Wednesday, December 14, 2016

ABMS/ABIM MOC Controversy: 2016 Year-in-Review

It's hard to believe that another year has come and gone since my 2015 update on the ABMS/ABIM Maintenanence of Certification controversy. I thought it would be important to maintain this chronological annual review of the ABIM and their conspiring organizations to keep physicians and the public apprised of the situation unfolding. Here is the timeline of the major developments regarding the ABIM MOC controversy for the past year so far:*

  • 12 Jan 2016 - All ABIM archived webpages published after 1 Jan 2014 are removed from the internet archive Wayback Machine at

  • 13 Jan 2016 - More evidence for improper research practices used at ABIM surface on the ABIM website as physicians are asked to "update their profile" so the ABIM can research ways to "improve health care." ABIM diplomates are not informed on the research being conducted nor have they been given informed consent about the research activities being conducted.

  • 21 Jan 2016 - ABIM Foundation publicly discloses for the first time $56 million in transfers (unverified) from ABIM since 1990.

  • 26 January 2016 - Robert Wachter, MD, former Chairman of the Board of the ABIM and its Foundation, publishes a New York Times opinion piece entitled "How Measurement Fails Doctors and Teachers" and suggests "the secret of quality is love." With the article, Wachter  fails to disclose his own conflicts with the "measurement industry" at the ABIM and ABIM Foundation and the stock earnings he received from IPC Hospitalist Company (later acquired by TeamHealth) that is under federal investigation for overbilling Medicare.

  • 16 Feb 2016 - The website goes live to support the legal defense and countersuit of Jamie Salas-Rushford, MD, a Puerto Rican physician sanctioned and then sued by the ABIM in 2012 for allegedly disclosing ABIM test questions to Rajender Arora, MD, the creator of the now defunct ACGME-accreditied Arora Board Review courses as he studied for his certification examination. Numerous sanction letters and court documents against Dr. Salas Rushford appear online.

  • 8 March 2016 - The peer-reviewed journal article, "Medical Specialty Certification in the US - A False Idol?" is published.

  • 11 March 2016 - Like the practicing physicians' anti-MOC activities underway, medical students push back against another unneccessary and expensive testing requirement: the National Board of Medical Examiners' Step 2 CS requirement.

  • 12 March 2016 - The sworn testimony of Rajender Arora, MD of the ABIM's raid on his home by Federal Marshals appears online and offers remarkable details of the operation ABIM used to gain access to hundreds of review course attendees' personal information and email accounts.

  • 1 April 2016 - Robert Wachter's industry-sponsored blog, Wachter's World, disappears from the internet. Recall that Wachter's company, IPC The Hospitalist Company, for which he served as director and received 3,995 shares of stock valued between $50.68 and $58.50 per share, was sued by the Department of Justice for was overbilling federal insurance providers. The company was later acquired by TeamHealth 23 Nov 2015 for $80.25 a share, netting him and his University, the University of California, San Francisco (with whom he had a sharing agreement with), a comfortable profit.

  • 26 April 2016 - Oklahoma passes comprehensive anti-ABMS MOC legislation and ABMS responds.

  • 10 May 2016 - More changes to the ABIM MOC program to be implemented 1 Jan 2018 that includes more frequent testing are announced.

  • 12 May 2016 - Public disclosure of American College of Physician's Executive Vice President Steven E. Weinberger, MD's upcoming retirement appears.

  • 13 May 2016 - ABIM posts June 30, 2015 Form 990s. ABIM Foundation reports correct year and state of incorporation after six years of inaccurate reporting.

  • 20 May 2016 - The ABIM Foundation moves $6.5 million of diplomate testing fees offshore to the Cayman Islands in fiscal year 2015.

  • 9 June 2016 - The dark story of ABIM's felonious "Director of Investigations" and the strongman tactics used by the organization against economically vulnerable physicians is reported.

  • 14 June 2016 - Scott Shapiro, MD, Bonnie Weiner, MD, Charles Cutler, MD, myself, and Mr. Charles P. Kroll appear before the AMA House of Delegates meeting in Chicago to deliver our evidence supporting financial and professional mismanagement at the ABIM that culminated in the Pennsylvania Medical Society issuing a formal "vote of no confidence" against the ABIM.

  • 16 June 2016 - The AMA membership presses for an immediate end to MOC.

