1See also “From the Bookshelves: ‘Critical,’” Tom Daschle interview by Jackie Judd, The Healthcast (podcast), Kaiser Family Foundation, March 20, 2008, at 2:16, https://web.archive.org/web/20091113171751/http://podcast.kff.org/podcast/2008/032008_kn_daschle_audio.mp3. Michael F. Cannon, “Can Congress Manage the Health Care Sector?,” Cato at Liberty (blog), May 1, 2008, https://www.cato.org/blog/can-congress-manage-health-care-sector.
2Phil Gramm, 142 Cong. Rec. S9923 (September 5, 1996).
3Naomi Lin, “Bill Clinton Calls Obamacare ‘the Craziest Thing in the World,’ Later Tries to Walk It Back,” CNN Politics, October 5, 2016, http://www.cnn.com/2016/10/04/politics/bill-clinton-obamacare-craziest-thing/index.html.
1Megan Headley, “Why Are Medical Errors Still a Leading Cause of Death?,” Patient Safety & Quality Healthcare, April 5, 2017, https://www.psqh.com/analysis/why-are-medical-errors-still-a-leading-cause-of-death/.
2Chad Terhune, “Putting a Lid on Waste: Needless Medical Tests Not Only Cost $200B—They Can Do Harm,” Kaiser Health News, May 24, 2017, http://khn.org/news/putting-a-lid-on-waste-needless-medical-tests-not-only-cost-200b-they-can-do-harm/.
3Lisa Du and Wei Lu, “U.S. Health-Care System Ranks as One of the Least-Efficient: America Is Number 50 out of 55 Countries That Were Assessed,” Bloomberg.com, September 28, 2016, https://www.bloomberg.com/news/articles/2016-09-29/u-s-health-care-system-ranks-as-one-of-the-least-efficient.
4Centers for Medicare and Medicaid Services, “CMS Releases 2015 National Health Expenditures,” news release, December 2, 2016, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2016-Press-releases-items/2016-12-02.html.
5Emily Ekins, “Large Majorities Support Key Obamacare Provisions, Unless They Cost Something,” Cato at Liberty (blog), April 25, 2017, https://www.cato.org/blog/large-majorities-support-key-obamacare-provisions-unless-they-cost-something.
6Carolyn Y. Johnson, “Trump on Drug Prices: Pharma Companies Are ‘Getting Away with Murder,’” Washington Post, January 11, 2017, https://www.washingtonpost.com/news/wonk/wp/2017/01/11/trump-on-drug-prices-pharma-companies-are-getting-away-with-murder/?utm_term=.eef4204841db.
7Emily Kopp, “White House Task Force Echoes Pharma Proposals,” Kaiser Health News, June 16, 2017, http://khn.org/news/exclusive-white-house-taskforce-echoes-pharma-proposals/.
8Sydney Lupkin, “Drugmakers Dramatically Boosted Lobbying Spending in Trump’s First Quarter,” Kaiser Health News, April 21, 2017, http://khn.org/news/drugmakers-dramatically-boosted-lobbying-spending-in-trumps-first-quarter/.
9Ibid.
10Ibid.
11Jay Hancock, Sydney Lupkin, and Elizabeth Lucas, “With Drug Costs in Crosshairs, Health Firms Gave Generously to Trump’s Inauguration,” Kaiser Health News, April 19, 2017, http://khn.org/news/with-drug-costs-in-crosshairshealth-firms-gave-generously-to-trumps-inauguration/.
12Theodore R. Marmor and Jonathan Oberlander, “Medicare at Fifty,” in The Oxford Handbook of U.S. Health Law, eds. I. Glenn Cohen, Allison K. Hoffman, and William M. Sage (New York: Oxford University Press, 2017).
13Charles Silver, “Healthcare Insurance: America’s Collective Action Nightmare,” The Health Care Blog, March 7, 2017, http://thehealthcareblog.com/blog/2017/03/07/healthcare-insurance-americas-collective-action-nightmare/.
14Christy Ford Chapin, “How Did Health Care Get to Be Such a Mess?,” New York Times, June 19, 2017, https://www.nytimes.com/2017/06/19/opinion/healthinsuranceamericanmedicalassociation.html?emc=eta1&_r=0.
15On the lack of cost controls in Medicare, see Uwe E. Reinhardt, “How the Medical Establishment Got the Treasury’s Keys,” New York Times, February 28, 2014, http://economix.blogs.nytimes.com/2014/02/28/how-the-medical-establishment-got-the-treasurys-keys/?_php=true&_type=blogs&src=recg&_r=0; and Ezekiel Emanuel, Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System (New York: PublicAffairs, 2014), p. 21. For more on the guaranteed hospital profit, see Herman Miles Somers and Anne Ramsay Somers, Medicare and the Hospitals: Issues and Prospects (Washington: Brookings Institution, 1967). On moving money to health care businesses, see Rick Mayes, “The Origins, Development, and Passage of Medicare’s Revolutionary Prospective Payment System,” Journal of the History of Medicine and Allied Sciences 62, no. 1 (2007): 21–55, https://academic.oup.com/jhmas/article-abstract/62/1/21/724956. A discussion of the hikes in physicians’ fees and hospital charges that came on the heels of Medicare’s enactment can be found in Theodore R. Marmor, The Politics of Medicare (New York: Transaction Publishers, 1970), pp. 85–90.
16U.S. Department of Justice, “Departments of Justice and Health and Human Services Announce over $27.8 Billion in Returns from Joint Efforts to Combat Health Care Fraud,” news release, March 19, 2015, https://www.justice.gov/opa/pr/departments-justice-and-health-and-human-services-announce-over-278billion-returns-joint.
17“The $272 Billion Swindle: Why Thieves Love America’s Health Care System,” The Economist, May 31, 2014, https://www.economist.com/news/unitedstates/21603078-why-thieves-love-americas-health-care-system-272-billion-swindle.
18Kim Janssen, “Cost of Name-Brand Prescription Drugs Doubled over Last 5 Years: Report,” Chicago Tribune, March 15, 2016, http://www.chicagotribune.com/business/ct-prescription-drug-prices-0316-biz-20160315-story.html.
19Sarah Kliff, “The Problem Is the Prices: Opaque and Sky High Bills Are Breaking Americans—And Our Health Care System,” Vox, October 16,2017, https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-care-prices-problem.
20Associated Press, “Woman Gives Birth in Car, Hospital Charges Full Delivery Fee,” News10.com, November 2, 2016, http://news10.com/2016/11/02/womangivesbirthincarhospitalchargesfulldeliveryfee/.
21Letitia Stein and Alexandra Zayas, “Florida Trauma Centers Charge Outrageous Fees the Moment You Come Through the Door,” Tampa Bay Times, March 7, 2014, http://www.tampabay.com/news/health/florida-trauma-centerscharge-outrageous-fees-the-moment-you-come-through/2169148.
22Ibid.
23Sarah Kliff, “The Problem Is the Prices: Opaque and Sky High Bills Are Breaking Americans—and Our Health Care System,” Vox.com, October 16, 2017, https://www.vox.com/policy-and-politics/2017/10/16/16357790/health-careprices-problem.
