Monday, November 23, 2020

For ABPN: Their Legal Headaches Aren't Over Until They're Over

Today, the first amended class action anti-trust complaint was filed by Drs. Emily Elizabeth Lazarou and Aafaque Akhter against the American Board of Psychiatry and Neurology (ABPN) in the US District Court for the Northern District of Illinois in response to Judge Martha Pacold's 11 Sep 2020 dismissal without prejudice of their earlier complaint. Much of the Amended Complaint is noteworthy, but paragraphs 20 and 21 drive home the true motivation behind Maintenance of Certification (MOC):

20. MOC is not about maintaining standards as ABPN contends. It is a revenue-driven commercial endeavor, motivated by tens of millions of dollars in new MOC fees.  (Emphasis mine) As indicated by the failure of its earlier voluntary CPD product, MOC is financially successful only because it is mandatory and tied to certifications. ABPN’s financial results amply document this. After the launch of MOC, from 2004 through 2018, ABPN’s “Program service revenue” exceeded its total expenses by a yearly average of $4,448,338, as reported in its Forms 990 filed with the Internal Revenue Service (“IRS”). But for its reporting status as a supposed not-for profit organization, this translates into almost $4,500,000 in average annual profits before investment and other income is taken into account.

21. During the same time, ABPN “Net assets or fund balances” skyrocketed over 971%, from $12,610,227 at the beginning of 2004 to $122,470,594 in 2018. In other words, while it took ABPN almost seventy years to accumulate net assets (assets less liabilities) of $12,610,227 from selling certifications, ABPN net assets increased almost ten-fold to $122,470,594 as a result of selling MOC, including $97,169,079 in cash, savings, and securities on hand at year-end 2018. (Emphasis mine)
The Amended Complaint filed today greatly simplifies the case for a better understanding by the judge: the extortion of US physicians for an unproven and falsely marketed educational product must end.



Anonymous said...

Here's the schism that I see in medicine. Ever since the gradual introduction and takeover of medicine by managed care, insurance companies, lawyers, there exists two types of physicians. The ones who slug it out in the trenches and the front line of patient care, trying to work 'within the system and still haven't forgotten why they went into medicine and do their best to care for patients.

The other group includes what I call 'the Administrative caste' or 'DINO's' - Doctors in name only. These are the doctors who folded like a cheap card table and like Judas Iscariot took their 30 pieces of silver from whatever organization wanted them to give things like MOC a thin scrim of medical credibility to say "see? Your colleagues approve. They did this for the cushy desk life of 9-5 days and no call and a significant paycheck.

I see these DINO's and I frequently have to ask why after the years, nights and weekends spent to get my medical degree, do I need some administrative overlord to tell me how to take care of patients?

MOC, no matter what medical specialty represents the worst of these types, the Cassells who despite applauding how good it is, don't participate.

We doctors are our own worst enemy. If you're wondering who could do this to us, you just have to head over to the board room of your hospital.

DrWes said...

Anony 10:41PM-

Your summary is one of the best assimilations of the underlying challenges the anti-MOC effort has encountered over these past seven years. We are, indeed, our own worst enemy. Nonetheless, the harms endured by physicians because of MOC need to be disclosed if for no other reason than to disclose the harms it continues to impact our patients as a result.

Executive Paycheck Protection said...

MOC, Quality Assurance and Private Equity -- Executive Paycheck Protection in the Novel Era of Covid

Hospitals, Bailouts, and CEO Pay
Biggest PPP [Covid Bailout] "Borrowers"
(behind a paywall)

Not-for-profits randomly selected







Greenhouse Internists PC (Founded by ABIM CEO)


ACC-F American College of Cardiology Foundation





Anonymous said...

MOC is a chronic migraine for docs with optical side effects for patients.
It ain't over 'til it's over. Let's get some relief from the courts now.

MOCeteers and the Lion City said...