  • 2 July 2016 - Expanding investigations of other member boards of the American Board of Pediatrics reveals retired President and CEO of the American Board of Pediatrics, James A. Stockman, III, MD earned $793,438 working just eight hours a work-week as an "advisor."

  • 10 July 2016 - ABIM Foundation sells its controversial luxury downtown Philaelphia condominium at an estimated $1.2 million loss.

  • 21 July 2016 - The untold story of three ABIM-sanctioned physicians appears that chronicals the humiliation, ethics course requirements, and a $5000 check one of them had to pay ABIM to reinstate their certification.

  • 2 August 2016 - Several doctors of osteopathy file a class action lawsuit against the American Osteopathic Association seeking to recover millions of dollars in annual membership fees that the doctors allege they have been forced to pay for years to the organization to maintain their certification.

  • 4 August 2016 - ABIM Foundation shifts from defining and promoting "medical professionalism" to "co-creating" health care.

  • 5 August 2016 - Medical Economics publishes MOC promotional piece by Richard Baron, MD, President and CEO of the ABIM, then asks for a physician rebuttal via its Twitter feed. After writing the rebuttal at their request, Medical Economics refuses to publish it. The rebuttal is published on these pages and received over 10,000 page views within 48 hours.

  • 24 September 2016 - Retirement plan and change in audit firm disclosed publicly for the first time: value of ABIM's 100% employer funded Retirement Plan now exceeds combined value of ABIM and Foundation accumulated since 1936 (ABIM) and 1989 (Foundation).

  • 28 September 2016 - My 22-minute talk on "Why MOC is Broken and How to Fix It,  delivered at the AAPS meeting in Oklahoma City, appears (video).

  • 16 October 2016 - How the major medical journals, including JAMA and the New England Journal of Medicine, shield ABMS authors' conflicts of interest via IRS Form 990 tax filings and do not report these conflicts (and their own conflicts with the program) in their journals.

  • 16 October 2016 - The California Medial Society holds a debate between Lois Margaret Nora, MD, JD, CEO of the American Board of Medical Specialties and Paul Teirstein, MD, the unpaid President and CEO of the National Board of Physician and Surgeons. Attempts to shorten Teirstein's talk by the moderators are shouted down and Teirstein delivers his 14-minute talk and then receives a standing ovation (video).

  • 27 October 2016 - Press release announcing the retirement of ABMS President and CEO, Margaret Lois Nora, MD, JD appears.

  • 28 October 2016 - Mayo Clinic Proceedings publishes a survey on MOC with editorial commentary by James C. Puffer, MD, the President of the American Board of Family Medicine (ABFM), yet fails to disclose the ABFM's financial conflicts with MOC that includes running ABFM Realty, LLC, a firm that manages a $4.2 million office building purchased with ABFM diplomate testing fees in 2012.

  • 11 November 2016 - ABIM certification scoring methods that changed pass rate cut-offs are disclosed.

  • 14 November 2016 - Resolution 607 re: request for independent ABIM audit, passes in AMA House of Delegates.

  • 21 November 2016 - Letter from the American Board of Anesthesia threatening to report a physicians' certification status as "Not Participating in MOCA" if he does not pay for and complete their MOCA-Minute program by 21 December 2016 appears. (The impact on the physicians' ability to receive payment from insurers if this occurs is not mentioned).

  • 1 December 2016 - New England Journal of Medicine publishes "Knowing What We Don't Know - Improving Maintenance of Certification" by Richard Baron, MD and Clarence H. Braddock, III, MD, MPH, both employees of the American Board of Internal Medicine, and fails to allow comments or rebuttal, and (once again) fails to disclose the Journal's conflict of interest with the program.

  • 2 Deceember 2016 - The American College of Cardiology sends an email to all of its members announcing their collaboration with Part IV of MOC program and their approval as a Portfolio Program Sponsor by ABMS.

  • 16 Deceember 2016 - Philadelphia Medicine magazine publishes issue dedicated to ABIM. ABIM declines to contribute, stating "We do not feel that this format appropriately presents the variety of viewpoints about MOC." (PDF of entire issue available here.)


*Additional updates to this timeline with be made for the remainder of December as needed or if other newsworthy events were missed.


Scorpions and Cockroaches said...

Cloaked in darkness ABMS stings physicians, eats away a patient's right to care.

RJR said...

Interesting that the "year in review" begins with a cover-up and ends with more ABIM/ABMS conspiracy, deception, and selling-out of physicians and patients.

Eliot said...