24Kimberly Mitchell, “Like Magic? (‘Every System Is Perfectly Designed . . .’),” IHI Improvement Blog, Institute for Healthcare Improvement, August 21, 2015, http://www.ihi.org/communities/blogs/_layouts/15/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=159.
25See Veronique de Rugy, “U.S. Health Care Spending More than Twice the Average for Developed Countries,” Mercatus Center, George Mason University, September 17, 2013, http://mercatus.org/publication/us-health-care-spendingmore-twice-average-developed-countries. To read more on the missing “bang for your buck,” see Anna Edney, “U.S. Health System among Least Efficient before Obamacare,” Bloomberg News, September 18, 2014, http://www.bloomberg.com/news/print/2014-09-18/u-s-health-system-among-least-efficient-beforeobamacare.html. For more on secretive hospitals, see Elizabeth Cohen and John Bonifield, “Secret Deaths: CNN Finds High Surgical Death Rate for Children at Florida Hospital,” CNN.com, June 2, 2015, http://www.cnn.com/2015/06/01/health/st-marys-medical-center/. For information on the amount of money the feds recouped from wrongdoers, see the Department of Health and Human Services and the Department of Justice, Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Control Program FY 2014, March 19, 2015, https://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf; to learn about how much money criminals are thought to steal from Medicare, see Thomas Sullivan, “Big Data, CMS and OIG Discuss ‘The Use of Data to Stop Medicare Fraud’ before House Ways and Means Subcommittee,” Policy and Medicine, April 8, 2015, http://www.policymed.com/2015/04/cms-and-oig-discuss-the-use-of-data-to-stop-medicare-fraud-before-house-ways-and-means-subcommittee.html.
26For discussion of variation in complication and death rates after surgery, see Marshall Allen and Olga Pierce, “Surgery Risks: Why Choosing the Right Surgeon Matters,” ProPublica, July 13, 2015, https://www.propublica.org/article/surgery-risks-patient-safety-surgeon-matters. For a critique of ProPublica’s methodology and a reply, see Mark W. Friedberg, Peter J. Pronovost, David M. Shahian, et al., “A Methodological Critique of the ProPublica Surgeon Scorecard,” RAND Health Quarterly 5, no. 4 (2016), http://www.rand.org/content/dam/rand/pubs/perspectives/PE100/PE170/RAND_PE170.pdf; Stephen Engelberg and Olga Pierce, “Our Rebuttal to RAND’s Critique of Surgeon Scorecard,” ProPublica, October 7, 2015, https://www.propublica.org/article/our-rebuttal-to-rands-critique-of-surgeon-scorecard?utm_source=et&utm_medium=email&utm_campaign=dailynewsletter&utm_content=&utm_name=.
27Infection rates vary greatly across hospitals. See Joel Keehn, “12 Hospitals You Might Want to Avoid for Infections,” Consumer Reports, December 7, 2015, https://www.consumerreports.org/cro/health/12-hospitals-to-avoid.
28On variation in survival rates across hospitals for patients receiving the same procedures, see John Commins, “Choose Hospitals on Performance Data, Consumers Urged,” Health Leaders Media, October 20, 2015, http://healthleadersmedia.com/print/QUA321847/ChooseHospitalsonPerformanceDataConsumersUrged.
29Brian Krans, “Campaign Launched to Fight Back Against Massive, Surprise ‘Out of Network’ Medical Bills,” HealthlineNews, November 3, 2015, http://www.healthline.com/healthnews/campaignlaunchedtofightbackagainstmassivesurpriseoutofnetworkmedicalbills110315#1.
30For further discussion and resources on central line-associated bloodstream infections, see Chapter 13, “Bad Business.” For employer and employee tax exclusions, see Matthew Rae, Gary Claxton, Nirmita Panchal, and Larry Levitt, “Tax Subsidies for Private Health Insurance,” The Henry J. Kaiser Family Foundation, October 27, 2014, http://files.kff.org/attachment/tax-subsidies-for-privatehealth-insurance-issue-brief.
31Ryan Basen, “AMA Does Not Want PA Autonomy,” MedPage Today, June 15, 2017, https://www.medpagetoday.com/meetingcoverage/ama/66039.
32Peter Whoriskey and Dan Keating, “How a Secretive Panel Uses Data That Distort Doctors’ Pay,” Washington Post, July 20, 2013, http://www.washingtonpost.com/business/economy/how-a-secretive-panel-uses-data-that-distorts-doctorspay/2013/07/20/ee134e3a-eda8-11e2-9008-61e94a7ea20d_story.html.
33Peter Whoriskey and Dan Keating, “Medicare Pricing Drives High Healthcare Costs,” Washington Post, December 31, 2013, http://www.washingtonpost.com/business/economy/medicare-pricing-drives-high-health-care-costs/2013/12/31/24befa46-7248-11e3-8b3f-b1666705ca3b_story.html.
34Goodreads.com, “Mahatma Gandhi,” https://www.goodreads.com/quotes/84976-there-goes-my-people-i-must-follow-them-for-i. The quote is probably apocryphal. Suzy Platt, ed., Respectfully Quoted: A Dictionary of Quotations (New York: Barnes & Noble, 1993), p. 194.
35Samuel Greengard, “Understanding Knee Replacement Costs: What’s on the Bill?,” Healthline, February 23,2015, http://www.healthline.com/health/total-knee-replacement-surgery/understanding-costs#1.
36The website of the Surgery Center of Oklahoma, http://www.surgerycenterok.com/.
37Mark Hendrickson, “The Real Class Warfare in America Today,” Forbes.com, May 2, 2014, http://www.forbes.com/sites/markhendrickson/2014/05/02/thereal-class-warfare-in-america-today/.
1Margot Sanger-Katz, “Even Insured Can Face Crushing Medical Debt, Study Finds,” New York Times, January 5, 2016, http://nyti.ms/1O82fb2.
1J. Weston Phippen, “Who Wants to Punch Martin Shkreli in the Face (for Charity)?,” Atlantic, September 28, 2016, https://www.theatlantic.com/news/archive/2016/09/martin-shkreli-punch-face/502010/.
2Devin Leonard and Annmarie Hordern, “Who Bought the Most Expensive Album Ever Made?,” Bloomberg.com, December 9, 2015, http://www.bloomberg.com/features/2015-martin-shkreli-wu-tang-clan-album/.
3Ben Popken, “Industry Insiders Estimate EpiPen Costs No More than $30,” NBCNews.com, September 6, 2016, http://www.nbcnews.com/business/consumer/industryinsidersestimateepipencostsnomore30n642091.
4Robert Langreth and Rebecca Spalding, “Shkreli Was Right: Everyone’s Hiking Drug Prices,” Bloomberg, February 2, 2016, https://www.bloomberg.com/news/articles/2016-02-02/shkreli-not-alone-in-drug-price-spikes-as-skin-gelsoars-1-860.
5Ibid.
