ABIM Fails to Disclose Lobbying Efforts

Shhhh.

The public wasn't supposed to know.

Neither was the Internal Revenue Service (IRS).

According to the American Board of Internal Medicine's (ABIM) most recent tax forms, they never participated in lobbying, nor spent money to do so.

Yet, according to public record, it appears the ABIM most certainly did lobby Congress as a 501(c)(3) organization and has repeatedly failed to disclose this reality to the IRS.

The ABIM's Lobbying Disclosures

Here's the information the ABIM filed with the IRS on their most recent "audited" 2013 Form 990 which includes expenses paid from 1 July 2013 to 30 June 2014 as a 501(c)(3) organization:

ABIM 2013 Form 990 Lobbying Disclosure
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ABIM 2013 Form 990 Itemized Lobbying Expenses
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The ABIM's History of Lobbying

But searching OpenSecrets.org, a website dedicated to transparent government spending, it seems the ABIM spent quite handsomely on lobbying during its fiscal year 2014:

ABIM Lobbying Expenditures for 2014 Election Cycle
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In fact, the ABIM has been lobbying for years (and continues to do so):

ABIM's History of Lobbying since at least 2009

When we delve into who the ABIM paid for these lobbying efforts, we find even more interesting information.  In 2014, the lobbying firm used was Mehlman Vogel Castegnetti, Inc. (Vogel later spun off in 2014 to create his own lobbying firm and the new firm is now called Mehlman Castegnatti Rosen Bingel and Thomas) and used the following list of lobbyists:

ABIM Lobbying Firm in 2014
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Of these lobbyists, five have current or former ties to the insurance industry (Bingel, Castagnetti, Gupta, Rosen and Zook) and one (Thomas) to the Federal Trade Commission and one (Eastman) to the Ways and Means Committee in the House of Representatives.  Needless to say, 13 of the 14 have "revolving door" relationships with one or more government offices.

These revelations are important. Recall that the American Board of Medical Specialties (of which the ABIM is but one of 24 "member boards") was magically inserted into Social Security Act 1848 (k)(4)  that deals with physician payment with passage of the Affordable Care Act in 2010. More recently in January of 2014 changes made to the ABIM's Maintenance of Certification (MOC) program that force doctors to pay them to remain "board certified" in good standing so they can remain credentialed to practice medicine with their employing hospital system and to receive insurance payments.

On January 1, 2014, the Organization revised the nature of the MOC program. The MOC program is now a continuous program based on a calendar year. Upon entering the MOC program, a diplomate must actively maintain their certification by completing certain requirements. These requirements are expected to be completed every two, five and ten years. Candidates choose to pay annually or to prepay for ten years for access to the program.

At the same time, CMS offered a payment incentive to physicians for participation in MOC.  Given the lobbying efforts uncovered here, no longer is the collusion between the ABIM 's MOC program and influential government personnel or agencies just a theory, it now appears (based on public record) to be a very real possibility. The ABIM's long-standing unreported lobbying history raises the very real possibility that the more recent leadership of the ABIM has been more concerned about creating a financial monopoly for itself (and trying to hide it) rather than truly improving patient care.

Further Questions Regarding the ABIM's Auditor

The auditing firm  McGladrey, LLC, appears to have audited he most recent financials for the ABIM. Their "responsibility statement" in the ABIM's financials states:

Our responsibility is to express an opinion on these financial statements based on our audits. We conducted our audits in accordance with auditing standards generally accepted in the United States of America. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free from material misstatement.

Now I'm just a practicing cardiac electrophysiologist here in the United States, not an auditor and I have no idea what "opinion" was actually "expressed" to the ABIM board members by McGladrey's auditors. But if I can find these financial and tax filing discrepancies (among others) thanks to the wonders of the internet, I think the ABIM and the ABIM Foundation needs a new auditor...

… like maybe the IRS or the Office of the Inspector General of the Department of Health and Human Services.

-Wes

Addendum: On 6/30/2015, a Lobbying Report was filed by the ABIM in accordance with the Lobbying Disclosure Act of 1995 (Section 5) terminating the ABIM's relationship with their lobbying firm Mehlman Castagnetti Rosen Bingel & Thomas, Inc.

The IRS, NSA, and Justice Department Scandals and What They Mean for HIPAA

As my head reels at the implications of the IRS scandal mushrooming in Washington, the IRS's recently disclosed ability to access e-mails without warrant, the intricacy of the NSA PRISM wiretap techiques that includes their ability to acquire tech firms' digital data, and even the Justice Department's ability to secretly acquire telephone toll records from the Associated Press, I wonder (as a doctor) what all this means for the privacy protections afforded by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in our new era of mandated electronic medical records.  Are such privacy protections credible at all?

It doesn't seem so.

Now it seems everyone's health data is just as vulnerable to federal review as their Google search data.  This is not a small issue.  We have already seen that discovering "leaks" of personal health information has produced some very handsome rewards for the feds, so it is not beyond reason to think that HIPAA might also be a funding tool for our government health care administration disguised as a beneficent effort to protect the health care data of our populace.

But even more concerning is the role the IRS scandal has for America's health care system.  After all, the Affordable Care Act is ultimately funded by the IRS by administering some 47 tax provisions.  These include the right to levy a penalty against businesses and individuals who don't provide or acquire insurance and determining how to distribute annual subsidies to 18 million people who make less than $45,000 a year and thus qualify for subsidies in buying health coverage. In addition, the agency will collect taxes on medical devices and a surtax on people making more than $200,000 a year, as well as conducting compliance audits of tax-exempt hospitals.

We are left to wonder: given the IRS's recent actions in favor of one political party, could other aspects of our evolving health care system be similarly politically targeted?  What if the government agencies turn a disapproving eye on physician-run hospitals or independent concierge medical practices?  What if the market place emergence of a two-tier health care system is systematically crushed?  For these types of concerns we instinctually rely on a fair, beneficent government, but these latest revelations challenge that assumption.

To the political class, the ends always justifies the means.  Now, we're seeing that the means includes stealth digital tracking, e-mail browsing, and wiretaps.

Health care data protection by HIPAA?

Meh.

We should think about the far-reaching implications of what we're seeing from our government agencies as we turn the reins of health care financing over to them lock, stock, and barrel.  Perhaps Peggy Noonan said it best:

What does it mean when half the country—literally half the country—understands that the revenue-gathering arm of its federal government is politically corrupt, sees them as targets, and will shoot at them if they try to raise their heads? That is the kind of thing that can kill a country, letting half its citizens believe that they no longer have full political rights.

Those who think this is just business as usual are ahistorical, and those who think nothing can be done, or nothing serious should be done, are suffering from Cynicism Poisoning.

In the blink of an eye, HIPAA privacy protections now seem small.

Very, very small.

-Wes

Addendum: Thanks to @BillHart46 for pointing me to this: Suit Alleges IRS Improperly Seized 60 Million Personal Medical Records