Most ABIM evil occurs under the radar. ABMS is now a police/surveillance state. It now exists for self-dealing executives involved in partisan propaganda, politics, influence pedaling, and lobbying. They are supported by a monopolistic testing franchise run by business elites and political professionals who operate without moral boundaries but hand-pick those with a veneer of ethics as showcase executives. The business model can best be described as white collar racketeering with a façade of working in the interest of the public trust. They employ scoundrels who maintain the enterprises utilizing revolving-door enforcement professionals. Extracurricular racketeering occurs with dirty-cop felons, risk managers, third-party contractors, vendors and dirty attorneys all getting into the act. Policy is harsh, take it or leave it contracts strictly enforced for clients of the business with lax to non-existent policies for the 'member elites' who run the show.

Anonymous said...

ABIM and Dr. Baron have no higher calling than . . . money!

What a Scam from the ABIM Flim-Flam said...

New options for MOC! Designed by the flim-flam ABIM in cooperation with ABMS auditors RSM. McGladrey (RSM) signs-off on ABIM/ABMS' books and gets a sweet deal. RSM has a nice business partnership with the elites who bought out UpToDate--Wolters-Kluwer.

Yes, Dr. Baron is listening! He is listening to his business partners.

It was not decided by physician feedback or the invitation-only docs who joined in the intimate ABMS discussions. It was decided by the bottom-line. Sorry docs!

'Deferred 10-year income' in complicity with 'current revenues' wins. They are keeping their tax filings flexible. It is not about options, but economic necessity.

Anonymous said...

From Gary Kasparov's editorial in the WSJ.
"...The story of human progress is striving, dreaming and sacrificing for a better future. Instead of believing that happy, successful individuals make for a successful society, socialism insists that a perfectly functioning system will produce happy individuals. When the system comes first, the individual becomes an afterthought. When the system fails, individuals are blamed for not surrendering to it enough...."
These words resonate in this rabid attempt of achieving robotic, centralized behavior in health care. Even more so when the ABIM MOC debacle is integrated into our political process in Medicine.
Shame on all of us for our collective willful ignorance.
"...The internet was going to connect every living soul and shine a light into the dark corners of the world. Instead, the light has reflected back to illuminate the hypocrisy and apathy ...and not a one of us can say that we did not know. We can say only that we did not care..."
Shame on the ABIM, the ACP and the ACC.

The Grand Cayman Review said...

Thick-beard's year in review

Captain Baron's booty tax and the Grand Cayman hurricane fund; they write off the booty tax as executive compensation and the hurricane fund as deferred compensation and golden life vests.

Captain Baron's rancorous 'director of kettles' stuffs illicit gold in his own private pots; aids and abets the piratical pots of his cronies. Baron's director and executives dish out false criticism/threats aimed at intimidating client victims and reporters with a tone of personal reprisal. But Baron's minions do not fare well when confronted with their own shameful reality and documented criminality.

The thieves remain mostly mum, with streamlined press releases denying complicity claiming the kettle with the stolen booty is not theirs. They try to deflect from the awful truth by saying that the pending legal claims against the pirates are all exaggerated.

The ship is sinking in the harbor under its own excessive weight and the continued holes shot in their denials of wrongdoing. They threaten subtly to sue for harassment if any more holes are shot in any more of their several self-funded scientific tales surrounding their fabulously-supported "ethical" lives.

The first mate of Ballard Spahr and their bullies told everyone privately that they would cut out their tongues and leave them tied high, dry and deserted if they talked.

The last king and his sheriffs gave the pirates pardons for their partisan service. Let's see how these pirates fare under the new king and his sheriffs.

Anonymous said...

MOC has been a well-orchestrated criminal enterprise involving complicity with all 24 ABMS medical boards. It has employed criminals and unethical professionals to further this money-making enterprise since 1986 through use of guile, fear, lobbying and hidden from view legislation. These are facts without exaggeration of any kind. Many of the unethical criminal executives involved have left and are no longer in control of operations. But these former individual executives are not without influence even today via a huge network of associates and affiliates. It is surprising that the department of justice has not pounced on them. It is shocking that the IRS has not investigated and demanded to run annual audits with denial of not-for-profit status. I am personally appalled that the FTC has not open its own case into this mega-monopoly involving many revolving door NGO's, foundations, think tanks, corporate entities and government agencies.

dspjhop said...