6Robert Langreth, “Drug Prices Defy Gravity, Doubling for Dozens of Products,” Bloomberg Business, April 30, 2014, https://www.bloomberg.com/news/articles/2014-04-30/drug-prices-defy-gravity-doubling-for-dozens-of-products.
7Robert Pearl, “New Checks and Balances for Big Pharma,” The Health Care Blog, May 12,2017, http://thehealthcareblog.com/blog/2017/05/12/thelouisianapurchase/.
8Remarks by Andy Slavitt, “The Need to Partner on Drug Innovation, Access and Cost,” delivered at the Biopharma Congress in Washington, D.C.,The CMS Blog, November 3, 2016, https://blog.cms.gov/2016/11/04/remarks-by-andy-slavittthe-need-to-partner-on-drug-innovation-access-and-cost/.
9Stephen W. Schondelmeyer and Leigh Purvis, “Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans, 2006 to 2015,” Rx Watch Pricing Report, AARP Public Policy Institute, December 2016, http://www.aarp.org/content/dam/aarp/ppi/2016-12/trends-in-retail-pricesdec-2016.pdf.
10Aimee Picchi, “Prognosis for RX in 2017: More Painful Drug-Price Hikes,” CBSNews.com, December 30, 2016, http://www.cbsnews.com/news/drug-pricesto-rise-12-percent-in-2017/.
11Alfred Engelberg, “Memo to the President: The Pharmaceutical Monopoly Adjustment Act of 2017,” Health Affairs Blog, September 13, 2016, http://healthaffairs.org/blog/2016/09/13/memo-to-the-president-the-pharmaceutical-monopolyadjustment-act-of-2017/.
12Aaron S. Kesselheim, Jerry Avorn and Ameet Sarpatwari, “The High Cost of Prescription Drugs in the United States: Origins and Prospects for Reform,” JAMA 316, no. 8 (2016): 858–71, https://jamanetwork.com/journals/jama/article-abstract/2545691.
13Evan Sernoffsky, “California Voters Reject Drug-Price Measure Prop 61,” SFGate.com, November 9,2016, http://www.sfgate.com/bayarea/article/California-voters-reject-drug-price-measure-Prop-10604256.php; Maureen Cruise, “Vote Yes on Prop 61, the California Drug Price Relief Act,” LA Progressive, November 2, 2016, https://www.laprogressive.com/california-prop-61/. See also Deena Beasley, “Support for California Drug Spending Limits Stokes Industry Fears,” Business Insider, October 5, 2016, http://www.businessinsider.com/r-support-for-california-drug-spending-limits-stokes-industry-fears-2016-10; David Lazarus, “Drug Companies Spend Millions to Keep Charging High Prices,” Los Angeles Times, August 26, 2016, http://www.latimes.com/business/lazarus/la-fi-lazarus-drug-prices-20160826snap-story.html.
14Brian Keppler, “Congress Has a Little Drug Problem,” The Health Care Blog, March 16, 2016, http://thehealthcareblog.com/blog/2016/03/16/congresshas-a-drug-problem/. See also OpenSecrets.org, “Top Industries,” https://www.opensecrets.org/lobby/top.php?indexType=i.
15Engelberg, “Memo to the President.”
16Ike Swetlitz, “As Epipen Prices Skyrocket, Consumers and EMTs Resort to Syringes for Severe Allergies,” PBS Newshour, July 6, 2016, http://www.pbs.org/newshour/rundown/as-epipen-prices-skyrocket-consumers-and-emts-resort-to-syringes-for-life-threatening-allergies/; Carmen Heredia Rodriguez, “The Need to Replace EpiPens Regularly Adds to Concerns about Cost,” PBS Newshour, October 2, 2016, http://www.pbs.org/newshour/rundown/epipens-replace-cost/.
17Sanofi US, “UPDATED: Sanofi US Issues Voluntary Nationwide Recall of All Auvi-Q Due to Potential Inaccurate Dosage Delivery,” news release posted on U.S. Food and Drug Administration website, October 30, 2015, https://www.fda.gov/Safety/Recalls/ucm469980.htm.
18Ariana Eunjung Cha, “Senator’s Daughter Who Raised Price of EpiPen Got Paid $19 Million Salary, Perks in 2015,” Washington Post, August 24, 2015, https://www.washingtonpost.com/news/to-your-health/wp/2016/08/24/senatorsdaughter-who-raised-price-of-epipen-got-paid-19-million-salary-perks-in-2015/.
19Mark Maremont and Theo Francis, “Mylan Chairman Received Nearly $100 Million Last Year,” Wall Street Journal, May 2, 2017, https://www.wsj.com/articles/mylan-chairman-received-nearly-100-million-last-year-1493717400.
20Charles Ornstein, “A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding over the Windfall,” ProPublica, May 31, 2017, https://www.propublica.org/article/drug-quintupled-in-price-now-drug-industry-players-feuding-over-windfall?utm_source=pardot&utm_medium=email&utm_campaign=dailynewsletter#.
21Shefali Luthra, “Getting Patients Hooked on an Opioid Overdose Antidote, Then Raising the Price,” Kaiser Health News, January 30, 2017, http://khn.org/news/getting-patients-hooked-on-an-opioid-overdose-antidote-then-raising-the-price/.
22David Belk, “Brand Name Medication Prices,” True Cost of Healthcare, 2015, http://truecostofhealthcare.net/wp-content/uploads/2015/05/Brand-NameMedication-Prices-2.pdf.
23Joseph Walker, “Drugmakers’ Pricing Power Remains Strong,” Wall Street Journal, July 14, 2016, http://www.wsj.com/articles/drugmakerspricingpowerremainsstrong1468488601.
24Cynthia Koons, “Pfizer Raised Prices on 133 Drugs This Year, and It’s Not Alone,” Bloomberg, October 2, 2015, http://www.bloomberg.com/news/articles/20151002/pfizerraisedpriceson133drugsthisyearanditsnotalone.
25Aristotle, Politics, bk. 1, sec. 1259a.
26For a synopsis of the options for gaining monopoly control that the law makes available to pharma companies, see Engelberg, “Memo to the President.”
27Special Committee on Aging, United States Senate, Sudden Price Spikes in Off-Patent Prescription Drugs: The Monopoly Business Model That Harms Patients, Taxpayers, and the U.S. Health Care System, December 2016, https://www.aging.senate.gov/imo/media/doc/Drug%20Pricing%20Report.pdf.
28Marcia Angell, “Why Do Drug Companies Charge So Much? Because They Can,” Washington Post, September 25, 2015, https://www.washingtonpost.com/opinions/why-do-drug-companies-charge-so-much-because-they-can/2015/09/25/967d3df4-6266-11e5-b38e-06883aacba64_story.html?tid=a_inl.
29Victor Luckerson, “Everything to Know about the Arrested Drug Price-Hiking CEO,” Time.com, December 17, 2015, http://time.com/4153512/martin-shkreli-pharmaceuticals-arrested-turing-daraprim/.
