Sunday, September 18, 2016

Who Makes Insurance Companies Require MOC?

One of the largest reason physicians must participate in the ABMS Maintenance of Certification (MOC) program is because insurance companies demand it.

At least this is what the NCQA would like us to believe.

Those "evil-doer" insurance companies!

But it is the National Committee for Quality Assurance (NCQA), heavily marketed (video) by the likes of Atul Gwande, MD, that set the rules about which credentialing bodies US insurers can accept. Not surprisingly, the "Department of Health and Human Services (HHS) selected NCQA as an accrediting entity for Qualified Health Plan issuers participating in the Health Insurance Exchange Marketplace."

Who comprises the leadership ranks of the NCQA? Lots of good folks from the ABIM Foundation, the National Quality Forum, American College of Physicians (ACP), the Association of American Medical Colleges, and the insurance industry are members of its board of directors and its leadership team, who else?

And there you have it: a perfectly legal way to monopolize the credentialing process of US physicians, particularly one the ABMS, ACP, and ABIM stand to profit from.

And how much "quality" does the NCQA really require of insurance companies?

Not much:
(Click image to enlarge)
Sheesh. What an incredible waste of tax dollars.

If this is the hypocritical "quality" that the NCQA assures, we're all in trouble.

Time for the NCQA to add the National Board of Physicians and Surgeons ( to that list of accepted credentialing bodies for insurance companies to utilize nationwide. Otherwise, given the number of suits being filed against the AOA (a.k.a., the "American Osteopathic Information Organization" as circled in the letter above) and the ABMS and its member boards these days, the NCQA board members might need an alternative, legitimate credentialing body to add to their list of acceptable credentialing boards in order to keep their jobs.

Just saying'-



Wall Street Aquisitions Cash Act said...

NCQA, Richard Baron and the ACA
"Dr. Baron was a member of the NCQA Standards Committee from 2005-2011 and a director of NQF from 2009-2011. Dr. Baron was awarded the Pennsylvania Laureate Award and was named a Master of the American College of Physicians in 2010. He was named “Practitioner of the Year” by the Philadelphia County Medical Society in 2010."

"In 1989, Dr. Baron founded Greenhouse Internists and developed it to a seven-physician practice serving more than 10,000 patients in Philadelphia. Under Dr. Baron's leadership, Greenhouse was a pioneer in the comprehensive adoption of electronic health records and was among the first practices recognized by the National Committee for Quality Assurance (NCQA) as a Level 3 Patient Centered Medical Home."

Baron and Cassel are both associated with the Commonwealth Fund which has strong political ties and a revolving door with the NCQA.

Baron and Cassel's NCQA and Commonwealth Fund award their own

One two ACA punch of the NCQA and Commonwealth Fund

George Soros and the Commonwealth Fund (Soros and Cassel have a decades long relationship)

Anonymous said...

Are the NCQA and other orgs mentioned secret societies? I never heard of them.

"NCQA National Policy Conference

Each year, NCQA convenes a powerful policy conference where leading health care experts, employers, consumer advocates, providers, health plan executives and state and local government policy makers assemble in Washington, DC, to discuss the cause of and solutions to the current issues facing the US health care system. The Conference is promoted to NCQA’s extensive network of constituents spanning multiple sectors of health care.
Topics and speakers are carefully chosen
to highlight existing solutions to quality problems or examine future priorities in
quality improvement."

Federally Funded on MOC BLOCK said...

NCQA CEO Margaret E. O'Kane earns $750K on revenues of $60 million (2014 990 tax filings)

The NCQA and the Joint Commission look like "K Street" quality assurance lobbying firms located on prime real estate in Washington DC. In fact, the NQF, NCQA and Joint Commission are all in the same area a few minutes apart, and just a few minutes walk from the White House and Capitol Hill.

"Advisory Councils" [In house advisory groups to give themselves feedback!]

"NCQA also receives feedback on measure development and other areas through regular meetings and communications with various advisory councils. These groups include the Managed Care Organization Advisory Council, Purchasers Advisory Council, Consumer Advisory Council, and Public Sector Advisory Council. This network of key stakeholders ensures that NCQA’s products meet the various needs of multiple stakeholders."