ABIM and ABMS are very similar to a mafia like organization. Racketeering laws prohibit most of their activities.

Money Laundering: An Overview said...

"'The Board Established a Foundation to Serve as a Big Piggy Bank'"

"The ABIM accrued surpluses over the course of its nearly 100 years of existence. Between 1990 and 2008, the Board took the bulk of its reserves (about $55 million, when all the contributions are added up) and placed them in a Foundation, whose charge was to support the Board’s work and serve the broader medical community."

- Robert M. Wachter


Anonymous said...

Fact: the ABIM, founded in late 1936 was just over 78 years old at the time of Wachters apologia for Cassel, Baron, Langdon, Holmboe, the ABIM board, council, et al!

Fact: the ABIM transferred approximately 80 million dollars (not $55 million) to the American Board of Internal Medicine Foundation, which was initially registered in 1989 by the now retired CFO Henry "Hank" Strozeski, who now lives in Florida. Retirement package for the 30-year 'financial planner' has not been disclosed. Hank Strozeski was the sole signatory on the Foundation's registration with the state. Tax forms list the wrong state intentionally. We see evidence of carefully crafted planning to hide financial activities and later obfuscate it further with a 'new registration' of the ABIM Foundation with Christine Cassel as sole signatory in 1999.

Fact: Wachter failed to mention the ABIM Foundation's high risk investment practice culminating in huge losses for the Foundation during the bubble of the early 2000's. Huge portions of the risky investments were liquidated in order to mask ABIMF's heavy losses. More multi-million dollar transfers followed further covering-over the fiduciary negligence and irresponsibility.

Fact: ABIM Foundation engaged in disqualifying risky trades with hedge funds long before its risking/hiding millions in Cayman Island Funds and offshore accounts. ABIM Foundation's past hedge fund managers were mavericks from the defunct Drexel, Burnham, Lambert RICO/insider trading scandal of the late 1980's. Michael Milken and many others were prosecuted, fined and did time for illegal activities. Some of the luckier ones who were not prosecuted created 1838 Investment Advisors. The ABIM has never disclosed the status of their trading accounts/financial activities with Drexel, Burnham, Lambert and the transferal of accounts to 1838 Investment Advisors. 1838 Investment Advisors also became defunct by bleeding its investors dry by 2004. ABIMF did not resist their hedge fund managers' high tolerance for risk and appetite for putting "non-profit" charities in a systemic practice of engaging in fast and furious short term trades. In fact we see the tradition of hedge fund greed/potential higher loss has continued after the lessons of the past have been brushed aside.

Fact: ABIM Foundation's investments were liquidated with millions in losses during the early 2000's. Both the CEO/President Harry Kimball and CFO Henry Strozeski left the organization at this time of intense financial loss and failure. But not after the strange re-registering of the American Board of Internal Medicine Foundation as the ABIM Foundation with the sole signatory of ABIMF Chairperson Christine Cassel in 1999.

Comment: Disclosure of financial documents and compensation arrangements for executives who left the organization at this time period of transition to Cassel's leadership should be/should have been made available for scrutiny. Any suggestion or future promise of position to Christine Cassel at the ABIM at what could be seen as the signing-off of responsibility of predecessors financial risk taking in exchange for future promises of employment/political power should have been made public. This should be especially apparent to anyone given the extraordinarily opaque and eyebrow raising circumstances surrounding the financial activities under the political leadership of Harry Kimball and the financial guidance of Henry Strozeski. MOC was created under their tenure as executives. We must not forget Lynn Langdon's continuous role in all this as COO and senior advisor to several CEO/Presidents. (Langdon has over forty years of influence and control with high financial gains at the ABIM and ABIMF.)

See the investigative article by journalist/physician Wes Fisher entitled, "The ABIM Foundation: Increasing Transparency or More Cover-up?"


COI, self-inurement at the ABIM and ABIM "Foundation"

Did ABIM compensate Robert Wachter monetarily or perhaps not offer some barter/exchange/personal benefit when Wachter published the above article on his commercial site? ("ABIM controversy where the critics are right where they are wrong and why I feel a need to speak out?" Link below.) Did the ABIM offer legal help to Wachter in preparing his responses to public criticisms? If so, how much legal help or ABIM advice was given to Wachter through attorneys and ABIM current or past executives. At what hourly or contractual rate? It would appear that many of the questions and answers are cleverly prepared dodges regarding legal liability/potential prosecution/loss of non-profit status.