30David Crow, “Drugmaker Raises Price of Acne Cream to $10,000 a Tube,” CNBC.com, September 21, 2016, http://www.cnbc.com/2016/09/21/drugmakerraisespriceofacnecreamto10000atube.html.
31Jackie Wattles, “Drugmaker Fined $100M for Hiking Price 85,000%,” CNN.com, January 18, 2017, http://money.cnn.com/2017/01/18/news/drugpricingmallinckrodtftcfine/index.html.
32U.S. Government Accountability Office, Generic Drugs under Medicare Part D: Generic Drug Prices Declined Overall, but Some Had Extraordinary Price Increases, August 2016, http://www.gao.gov/assets/680/679022.pdf.
33Trefis Team, “Why Are Generic Drug Prices Shooting Up?,” Forbes.com, February 27,2015, http://www.forbes.com/sites/greatspeculations/2015/02/27/why-are-generic-drug-prices-shooting-up/#26f1ccab377e.
34Melody Petersen, “Here’s Why Drug Prices Rise Even When There’s Plenty of Competition,” Los Angeles Times, September 1, 2016, http://www.latimes.com/business/la-fi-mylan-price-hikes-20160830-snap-story.html.
35Ibid.
36Mary Hiers, “Cost of Viagra at CVS, Walgreens, and Walmart,” AccessRX, April 25, 2012, http://www.accessrx.com/blog/erectile-dysfunction/viagra/cost-viagra-cvs-walgreens-walmart/.
37WebMD, “Erectile Dysfunction: Medicines to Treat ED,” http://www.webmd.com/erectile-dysfunction/guide/cialis-levitra-staxyn-viagra-treat-ed.
38AccessRX Staff, “The Climbing Cost of Cialis—Price Has Increased 105% in Six Years,” AccessRX, January 8, 2010, http://www.accessrx.com/blog/erectiledysfunction/cost-of-cialis-price-up-105-percent/#ixzz2jbv3lrsu.
39Don Amerman, “Low Price Levitra Erectile Dysfunction Medication Order Online at AccessRx,” AccessRX, November 12, 2012, https://www.accessrx.com/blog/erectile-dysfunction/levitra/low-price-levitra-erectile-dysfunctionmedication-order-online-at-accessrx-m1102/.
40Ibid.
41Lydia Ramsey, “The Prices for Life-Saving Diabetes Medications Have Increased Again,” Business Insider, May 15, 2017, http://www.businessinsider.com/insulin-prices-increased-in-2017-2017-5.
42Lydia Ramsey, “A 93-Year-Old Drug That Can Cost More Than a Mortgage Payment Tells Us Everything That’s Wrong with American Healthcare,” Business Insider, September 16, 2016, http://www.businessinsider.com/insulin-prices-increase-2016-9.
43U.S. Government Accountability Office, Generic Drugs under Medicare Part D.
44Ibid.
45Ed Silverman, “Mylan Raised Prices for Some Drugs by Huge Amounts,” STAT, June 10, 2016, https://www.statnews.com/pharmalot/2016/06/10/mylandrug-prices-increase/.
46Gloria Riviera, Katie Yu, and Lauren Effron, “With Generic Prescription Drug Prices Surging, Families Are Feeling the Squeeze,” ABCNews.com, May 28,2015, http://abcnews.go.com/Health/generic-prescription-drug-prices-surging-families-feeling-squeeze/story?id=31374562.
47Stephen Feller, “Criminal Charges Expected for Generic Drug Price-Fixing by End of Year,” UPI, November 3, 2016, http://www.upi.com/Business_News/2016/11/03/Criminal-charges-expected-for-generic-drug-price-fixingby-end-of-year/2761478224768/.
48Eric Kroh, “Generic Drug Price-Fixing Suits Just Tip of the Iceberg,” Law360.com, January 6,2017, https://www.law360.com/articles/877707/generic-drug-price-fixing-suits-just-tip-of-the-iceberg.
49Eric Kroh, “20 States Sue Generic-Drug Companies over Collusion,” Law360.com, December 15, 2016, https://www.law360.com/articles/873185/20-states-sue-generic-drug-companies-over-collusion; Kevin McCoy, “Lawsuit: Steak Dinners, Girls Nights Out Keyed Generic Drug Price-Fixing,” USAToday, December 15, 2016, http://usat.ly/2hLOfyv.
50See Tim Worstall, “Markets Work: Martin Shkreli, Daraprim and Turing Pharma Edition,” Forbes.com, October 23, 2015, http://www.forbes.com/sites/timworstall/2015/10/23/marketstheyworkmartinshkrelidaraprimandturingpharmaedition/print/.
51Priti Radhakrishnan, “Pharma’s Secret Weapon to Keep Drug Prices High,” STAT, June 14,2016, https://www.statnews.com/2016/06/14/secondary-patent-gilead-sovaldi-harvoni/.
52Tahir Amin and Aaron S. Kesselheim, “Second Patenting of Branded Pharmaceuticals: A Case Study of How Patents on Two HIV Drugs Could Be Extended for Decades,” Health Affairs 31, no. 10 (2012): 2286–94.
53Robin Feldman and Connie Wang, “May Your Drug Price Be Ever Green,” October 29, 2017. Available at SSRN: https://ssrn.com/abstract=3061567.
54Ibid.
55Song Hee Hong, Marvin D. Shepherd, David Scoones, and Thomas T. H. Wan, “Product-Line Extensions and Pricing Strategies of Brand-Name Drugs Facing Patent Expiration,” Journal of Managed Care Pharmacy 11, no. 9 (2005): 746–54.
56Ibid.
57U.S. Federal Trade Commission v. Actavis, Inc., 133 S. Ct. 1630 (2012).
58U.S. Federal Trade Commission, Pay-for-Delay: How Drug Company Pay-Offs Cost Consumers Billions, 2010, https://www.ftc.gov/reports/pay-delay-how-drugcompany-pay-offs-cost-consumers-billions-federal-trade-commission-staff.
59Community Catalyst and US PIRG, Top Twenty Pay-for-Delay Drugs: How Drug Industry Payoffs Delay Generics, Inflate Prices and Hurt Consumers, July 2013, http://www.uspirg.org/sites/pirg/files/reports/Top_Twenty_Pay_For_Delay_Drugs_USPIRG.pdf. See also U.S. Federal Trade Commission, Bureau of Competition, “Overview of Agreements Filed in FY 2013,” December 22, 2014, https://www.ftc.gov/news-events/press-releases/2014/12/ftc-staff-issues-fy2013-report-branded-drug-firms-patent.
60Arthur Allen, “A Giant Pain in the Wallet: How Drug Companies Are Making Crucial, Common Drugs up to 100 Times More Expensive,” Slate.com, March 29, 2011, http://www.slate.com/articles/health_and_science/medical_examiner/2011/03/a_giant_pain_in_the_wallet.html.