"Funding Development of HEDIS Measures"

"In the past, funding for measure development and maintenance was from revenues earned from accreditation and other evaluation programs. However, supporting
measure development and maintenance has become increasingly time consuming and expensive with the increasing sophistication and complexity of measures and need for multiple external stakeholder reviews. At the same time, many policymakers would like measures to be available without charge to all users.
An increasing share of measure development and maintenance is now paid for by private and public (primarily federal) grants and contracts. NCQA does not accept any corporate sponsorship of measure development.
While the cost of measure development depends on the complexity of the measure and the extent of pilot testing of the measures, a reasonable estimate is about $500,000 per measure or set of measures developed together."

"National Quality Forum Endorsement (NQF): NCQA routinely seeks NQF endorsement, as it reviews measures for broad use. Nearly all NCQA measures submitted receive full NQF endorsement."

"Addressing Conflict of Interest" [COI are all self addressed without external oversight. Potential conflicts are not posted on their site. No financial information is offered such as 990 tax filings or federal grant money.]

"NCQA has a strong conflict of interest policy, approved by the Board and displayed on the Web site. Committee members make written disclosures and review potential material conflicts before new members are appointed. NCQA asks for updates to the written statements annually and requires verbal disclosure of potential conflicts. NCQA also seeks balanced representation on committees as a further check on the potential for undue influence from a single stakeholder perspective."

UnitedHealthcare/CMS Merger said...

UnitedHealthcare credentialing plan 2015-2016 (NCQA is referenced everywhere!!!)

"'Credentialing Authorities' means the National Committee for Quality Assurance (“NCQA”), other accrediting body as applicable to UnitedHealthcare, the Center for Medicare and Medicaid Services (“CMS”), as applicable, and other applicable state and federal regulatory authorities; to the extent such authorities dictate credentialing requirements."

" “Primary Source Verify” means to verify directly with an educational, accrediting, licensing, other entity, or NCQA approved entity that the information provided by Applicant is correct and current." (Insures ABMS Solutions revenues.)

Cached UnitedHealthcare Credentialing Plan 2013-14 with NCQA)

Anonymous said...

Just follow Ms. Cassell's trajectory and it will led you to the nexus of corruption

Deaf and mute to 800K physicians said...

Report the ABIM/ABMS personal enrichment scheme - from Brem to Benson, Kimball, Cassel and Baron

NCQA has a fraud hotline. Here are a few hot tips on individual quality assurance frauds and organizations they represent to report or follow up on:

-Bob Wachter, IPC Quality Chairman and Team leader trainer/advisor, DOJ vs. IPC Medicare Fraud. Obstruction of justice. Public fraud, etc.

-Christine Cassel, ABIM CEO/President, NQF CEO, PCAST Advisor to White House, Kaiser Foundation Hospitals, Premier, Inc. Egregious conflicts of interest, overreach, fiduciary negligence and malfeasance, failure to report conflicts of interest, abuse of executive power, misconduct as a PCAST advisor profiteering from insider knowledge, influence pedaling, and providing favors to affiliated corporations and government officials, obstruction of justice, and so on.

-Richard Baron, fiduciary irresponsibility, overreach, overstepping his job description in persecuting board prep courses and physicians attending them, running a political action group within a non-profit a political NGO, dissemination of political propaganda, covering up/keeping silent about the knowledge of life-threatening and deathly consequences of the Choosing Wisely program, squandering hundreds of thousands of phycians' fees on a luxury condo whose purpose was primarily to support executive travel for illegal lobbying and political activities,
approving the investment in offshore funds for purposes contrary to the bylaws and tax codes regulating a non-profit organization, racketeering, restructuring the ABIM into a police/surveillance state by hiring felons and goons squads, and failure to report necessary items and key individuals on 990 tax filings. Entering into a conspiracy with the above name individuals and John Does 1-300 to defraud physicians by forcing an onerous MOC regimen including deceitful financial obligations, plus lying about MOC by calling it voluntary, when it is in fact "regulatory capture" of the most deceptive and heinous kind.

Don't expect them to listen; they may have their own felon screening the calls!

