings Policy Strategies. Current and former clients include the A.F.L.-C.I.O., the Bipartisan Policy Center, the Federation of American Hospitals, General Motors and the Generic Pharmaceutical Association.

    Mr. Jennings was a registered lobbyist, but has not been one for a couple of years, so he would not have to worry about Obama administration restrictions on lobbyists joining the government."

    http://www.nytimes.com/2013/07/08/us/politics/clinton-aide-joins-obama-on-health-care.html

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  8. We need to rebel against the entire board certification process from the get go. As long as we allow them to tell us we can't practice without being "board certified" (which is a fancy way of saying that we played a memory game and answered some multiple choice questions on a test), they have us by the necks. There should be no requirement for any form of board certification period. Until that day happens, we will remain under the control of the ABMS. Getting rid of MOC only fixes a tiny portion of the problem.

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