61Many articles name URL Pharma as the company that obtained FDA approval for colchicine. See, for example, Aaron S. Kesselheim and Daniel H. Solomon, “Incentives for Drug Development—the Curious Case of Colchicine,” New England Journal of Medicine 362, no. 22 (2010): 2045–47, http://www.nejm.org/doi/full/10.1056/NEJMp1003126. The Federal Register identifies Mutual Pharmaceutical, Inc., a subsidiary of URL Pharma, as the company so we use that name here. FDA, Single-Ingredient Oral Colchicine Products; Enforcement Action Dates, October 1, 2010, https://www.federalregister.gov/documents/2010/10/01/2010-24684/single-ingredient-oral-colchicine-products-enforcement-action-dates.
62U.S. Department of Health and Human Services and U.S. Food and Drug Administration, “FDA Orders Halt to Marketing of Unapproved Single-Ingredient Oral Colchicine,” news release, September 30, 2010, http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2010/ucm227796.htm.
63Allan S. Brett, “Spotlight on Colchicine: The Colcrys Controversy,” NEJM Journal Watch, June 10, 2010, http://www.jwatch.org/jw201006100000001/2010/06/10/spotlight-colchicine-colcrys-controversy.
64Kurt Ullman, “Colcrys Approval Triggers Questions,” Rheumatologist, May 1, 2010, http://www.the-rheumatologist.org/details/article/865591/Colcrys_Approval_Triggers_Questions.html.
65Orphan Drug Act, Title 21, 316.3 (12).
66Aaron S. Kesselheim, Jessica M. Franklin, Seoyoung C. Kim, John D. Seeger, and Daniel H. Solomon, “Reductions in Use of Colchicine after FDA Enforcement of Market Exclusivity in a Commercially Insured Population,” Journal of General Internal Medicine 30, no. 11 (2015): 1633–38, doi:10.1007/s11606-015-3285-7.
67Lisa Schenker, “FDA Approves Northbrook Company’s $89,000 Muscular Dystrophy Drug,” Chicago Tribune, February 9, 2017, http://www.chicagotribune.com/business/ct-muscular-dystrophy-drug-fda-approval-0210-biz-20170209story.html.
68Sarah Jane Tribble and Sydney Lupkin, “Sky-High Prices for Orphan Drugs Slam American Families and Insurers,” Kaiser Health News, January 17, 2017.
69Ed Silverman, “FDA Designated a Record Number of Orphan Drugs Last Year,” STAT, February 11,2016, https://www.statnews.com/pharmalot/2016/02/11/fda-designates-record-number-of-orphan-drugs/.
70Michael G. Daniel, Timothy M. Pawlik, Amanda N. Fader, Nestor F. Esnaola, and Martin A. Makary, “The Orphan Drug Act: Restoring the Mission to Rare Diseases,” American Journal of Clinical Oncology 39, no. 2 (2016): 210–13, https://jhu.pure.elsevier.com/en/publications/the-orphan-drug-act-restoring-the-mission-to-rare-diseases-4.
71Ibid.
72Ed Silverman, “Law for Rare Disease Drugs Needs Revamping, Researchers Say,” STAT, November 30, 2015, https://www.statnews.com/pharmalot/2015/11/30/orphan-drug-act-rare-diseases/; Daniel et al., “The Orphan Drug Act.”
73Harris Meyer, “Does the FDA Enable Drugmakers to Jack Up Prices on Cheap Old Drugs?,” Modern Healthcare Vital Signs (blog), October 17, 2016, http://www.modernhealthcare.com/article/20161017/BLOG/161019928.
74Joanne Armstrong, “Unintended Consequences—The Cost of Preventing Preterm Births after FDA Approval of a Branded Version of 17OHP,” New England Journal of Medicine 364, no. 18 (2011): 1689–91, http://www.nejm.org/doi/full/10.1056/NEJMp1102796.
75Allen, “A Giant Pain in the Wallet.”
76Ed Silverman, “A New Drug and the High Cost of Premature Births,” Pharmalive.com, March 10, 2011, http://www.pharmalive.com/new-drug-high-cost-premature-births; Yesha Patel and Martha M. Rumore, “Hydroxyprogesterone Caproate Injection (Makena) One Year Later,” Pharmacy and Therapeutics 37, no. 7 (July 2012), http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3411212/; Pharmalot, “KV Pharmaceuticals under Federal Scrutiny for Price Gouging,” Seeking Alpha, March 19, 2011, http://www.firstwordpharma.com/node/354087.
77Jim Doyle, “KV Pharmaceutical Files for Bankruptcy,” St. Louis Post-Dispatch, August 7, 2012, http://www.stltoday.com/business/local/kv-pharmaceuticalfiles-for-bankruptcy/article_4a26c62c-dfde-11e1-9ffb-0019bb30f31a.html.
78Courtney Hutchison, “KV Pharma Cuts Price of Costly Premature Birth Prevention Drug,” ABCNews, April 1, 2011, http://abcnews.go.com/Health/WomensHealth/kv-pharma-cuts-price-makena-costly-drug-prevents/story?id=13274910.
79Charles L. Hooper, “Never Mind: FDA Changes Own Rules in Midstream,” Library of Economics and Liberty, November 5, 2012, http://www.econlib.org/library/Columns/y2012/Hooperdrugs.html.
80U.S. Department of Health and Human Services and U.S. Food and Drug Administration, “FDA Takes Action Against KV Pharmaceutical Company: Company Making, Marketing and Distributing Adulterated and Unapproved Drugs,” news release, March 2, 2009, http://www.firstwordpharma.com/node/354087.
81U.S. Department of Justice, Office of Public Affairs, “Former Drug Company Executive Pleads Guilty in Oversized Drug Tablets Case: St. Louis Judge Imposes Sentence of $1 Million Fine, $900,000 Forfeiture, 30 Days in Jail,” news release, March 10, 2011, http://www.justice.gov/opa/pr/2011/March/11-civ-306.html; Joseph Whittington and Andrew M. Harris, “Ex-KV Pharmaceutical CEO Pleads Guilty, Gets 30-Day Sentence,” Bloomberg Business, March 10, 2011, http://www.bloomberg.com/news/articles/2011-03-10/ex-kv-pharmaceutical-ceo-hermelin-pleads-guilty-to-drug-label-law-breach.
82Jim Doyle, “KV Pharmaceutical Agrees to $17 Million Settlement,” St. Louis Post-Dispatch, December 6, 2011, http://www.stltoday.com/business/local/kv-pharmaceutical-agrees-to-million-settlement-with-doj/article_3c947aee-2054-11e1-8c50-001a4bcf6878.html#ixzz1l2nvv3Uz.
83Nicholas Fogelson, “Boycott Makena: March of Dimes Responds to KV Pharmaceuticals,” Academic OB/GYN (blog), March 24, 2011, http://academicobgyn.com/2011/03/24/boycott-makena-march-of-dimes-responds-to-kv-pharmaceuticals/.
84Jennifer Howse, “March of Dimes Demands Prompt and Decisive Action from Ther-Rx,” March of Dimes website, March 23, 2011, http://www.marchofdimes.org/news/march-of-dimes-demands-prompt-and-decisive-action-from-ther-rx.aspx.