Its time for change

Anonymous said...

ABIM executives, including Cassel and her cronies, are guilty of misprision.

NCQA Alumni: Former WellCare CEO Still Doing Prison Time said...

The Value of NCQA Quality Accreditation for Crony Health Plans Who Commit Medicare Fraud (Read below about the $137.5 million DOJ settlement and the indictment and conviction of the former CEO of WellCare.)

NCQA Quality Accreditation Partnerships and the Cost of Cheating Medicare and Tricare

"WellCare Receives NCQA Quality Accreditation for Its Medicare Advantage Health Plan in Connecticut" 7-21-2016

"Achieving an Accreditation status from NCQA is a sign that a health plan is serious about quality," said Margaret E. O'Kane, president, NCQA. "It is awarded to plans whose service and clinical quality meet or exceed NCQA's rigorous requirements for consumer protection and quality improvement." "Our commitment to quality is demonstrated through this accreditation result," said Ryan Fogarty, market vice president, Connecticut. "This achievement was made possible through the hard work of our employees, who are committed to ensuring our members have access to the care they need, when they need it, through our partnerships with high-performing physicians, hospitals and community-based social service organizations."

About WellCare Health Plans, Inc. Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company serves approximately 3.7 million members nationwide as of March 31, 2016."


"Former Wellcare Chief Executive Officer Sentenced for Health Care Fraud"


"WellCare Enters into Settlement with DOJ for False Claims Act Violations"

"WellCare Health Plans recently entered into a settlement agreement with the Department of Justice (DOJ) to resolve False Claims allegations. WellCare agreed to pay a total of $137.5 million to the federal government and nine states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio. This settlement agreement will resolve four separate lawsuits brought against the corporation, with most arising from whistle blower complaints."

More NCQA Quality Accreditation Woes - Humana said...

NCQA-Humana Anti-trust Issues and whistleblower Medicare Advantage Fraud

NCQA Accredited Entities - Humana

Justice Department vs. Aetna-Humana trial set for Dec. 5, 2016

"Yet another whistleblower alleges Medicare Advantage fraud"

"Florida doctor claims Humana knew of inflated bills, but did nothing, even though misleading diagnoses could harm patients"

Anonymous said...

It's a vicious circle of scam. How can we break it?

United States Senate Committee on Finance said...

"It is a vicious circle of scam." That is a good way to put it.

Our country is experiencing a decline in morality and democracy as is evidenced by the corrupt wanton utilization of non-profit organizations for personal enrichment and the fulfillment of partisan political agendas.

The self-appointment, self-vetting, self-enrichment, private partisan political activities all amount to illegal self-dealing and racketeering of the most sophisticated and destructive kind. Our democracy and treasury are being devastated by professional schemers involved in opaque unethical and illegal scams.

All these politically-charged executives of new formation and their cronies are using non-profit NGOs and Foundations to advance and sustain Democratic party platforms and healthcare reforms. They are all getting awfully rich by hoodwinking the American voter/taxpayer and thumbing their noses at physicians who have become derelict in their duty to our country's democratic principles and our constitution.

And these professional medical bureaucrats are not even real Democrats in the tradition of John Kennedy or Robert Kennedy; these organizations are led by the most corrupt and despicable political people one can imagine. They profit from power and government rather than serving with humility. They use lip service to traditional strengths of the Democratic party by spouting falsely, pretending to be of the people and for the people, when in fact they are only full of themselves and dedicated to protecting their lies and greed for power and money.

In fact it is even worse than that. The media have become mouthpieces for such ambitious people and the corporations and special interests they serve. And as a result we have a "government" which no longer represents or serves the people. We are devoid of facts and information because we are given only what serves the official lie. Our political parties have become corrupted beyond recognition; and any alternative parties are too insignificant, powerless or naïve to make a difference.

But it is quite possible if enough physicians and patients (over-taxed people) rally together we can put an end to much of the rampant corruption in the medical bureaucracy that ruins our lives and comes between physician and patient. It is obvious that we must reverse the ACA and close down a great number of the quality assurance organizations that only exist to enrich themselves - the executives who also provide favors for the controlling entities who lobby for unhealthy changes that make us miserable and in want of real healthcare.