"ABPN Collaborates with Singapore Group to Develop Psychiatry Certification Examinations"

"The ABPN has engaged in a ten-year collaborative arrangement with the Ministry of Health, Singapore, through the ABMS Singapore, LLC, to jointly develop post-graduate examinations for psychiatrists in Singapore.

The assessment process developed under this collaboration is specifically designed for the Singapore health care system and to operate within that specific context.

The arrangement allows Singapore to share ABPN’s expertise in
certification for psychiatry and neurology to implement its system of medical certification and to incorporate elements of the US medical certification model."

MOC is sold in the USA not in Singapore. What does this mean

MOC is not sold to Singapore medical specialty graduates where the ABMS/ABPN monopolizes the certification market.

After supplanting the British medical system completely around 2012 the ABMS quickly found there was no appetite for the ABMS/ABPN's separate product called MOC.

MOC was rejected by physicians and the MOH emphatically.

In fact, just the mention of MOC of those who have any knowledge of the US market is enough to cause revolt in minds of Lion City physicians and its medical ministry.

MOC does not fit in the Singapore health system and it does not belong in the US system. The history of MOC tells a story of moneyed interests only and a power grab.

Therefore, MOC is not required in Singapore and is not even offered as an optional product. The Lion City (worthy of its name) is more enlightened as they do not condone the onerous MOC products, which are forced on physicians only in the US.

Insurance companies and employers/hospitals don't require MOC in Singapore. Certifications are not dependent on MOC. Singapore understands that MOC is conflicted and would appear as racketeering to the subtly Asian mind and sensibility.

We have the ABPN's own words on page 8 of their Annual Report in 2015 that the ABPN's assessment process incorporates only elements of the US certification model.

MOC cannot be considered as anything but a separate product as it is not even mentioned anywhere in ABMS/ABPN's graduate training assessments and the ABMS advertisements in Singapore.

We might add there are no such arbitrary distinctions of those "participating in MOC" and those who are "not participating in MOC."

MOC does not exist in this market. Period. CME is voluntarily purchased in the open market.

How much clearer can one be in making the argument that MOC is in fact an illegally tied separate product sold separately and only in the US.

Why Report said...

Why are the ACGME-International ABMS-International, ABIM/ABPN rest of the medical specialty boards really doing in Singapore.

Is it quality of medical education and assessment of graduated medical education for the ACGME/ABMS or is it more complex and perhaps quite conflicted? Given the history we can assume that the Casselian priniciple of conflicted fox in the henhouse precedes all action.

One needs only to examine the financially motivated adventurist exploits of the ABMS and question their globalist agendas.

As an example of possible conflicts of interest, Temasek is the government investment fund for Singapore. Their portfolio has decreased or remained flat in all categories of holdings in their investments, except healthcare. This category has doubled in its investments in life sciences/healthcare after the ABMS came to the country. Look at the recent purchase of German interests BioNTech in the covid vaccine, which partnered with Pfizer.
"Singapore's state investor Temasek and other investors are injecting $250 million into German biotech company BioNTech BNTX.O, which is developing an experimental vaccine against the coronavirus with pharmaceutical giant Pfizer PFE.N."

Here are some of the top holdings in their "life sciences" "agribusiness" category.
Bayer/Monsanto is their top holding.

It would be interesting to many of us if the ABMS et al would discuss their investments and interactions with their global partners. The question is still outstanding. Is their existence about quality or is it about money.

The existence of the MOC mandate in the US tells us all it is about the money and power and how executive/advisors benefit personally from it.

By the way the two Chinese healthcare companies in Singapore's Temesek portfolio are involved with GlaxoSmithKline. It appears they have their own Covid vaccine endeavors moving into large offices next door to one another in Philadelphia where the ABIM resides.

The ABIM has a relationship with GlaxoSmithKline as we have seen through the appointment of a former Chief of Staff with familial/financial ties to the company and through their current "CMO", a PwC veteran.

WuXi AppTec Co., Ltd.
WuXi Biologics (Cayman) Inc.

ABPN Specialty of MOC Distracts From Providing Core Education said...