85Ryan M. Mott, “Colchicine, Guaifenesin, and the Constitutionality of FDA Market Exclusivity for Approval Pioneers,” unpublished paper, University of Michigan Law School, March 19, 2012, http://works.bepress.com/ryan_mott/1, citing Tammy M. Muccio, “Guaifenesin and FDA Approval of Marketed Unapproved Drugs: Protecting the Public or Protecting Profits?,” Harvard Law School 2 (May 3, 2007), http://leda.law.harvard.edu/leda/data/834/Muccio_07.pdf.
86Sinead M. Murphy, Araya Puwanant, Robert C. Griggs, and the Consortium for Clinical Investigations of Neurological Channelopathies (CINCH) and Inherited Neuropathies Consortium (INC) Consortia of the Rare Disease Clinical Research Network, “Unintended Effects of Orphan Product Designation for Rare Neurological Diseases,” Annals of Neurology 72, no. 4 (2012): 481–90, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490440/.
87Ibid.
88Elisabeth Rosenthal, “The Soaring Cost of a Simple Breath,” New York Times, October 12, 2013, http://www.nytimes.com/2013/10/13/us/the-soaring-costof-a-simple-breath.html?pagewanted=all.
89Ibid.
90Partners Healthcare Asthma Center, “Ozone, CFC’s and Your Asthma,” in The Best of Breath of Fresh Air: 1995–2000, http://www.asthma.partners.org/newfiles/BoFAChapter10.html.
91Nick Baumann, “Why You’re Paying More to Breathe,” Mother Jones, July/August 2011, http://www.motherjones.com/environment/2011/07/costincrease-asthma-inhalers-expensive.
92Ibid.
93Rosenthal, “The Soaring Cost of a Simple Breath.”
94ProCon.org, “State-by-State Guide to Physician-Assisted Suicide,” February 21,2017, https://euthanasia.procon.org/view.resource.php?resourceID=000132.
95Roxanne Nelson, “When Dying Becomes Unaffordable,” Medscape, November 9, 2017, https://www.medscape.com/viewarticle/888271.
96Langreth, “Drug Prices Defy Gravity, Doubling for Dozens of Products.”
1Bruce Japsen, “At $1,000 a Pill, Hepatitis C Drug Sovaldi Rattles Medicaid Programs,” Forbes.com, April 28, 2014, http://www.forbes.com/sites/brucejapsen/2014/04/28/pricey-hepatitis-pill-sovaldi-rattles-medicaid-programs/.
2Kristen Fischer, “New Hep C Drug Sovaldi Ignites Fierce Pricing Debate,” Healthline, April 11, 2014, http://www.healthline.com/health-news/newhepatitis-c-drug-stirs-controversy-041114.
3U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, National Health Expenditure Projections 2012–2022, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/proj2012.pdf.
4Priti Radhakrishnan, “Pharma’s Secret Weapon to Keep Drug Prices High,” STAT, June 14,2016, https://www.statnews.com/2016/06/14/secondary-patent-gilead-sovaldi-harvoni/.
5John Carroll, “Merck Goes Toe-to-Toe with Gilead’s Hep C Goliath, Flags Discount with Blockbuster OK,” FierceBiotech, January 28, 2016, http://www.fiercebiotech.com/regulatory/merck-goes-toe-to-toe-gilead-s-hep-c-goliath-flags-discount-blockbuster-ok.
6Ed Silverman, “Gilead Hep C Drug Prices Blamed for England’s Health Service Rationing Treatment,” STAT, July 28, 2016, https://www.statnews.com/pharmalot/2016/07/28/gilead-hepatitis-drug-prices/.
7U.S. Senate Committee on Finance, “Wyden–Grassley Sovaldi Investigation Finds Revenue-Driven Pricing Strategy behind $84,000 Heptatitis Drug,” December 1, 2015, http://www.finance.senate.gov/newsroom/ranking/release/?id=3f693c730fc24a4cba92562723ba5255.
8Silverman, “Gilead Hep C Drug Prices.”
9Ed Silverman, “Colorado Is Latest State to Be Sued for Restricting Access to Hepatitis C Drugs,” STAT, September 26, 2016, https://www.statnews.com/pharmalot/2016/09/22/colorado-sued-for-restricting-hepatitis-c-medicine/.
10Stephanie M. Lee, “$1,000 Hepatitis C Pill a Tough Miracle to Swallow,” SFGate, May 8, 2014, http://www.sfgate.com/health/article/1-000-hepatitis-Cpill-a-tough-miracle-to-swallow-5455230.php.
11Ed Silverman, “Less Than 1 Percent of State Prisoners with Hepatitis C Get Treated Due to Drug Costs,” STAT, October 5, 2016, https://www.statnews.com/pharmalot/2016/10/05/prisons-hepatitis-drug-prices-gilead/.
12Associated Press, “Pricey Drugs Overwhelm Medicare Safeguard,” STAT, July 25, 2016, https://www.statnews.com/2016/07/25/medicare-drug-pricesharvoni-solvaldi/.
13Charles Ornstein, “Medicare Spending for Hepatitis C Cures Surges,” ProPublica, October 16, 2015, https://www.propublica.org/article/medicare-spendingfor-hepatitis-c-cures-surges.
14Associated Press, “Pricey Drugs Overwhelm Medicare Safeguard.”
15Shannon First, “Reining in Medicare Rx Costs: What Will Work?,” MedPage Today, November 4, 2016, http://www.healthleadersmedia.com/health-plans/reining-medicare-rx-costs-what-will-work-0.
16Chuck Grassley, “Grassley Presses the Administration on Reasons for Alarming Increase in Medicare Catastrophic Drug Spending,” news release, July 27, 2017, https://www.grassley.senate.gov/news/news-releases/grassley-pressesadministration-reasons-alarming-increase-medicare-catastrophic.
17Caroline Humer, “Express Scripts Drops Gilead Hep C Drugs for Cheaper AbbVie Rival,” Reuters, December 22, 2014, http://www.reuters.com/article/us-express-scripts-abbvie-hepatitisc-idUSKBN0K007620141222.
18U.S. Senate Committee on Finance, The Price of Sovaldi and Its Impact on the U.S. Health Care System, (Washington: Government Printing Office, December 2015), https://www.finance.senate.gov/imo/media/doc/1%20The%20Price%20of%20Sovaldi%20and%20Its%20Impact%20on%20the%20U.S.%20Health%20Care%20System%20(Full%20Report).pdf.
19Avik Roy, “The Sovaldi Tax: Gilead Can’t Justify the Price It’s Asking for Hepatitis C Therapy,” The Apothecary (blog), Forbes.com, June 7, 2014, http://www.forbes.com/sites/theapothecary/2014/06/17/the-sovaldi-tax-gilead-cant-justify-the-price-its-asking-americans-to-pay/.
20Letter from Sen. Bernard Sanders to the Honorable Robert A. McDonald, Secretary, U.S. Dept. of Veterans Affairs, May 12, 2015, https://www.sanders.senate.gov/download/051215-letter/?inline=file.
21Roy, “The Sovaldi Tax.”