These people that want blind worship from patients and physicians are corrupt beyond belief and only do harm through their illegal use of non-profit organizations!

Enforcement of tax laws will go a long way to put an end to much of it; and the DOJ has to be made independent and responsible again to indict and prosecute these professional medical cleptocrats who have been give a pass. They betray our country, and the professional medical community they should have happily and selflessly been a part of. They have betrayed the patient and they have in the process betrayed themselves.

Third-term for Billy and Hillary???!!! said...

Daily Mail - Clinton donors DID give money to get access to Hillary admits Bill: Bombshell admission from ex-president as the final Clinton Global Initiative starts in New York

CGI meeting - "A defiant Bill Clinton admitted that some Clinton Foundation donors probably gave money to the charity in order to gain influence with the former president and his secretary of state wife. But that doesn't mean there was any wrongdoing on his wife's part, he argued."

RNC response - "'The Clinton Foundation’s continued acceptance of foreign contributions while she runs for the White House is an unprecedented and unacceptable conflict of interest that undermines her ability to serve,' Priebus said. 'This is even more evident in light of Bill Clinton’s admission this morning that it was only "natural" for donors to ask for favors from Hillary Clinton’s State Department.
'The pattern of foundation donors and officials benefiting from access, favors and official actions by Clinton’s State Department is deeply troubling and deserves to be investigated by an independent special prosecutor,' Priebus continued.
'Pay-to-play corruption may be how Hillary Clinton intends to run the White House, but it’s not the kind of leadership the American people expect or deserve,' the chairman added."

Art Fougner MD said...

"You take the blue pill, the story ends. You wake up in your bed and believe whatever you want to believe. You take the red pill, you stay in Wonderland, and I show you how deep the rabbit hole goes." Morpheus, "The Matrix"

No robust evidence to justify MOC said...

The myth of voluntary certification and the fallacy of mandated MOC -
Richard Baron concedes there is no robust evidence. Why do MOC then?

ABIM's marketing engines rev up the nation with the noise that certification matters, and their exhaust pipes spit out the choking BS of MOC's importance - bought and paid for by physician fees funneled into ABIM's own in-house research:

The Public Expects It
• The public expects, in return for the privilege of self-regulation,
that physicians undergo a rigorous, periodic examination
of knowledge.
• A recent ABMS consumer survey found 95 percent of Americans
say it is important to them that their doctors participate in a
program to maintain their board certification.
• An ABMS consumer survey found that 91 percent of respondents
said that board certification is “very important” or “important” in
choosing a doctor.
• A recent survey found that parents of pediatric patients report
a preference for board certified physicians and expect them to
participate in MOC.
Physicians Value It
• In general, physicians seem to value the MOC process for its
effort to improve quality of care and patient safety.
• Physicians find the ABIM MOC program personally (62%) and
professionally (68%) valuable.
• 84% of physicians who completed an ABIM self-assessment of
knowledge module agree that it helped them identify further areas
of study, and 87% agree that it enhanced their competence in how
to improve patient care.
• 84% of physicians would recommend the ABIM PIM Practice
Improvement Module® to a colleague. 84% indicated that they
changed their practice as a result of the module.

Clinical Judgment & Diagnostic Errors
• Clinical judgment and the ability to deal with uncertainty are especially
critical with respect to misuse and overuse of processes of care.
• Physician knowledge and clinical judgment are central to making
correct diagnoses.
• One study found that premature closure, i.e., the failure to continue
considering reasonable alternatives after an initial diagnosis was
reached, was the single most common cause of diagnostic error.
Other common causes included faulty context generation, misjudging
the salience of findings, faulty perception and errors arising from
the use of heuristics.
• Physicians underappreciate the likelihood that their diagnoses are
wrong and that this tendency to overconfidence is related to both
intrinsic and systemically reinforced factors.
Physician Skills Deteriorate Over Time
• On average, clinical skills tend to decline over time.
• Amount of clinical experience does not necessarily lead to better
outcomes or improvement of skills.
• A physician’s ability to independently and accurately self-assess
and self-evaluate without guidance is limited."