What are ABIM's conflict of interest policies concerning such complicit acts of publishing to influence public opinion? But moreover what are the underlying issues of self-inurement, self-dealing and public fraud at the highest levels of the ABIM?

Compensation and Luxury Condo. IRS and distraction from sensitive legal issues.

Personal inurement is an issue that is dodged by Wachter. Baron is inured to excess - so much money in fact that it is embarrassingly gross. Cassel was compensated in extreme paid triple what the president of the United States gets for not even showing up for her 35 hours of weekly work. One man runs a country. Cassel ran the ABIM into the ground by draining it with her personal inurement plans (ABIM and ABIMF) and deferred monetary packages. Cassel lived elsewhere and brought her husband in tow using first class travel and a private chauffeur. It was certainly self-inurement for Cassel to have use of luxurious private living quarters and a designated "lobbying" and "party" space for the ABIM. Read Wachter's careful lies and partiality below.

Wachter writes: “The Salaries are Outrageous, and Then There’s The Condo”

Here, the allegations are flying fast and furious. The latest concerns CEO Richard Baron’s salary. Rich is one of the smartest and most committed people I’ve met in medicine. He is a person of unending integrity. The fact that the critics have now seen fit to take him on with caricatures and half-truths is cynical and sickening.

Part of the reason that Rich emerged as our preferred candidate was his real-world experience, which we felt was crucial as the Board worked to connect better to physicians engaged in the day-to-day practice of medicine. Rich’s current base pay of $579,000, with a bonus opportunity of another 20 percent, is significantly lower than that of his predecessor (Dr. Cassel’s salary was higher because she was recruited from a prior job as the dean of a major medical school and she served as ABIM CEO for a decade). The salary I offered Rich (as chair, I led the negotiations) was in the range recommended by consultants after a detailed analysis of salaries of other CEOs of healthcare nonprofits. It is a lot of money (and more than twice what Rich earned as a primary care physician), but he is paid to run a large, complex organization in a swirling political environment. In the grand scheme of things, taking into account what other healthcare executives earn, it seems fair to me.

If there is one money issue that has become a piñata, it has got to be “The Condo.” Like many large, complex organizations, the ABIM often has consultants coming into Philadelphia to help it with its work. When Chris Cassel was CEO, after analyzing the costs of putting these folks up in hotels, she decided to purchase a condo to serve the same function. This was designed to be revenue neutral, and it has been. But, of course, it creates a hanging curveball for those looking for profligacy. Do I wish we had never bought it? Of course; politically it was a dumb thing to do. Is it a scandal? No." - Bob Wachter, former ABIM Chairman and 20/20 Task Force

Anonymous said...

Retirement and incentives in the quality assurance non-profit NGOs should be put under the spotlight. These financially corrupt highly political organization that sprung up suddenly over the past few decades should be investigated by the IRS and DOJ, OIG for HHS, and any federal agency that orgs like the ABMS, NQF, NCQA come under the watch of.

Case in point. NCQA excessive inurement: executive officers' compensation, bonuses, and retirement packages. (NCQA appears to be selling products and services and lobbying for policies that benefit its executives and may not be in the best interest of healthcare industry. They are making huge profit and distributing it among themselves. They have over 130 positions with compensation of over 100,000.)

NCQA IRS 990 2013 Schedule J Part III Supplemental information.
1.Supplemental non-qualified retirement for Margaret O'Kane. 457F of IRS code.

2.Incentive packages based on predetermined financial performance

Where is this mentioned in 2015 filings?

Part X other liabilities 2015 filing deferred compensation is listed at $1,221,918
Who is that for? O'Kane? No other party is mentioned for receipt of supplemental retirement mentioned in NCQA IRS 990 2013 Schedule J Part III Supplemental information.
1.Supplemental non-qualified retirement for Margaret O'Kane. 457F of IRS code.

Anonymous said...

NCQA is a totally worthless organization. O'Kane and company have been ripping off the public more and more every year since. DOJ, please investigate this fraudulent component of the quality assurance mafia; indict them! Try them fairly, but make sure you put them behind bars. Totally corrupt racketeers. Send the nation a message that law an order is back. Make these greedy criminal quality assurance organizations and their ringleaders pay for the damage they have done to medicine and the theft of billions. They have been hiding behind the mask of "non-profit charity" for too long. Let them do hard time for their cheating and collusion with the ABMS, hospitals, crooked politicos, and insurers.