22Robert Langreth, “Gilead CEO Becomes Billionaire on $84,000 Hepatitis Drug,” Bloomberg Business, March 3, 2014, http://www.bloomberg.com/news/2014-03-03/gilead-ceo-becomes-billionaire-on-84-000-hepatitis-drug.html.
23Merrill Goozner, “Why Sovaldi Shouldn’t Cost $84,000,” Modern Healthcare, March 3, 2014, http://www.modernhealthcare.com/article/20140503/MAGAZINE/305039983.
24See also National Institute of Allergy and Infectious Diseases, “Investigational Oral Regimen for Hepatitis C Shows Promise in NIH Trial,” NIH News, August 27, 2013, http://www.nih.gov/news/newsreleases/2013/Pages/hepCtrial.aspx.
25Aaron S. Kesselheim, Yongtian Tina Tan, and Jerry Avorn, “The Roles of Academia, Rare Diseases, and Repurposing in the Development of the Most Transformative Drugs,” Health Affairs 34, no. 2 (2015): 286–93.
26Robert Weisman, “Doctors Challenge Vertex over High Price of Cystic Fibrosis Drug,” Boston Globe, July 20, 2015, http://www.bostonglobe.com/business/2015/07/20/researcher-and-group-doctors-challenge-vertex-pricenew-cystic-fibrosis-drug/d5PZMlj6T6uzq0usm2xLEL/story.html. See also Ed Silverman, “How High? The Backlash over Rising Prescription Drug Prices Gains Steam,” Pharmalot (blog), Wall Street Journal, July 21, 2015, http://blogs.wsj.com/pharmalot/2015/07/21/how-high-the-backlash-over-rising-prescription-drug-prices-gains-steam/.
27Silverman, “How High?”
28Alfred Engelberg, “Memo to the President: The Pharmaceutical Monopoly Adjustment Act of 2017,” Health Affairs Blog, September 13, 2016, http://healthaffairs.org/blog/2016/09/13/memo-to-the-president-the-pharmaceutical-monopoly-adjustment-act-of-2017/.
29Ibid.
30Ibid.
31Stan Finkelstein and Peter Temin, Reasonable RX: Solving the Drug Price Crisis (Upper Saddle River, NJ: FT Press, 2008), chap. 4.
32Joe Nocera, “The $300,000 Drug,” New York Times, July 18, 2014, http://www.nytimes.com/2014/07/19/opinion/joe-nocera-cystic-fibrosis-drug-price.html?_r=0.
33Robert Pear, “Medicare, Reversing Itself, Will Pay More for an Expensive New Cancer Drug,” New York Times, August 8, 2015, http://www.nytimes.com/2015/08/09/us/medicare-reversing-itself-will-pay-more-for-an-expensive-new-cancer-drug.html?emc=edit_th_20150809&nl=todaysheadlines&nlid=15782921.
34Richard Knox, “Cancer Drug Mark-Ups: Year of Gleevec Cost $159 to Make but Sells for $106K,” CommonHealth, September 25, 2015, http://www.wbur.org/commonhealth/2015/09/25/cancer-drug-cost.
35Reuters, “These New Cancer Drugs Are Helping Patients Live Years Longer,” Fortune, May 19, 2016, http://fortune.com/2016/05/19/cancer-drugskeytruda-opdivo/.
36Tracy Staton, “Payers Beware: Bristol-Myers Prices PD-1 Cancer Med at $143,000 in Japan,” FiercePharma, September 4, 2014, http://www.fiercepharma.com/sales-and-marketing/payers-beware-bristol-myers-prices-pd-1-cancer-med-at-143-000-japan; Tracy Staton, “With $120K Price Tag, Yervoy Hailed as Potential Blockbuster,” FiercePharma, March 28, 2011, http://www.fiercepharma.com/pharma/120k-price-tag-yervoy-hailed-as-potential-blockbuster.
37Eric Palmer, “Roche Looks to Earn Even More from Perjeta with EU Nod,” FiercePharma, December 14, 2012, http://www.fiercepharma.com/financials/roche-looks-to-earn-even-more-from-perjeta-eu-nod.
38Aimee Picchi, “The Cost of Biogen’s New Drug: $750,000 per Patient,” CBSNews.com, December 29,2016, http://www.cbsnews.com/news/the-cost-of-biogens-new-drug-spinraza-750000-per-patient/.
39Keith Speights, “The 7 Most Expensive Prescription Drugs in the World,” The Motley Fool, April 18, 2017, https://www.fool.com/investing/2017/04/18/the-7-most-expensive-prescription-drugs-in-the-wor.aspx.
40Ibid.
41Ibid.
42Ibid.
43Liz Szabo, “Dozens of New Cancer Drugs Do Little to Improve Survival, Frustrating Patients,” Kaiser Health News, February 13, 2107, http://khn.org/news/dozensofnewcancerdrugsdolittletoimprovesurvivalfrustratingpatients/.
44Ibid.
45Ben Hirschler, “Academics Call Time on $100,000 Cancer Drugs,” Reuters.com, February 9, 2017, http://www.reuters.com/article/health-cancerpharmaceuticals-prices-idUSL1N1FU1EC.
46Liz Szabo, “Cascade of Costs Could Push New Gene Therapy above $1 Million per Patient,” Kaiser Health News, October 17, 2017, https://khn.org/news/cascade-of-costs-could-push-new-gene-therapy-above-1-million-per-patient/.
47Ibid.
48AHIP Center for Policy and Research, High-Priced Drugs: Estimates of Annual Per-Patient Expenditures for 150 Specialty Medications, April 8, 2016, https://www.ahip.org/report-high-priced-drugs-expenditures/.
49Stephen Barlas, “Are Specialty Drug Prices Destroying Insurers and Hurting Consumers? A Number of Efforts Are Under Way to Reduce Price Pressure,” Pharmacy and Therapeutics 39, no. 8 (2014): 563–66, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4123806/.
50AHIP Center, High-Priced Drugs.
51Carolyn Y. Johnson, “Specialty Drugs Now Cost More than the Median Household Income,” Washington Post, November 20, 2015, https://www.washingtonpost.com/news/wonk/wp/2015/11/20/specialty-drugs-now-cost-more-than-most-household-incomes/?utm_term=.df93c2adc145.
52William Shrank, Alan Lotvin, Surya Singh, and Troyen Brennan, “In the Debate about Cost and Efficacy, PCSK9 Inhibitors May Be the Biggest Challenge Yet,” Health Affairs Blog, February 17, 2015, http://healthaffairs.org/blog/2015/02/17/in-the-debate-about-cost-and-efficacy-pcsk9-inhibitors-may-be-the-biggestchallenge-yet/; Gina Kolata, “New Alternatives to Statins Add to a Quandary on Cholesterol,” New York Times, August 29, 2015, http://www.nytimes.com/2015/08/30/health/new-alternatives-to-statins-add-to-a-quandary-on-cholesterol.html?emc=edit_th_20150830&nl=todaysheadlines&nlid=15782921&_r=0.