MOC is financial racketeering. The surfeit MOC money often leads to political shenanigans and machinations conducted against physicians. (Citations not needed.)

MOC is not conducive to wholistic, wholesome or healthy learning for medical professionals. In fact it is counterproductive to learning, a distraction that violates constitutional rights.

MOC is discriminatory. MOC invades the privacy and rights of physicians and patients.

MOC is a money/compulsive/control disorder among ABMS/ABPN executives. Due to this fact unbiased psychiatrists and neurologists in a good positions to observe and study these facts in a scientific way.

MOC does damage to physicians' executive functions, emotional well-being, and nervous system. Stress of MOC creates a variety of MOC-induced anxieties and ailments.

Through probative counseling, relevant surveys and imaging of the brain for insights into the effects of MOC, dedicated researchers might conclude, as many have through intimate negative experiences, that MOC is a psychological form of torture with lasting damage to the brain, nervous system and psychology of physicians and trainees who fear it.

MOC money disorders/distracting MOC exercises and deleterious mandates instigated by ABMS executives has increasingly resulted in substandard education for trainees in psychiatry and neurology.

A study by ABPN reveals a great deal of these deficiencies, especially the last comment about inadequate training. ABPN/ABMS focus on money and investments has caused deterioration of the core training. Internal medicine training is insufficient and both psychiatry and neurology trainees miss the mark regarding cross training.

The ABPN/ABMS and ABIM are asleep at the wheel, because of profound conflicts of interest and monied pursuits pertaining to MOC. As money becomes increasingly the focus, core education falls by the wayside. The ABMS is the ACGME and vice versa.

MOC is about money and not about the quality of education. I hope this can be studied thoroughly and changed by responsive and responsible parties at the ABPN/ABMS and ABIM.

Litigation and its effect on all could be included in the study and remedy, which is clearly that mandated MOC and its monied interests needs to be deep-sixed.

ABMS MOC & PwC: What is the relationship? said...

ABMS, Insurance, Hospitals, and Advisor PwC

PwC should address their past and present relationship with the ABIM's CMO and how their team of "advisors" profit from insurance company consolidation and hospital mergers/buyouts.

The truth is they all benefit from MOC, which they understand is an illegal mandate giving a great degree of control over the professional medical labor force. (Physicians.)

The ABIM's "chief medical officer" lives in western New York not Philadelphia where he allegedly works. All CMO's and CEO's in the past have applied for Pennsylvania medical licenses. The standards and quality at the ABIM and other medical boards has declined remarkably as Richard Batagglia ABIM's CMO after five years at ABIM in Philadelphia as chief medical officer has still not acquired the necessary PA medical license to be credible as CMO in Philadelphia.

There needs to be a higher degree of scrutiny of those who qualify physicians and allege to be a liaison between the ABIM and professional medical community.

The plaintiffs in every case against the ABMS medical boards should ask for a record of hours, projects, perks and per-diem payments from all executives. Physician's hard earned money deserves a full accounting and audit of all medical board executives' work-related activities/payments and personal finances. They have always claimed no conflicts, but when digging investigators have found egregious conflicts.

A deep dive into any of the medical specialty boards and ABMS umbrella reveals rampant conflicts, massive fraud, and monopoly abuses. Every illegal act of tying MOC to certification is a criminal offense. An act of fraud and deception.

It amazes me that the DoJ has not investigated and issued indictments. The ABIM's current CMO, a ("former") PwC manager and director should be scrutinized for any current relationship with PwC, insurance companies and hospitals. The ABMS medical boards has contracted a double felon to persecute physicians in the past. This egregiously conflicted man was moonlighting with a company specializing in spying on ABMS certification clients, making a market and name for himself off the illegal spying and unconstitutional misdeeds against physicians.

The ABIM has been proven to be highly conflicted and there appears to be no reform whatsoever. They have just gotten more brazen and bold about their carefully hidden self-dealing. Any conflicts of interest does not alarm them. Their hypocritical trust campaign/PR stunt went bust before it began. The reasons are obvious.