MOC OCC said...

Is Your Healthcare Directed By A Criminal Enterprise? (Link to blogger's site who wrote correctly about the corrupt relationships that exist in the quality assurance racket. The ABIM, ABMS, ABIMF, NQF, CMS, RWJF, and so on.)

Anonymous said...

NCQA and Premier, Inc. Leapfrog Group, ABMS, ACP, AMA, are all paying NQF members. Annual fees are based on level of involvement.

Premier, Inc. is the first to receive certification for electronic clinical quality measures to support NCQA's HEDIS reporting, 2016

Premier Lies said...

Premier, Inc. payments to Christine Cassel from 2008-2014 for being a key Premier board member sheds a bright ray of light on her egregious conflicts of interest while sitting in the top executive seats at the ABIM and NQF. The Premier, Inc. 2008 annual report (link below) gives more weight to Cassel's already heavy involvement in the financial "padding" of Cecity for nearly five years leading up to the lucrative acquisition of Cecity by Premier, Inc.

Cassel aided in creating unfair business advantage for Premier, Inc. ABIM's major software/service agreements and purchases gave Cecity just enough additional revenue/contracts to keep Cecity profitable. Cecity was considered a well-placed jewel for Premier's portfolio of hospital offerings.

Other examples of Cassel's conflicts and giving unfair advantage to healthcare corporations:

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 as is the case when Kaiser Permanente bought out one of the oldest HMO's in the country - Group Health Cooperative based in Seattle recently. The CEO/President/Chairman of Kaiser Permanente (Bernard Tyson) was groomed by Cassel and introduced to her cronies.

This acquisition was a very big disappointment for those patients at GHC who already saw a decline in health care and coverage after the passage of the ACA. Kaiser notorious for giving their patients the short-ended stick.

More conflicts: Cassel has been up to no good for a very long time.

Note in the article below the key players in Bill and Hillary Clinton's 1997 healthcare commission/advisory. Janet Corigan, head of Clinton's 1997 commission later became head of the NQF. Janet Corigan reached out for help from Cassel as the NQF became embroiled in a scandal in 2010-2015 over conflicts of interest and bribery allegations. Charles Denham became a person of interest. Denham's TMIT was involved with the NQF since at least 2003 according to 990 filings. Denham's TMIT/HCC had financial relationships with AHRQ, Leapfrog, AHI, Joint Commission and others. The relationships have not been fully put into context regarding NQF's conflicts of interest and many of the key overlapping players like Bob Wachter, Christine Cassel, Richard Baron, Sylvia Burwell, Janet Corigan, and so on - even Chuck Denham's relationship with the Clinton Global Initiative.

According to the 990's of TMIT, Denham pumped hundreds of thousands of dollars in grants and services to the NQF since at least 2003 and there are many unanswered questions that arise from unreported errors in the official timeline. For example, the TMIT tax documents reveal that Denham may have been the NQF Safety Chairman for several years prior to what Wachter and others asserted when they distanced themselves from their own involvement with Denham and the "coincidental" organizations such as the Joint Commission, AHRQ, CDC, Leapfrog and so on.

Cassel accused Denham of lying to the NQF. But did he. His 990's for TMIT/HCC were easy to take a look at. Denham's 990's do not reveal the source of the revenues coming into TMIT, but there was clear documentation of all his activities with the NQF and Leapfrog, AHRQ and the Joint Commission. They all highly recommended ChloraPrep, were in fact on a multi-year global mission to have zero tolerance for HAI and CLABSI according to Joint Commission Research, Joint Commission, the CDC, WHO, TMIT and dozens of other easily accessible documents.

Anonymous said...

Is this a lie from Cassel?

"'Legislation is not the way to practice medicine. These decisions ought to be made by doctors and patients, not by Congress. When Congress prescribes the practice of medicine, it doesn't help the quality of care at all.'" - C K Cassel 1997
She obviously lied! She and others lied to the American public over egregious conflicts of interest and the facts behind healthcare reform. I believe we deserve to hear the real facts behind the "stories"!

fyi said...

ABIM Foundation is a paying member of the NQF and so is Becton-Dickenson BD the company that bought out CareFusion (ChloraPrep) in 2015.

Premier after CECity said...

Growing revenues at Premier with Cecity acquisition. (C+F Cecity)

ABIM Hall of Shame said...

What is the ABIM and what do they do? Christine Cassel/ABIM Flashback to 2009.

January-December 2009 Frontrunners countersuit against ABIM alleging restraint of trade, etc. Frontrunners was the victim of Christine Cassel, Lynn Langdon, Richard Baron and ABIM's director of investigations--a double felon named Benjamin Mannes who changed his name to obscure his criminal past.

January 2009 Christine Cassel was presented with formal complaint by African American manager of ABIM's Human Resources Dept. claiming they were a victim of racial discrimination by an ABIM Granatt HR, LLC auditor Donna Campbell, later appointed to HR director in 4/2008. Case is given to Lynn Langdon for "external audit". (Two female African Americans claimed racial discrimination in ABIM's HR - the only two.)

Feb. 2009 Christine Cassel's Commonwealth Fund announced health reform plan
"New Strategy from Commission of Leading Health Care Experts Would Insure Everyone, Improve Health, and Slow Spending Growth by $3 Trillion Through 2020"

Quarterly Board meetings with Kaiser Hospitals and Health Plans

Quarterly Meetings with Premier, Inc.

April 8, 2009 Lynn Langdon on behalf of Christine Cassel presents to ABIM's African American HR manager the results of discrimination allegations leveled against ABIM.

April 8, 2009 HR manager alleging race discrimination employment terminated by ABIM COO Langdon per January's formal complaint given to Christine Cassel.

April 27, 2009 Christine Cassel appointed White House healthcare advisor PCAST.

May 2009 Christine Cassel weighs in on ethics, professionalism and consumer-driven healthcare in JAMA

ABIM Hall of Shame said...


May 13, 2009 Christine Cassel, Court opinion given on ABIM's alleged racketeering, negligence, racial discrimination, restraint of trade, etc. Anand Munsif v. Christine Cassel, Richard Baron et al Precedential or Non-Precedential: Non-Precedential Docket No. 08-1418

June 2009 Christine Cassel's Commonwealth Fund cronies publish


August 2009 Christine Cassel and Lynn Langdon along with Eric Holmboe order ABIM employee to spy on competitor's board prep course in New York. Spy makes secret recordings without knowledge or approval of ABR and takes notes. ABIM's ongoing investigation of copyright infringement would lead to thousands of persecutions of physicians, demonization in the press, and continued fear-mongering from continuous sanctioning and lawsuits. 2008-present. While violating conflicts of interest policies, Cassel et al's overreach and abuse of power is unprecedented in the history of the ABMS.

August 7, 2009 Negligence in allowing the ABIM to become officially dissolved as a corporation. Christine Cassel's failure to submit required paperwork to the State of Iowa resulted in the dissolution of the ABIM.

August 20, 2009 Christine Cassel Conference on C-Span in DC, End of Life Issues and Health Care Legislation, Health Affairs Journal, National Press Club

November 19, 2009 Administrative Dissolution reversed by the Secretary of State of Iowa. Christine Cassel and Richard Baron realize they are administratively dissolved and must appeal with the State of Iowa for not filing and pay the fee and do the simple paperwork. (Too occupied with more important matters for three months to notice their non-compliance with state requirements.

December 9, 2009 Christine Cassel seizes Dr. Arora's private property to destroy board prep company ABR and go on a fishing expedition for thousands of physicians in a McCarthy-era style invasion of privacy/violation of civil liberties, a direct assault on democracy, and the destruction of the US constitution and amendments.

The timeline does not include any references to ABIM educational activities programs and services because they did not come up in our online search involving Christine Cassel.

Ingenix scrubbed from Andy Slavitt's history said...

No mention of Ingenix on Andy Slavitt's online history anymore. It used to be included for transparency.

Andy Slavitt, CEO Ingenix and David Blumenthal, National Coordinator for Health Information Technology - now president of the Commonwealth Fund.

Another wild Ingenix connection.

Ingenix and Claredi

Ingenix and Hipaa