53Peggy Peck, “PCSK9 Inhibitors: Now That We Have Them, What Do We Do?,” MedPage Today, September 8, 2015, http://www.medpagetoday.com/Cardiology/Dyslipidemia/53451?xid=nl_mpt_DHE_2015-09-09&eun=g452253d0r.
54Ibid.
55Andrew Pollack, “Express Scripts Says It Will Cover 2 New Cholesterol Drugs,” New York Times, October 6, 2015, http://nyti.ms/1RsFiCq.
56Ibid.
57Ibid.
58Institute for Clinical and Economic Review, “ICER Draft Report on Effectiveness, Value, and Pricing Benchmarks for PCSK9 Inhibitors for High Cholesterol Posted for Public Comment,” news release, September 8, 2015, http://www.icer-review.org/pcsk9-draft-report-release/.
59Shannon Firth, “D.C. Week: Libido Pill OK’d; Healthcare Draws Attention in 2016 Race,” Medpage Today, August 22, 2015, http://www.medpagetoday.com/Washington-Watch/Washington-Watch/53195; Andrew Pollack, “F.D.A. Approves Addyi, a Libido Pill for Women,” New York Times, August 18, 2015, https://www.nytimes.com/2015/08/19/business/fda-approval-addyi-femaleviagra.html; David Kroll, “FDA Approves Addyi (Flibanserin), ‘A Milestone Moment’ in Women’s Health,” Forbes, August 18, 2015, http://www.forbes.com/sites/davidkroll/2015/08/18/fda-approves-addyi-flibanserin-a-milestone-moment-in-womens-health/.
60Pollack, “F.D.A. Approves Addyi.”
61Kroll, “FDA Approves Addyi (Flibanserin).”
62Caroline Chen, Cynthia Koons, and Anna Edney, “Valeant Buys Female Libido-Drug Maker Sprout for $1 Billion,” Bloomberg.com, August 20, 2015, https://www.bloomberg.com/news/articles/2015-08-20/valeant-pharma-tobuy-female-libido-drug-maker-for-1-billion.
63GoodRX, “Addyi,” https://www.goodrx.com/addyi.
64Gretchen Morgenson, “To Stop Price Spikes on Prescription Drugs, a Widening Radar,” New York Times, December 23, 2016, http://nyti.ms/2hgUcSA.
65Charles Ornstein, “The Obscure Drug with a Growing Medicare Tab,” New York Times, August 4, 2014, http://nyti.ms/1olTDzt.
66Charles Ornstein, “A Drug Quintupled in Price. Now, Drug Industry Players Are Feuding over the Windfall,” ProPublica, May 31, 2107, https://www.propublica.org/article/drug-quintupled-in-price-now-drug-industry-players-feuding-over-windfall?utm_source=pardot&utm_medium=email&utm_campaign=dailynewsletter#.
67Andrew Pollack, “Drug Maker’s Donations to CoPay Charity Face Scrutiny,” New York Times, December 18, 2013, http://www.nytimes.com/2013/12/19/business/shake-up-at-big-co-pay-fund-raises-scrutiny-on-similar-charities.html.
68Benjamin Elgin and Robert Langreth, “How Big Pharma Uses Charity Programs to Cover for Drug Price Hikes: A Billion-Dollar System in Which Charitable Giving Is Profitable,” Bloomberg.com, May 19, 2016, https://www.bloomberg.com/news/articles/2016-05-19/the-real-reason-big-pharma-wants-to-help-pay-for-your-prescription.
69Ibid.
70Office of Inspector General, U.S. Department of Health and Human Services, “Supplement Special Advisory Bulletin: Independent Charity Patient Assistance Programs,” 79 Federal Register 104 (May 16, 2014): 31120–23, http://oig.hhs.gov/fraud/docs/alertsandbulletins/2014/independent-charity-bulletin.pdf.
71Corrected Expert Report of Joel W. Hay, PhD, ¶ 119, April 22, 2016, submitted in United States of America, ex rel. Beverly Brown v. Celgene Corp., Civil Action No. CV10-03165 GHK, https://www.lexis.com/research/retrieve?_m=fd361b888752f2fba6924da901ac0034&csvc=le&cform=byCitation&_fmtstr=CITE&docnum=1&_startdoc=1&wchp=dGLbVzt-zSkAA&_md5=3c697f98066c6bdf57c869f189efe2c4.
72Ibid.
73Bloomberg News, “PAN Foundation Responds to Bloomberg Article: Dan Klein,” Bloomberg, August 3, 2016, https://www.bloomberg.com/news/articles/2016-08-03/pan-foundation-responds-to-bloomberg-article-dan-klein.
74John R. Graham, “EpiPen: A Case Study in Health Insurance Failure,” NCPA Health Policy Blog, September 13, 2016, http://healthblog.ncpa.org/epipena-case-study-in-health-insurance-failure/.
1Robert Draper, “The Toxic Pharmacist,” New York Times, June 8, 2003, http://www.nytimes.com/2003/06/08/magazine/the-toxic-pharmacist.html?src=pm&pagewanted=3; Josh Freed, “Thousands of Diluted Drug Doses,” Associated Press, April 19, 2002, http://www.cbsnews.com/news/thousands-of-diluteddrug-doses/.
2Ibid.
3Danny McDonald, “Pharmacist in NECC Meningitis Outbreak Case Acquitted of Murder,” Boston Globe, October 25, 2017, https://www.bostonglobe.com/metro/2017/10/25/chin/sSmR8lC4AZloK4HidEmGWI/story.html.
4Susan Morse, “Feds Nab 10 More in $100 Million Tricare Fraud,” Healthcare IT News, October 21, 2016, http://www.healthcareitnews.com/news/feds-nab-10-more-100-million-tricare-fraud; Kevin Krause, “Dallas Firm That Marketed Compounded Pain Creams Busted in Massive Health Care Fraud, Kickback Case,” DallasNews.com, February 24, 2016, https://www.dallasnews.com/news/crime/2016/02/24/drug-compounders-marketing-firm-busted-for-allegedmassive-health-care-fraud-involving-doctor-kickbacks.
5Krause, “Dallas Firm Busted.”
6Ibid.
7Paula McMahon, “Feds Charge 16 in Massive $175M Prescription Cream Fraud Based in South Florida,” Sun-Sentinel, September 1, 2016, http://www.sun-sentinel.com/local/palm-beach/fl-compound-cream-fraud-20160901-story.html; Carolina Bolado, “Alleged Ringleader Pleads Guilty in $175M Health Fraud,” Law360, January 19, 2017, https://www.law360.com/articles/882839/alleged-ringleader-pleads-guilty-in-175m-health-fraud.
8Times Staff, “New Port Richey Pharmacy at Center of Federal Insurance Fraud Indictment,” Tampa Bay Times, August 10, 2016, http://www.tampabay.com/news/publicsafety/crime/new-port-richey-pharmacy-at-center-of-federal-indictment/2288992; Frances McMorris, “New Port Richey Pharmacy Owner Pleads Guilty in Massive Fraud Scheme,” Tampa Bay Business Journal, November 6, 2017, https://www.bizjournals.com/tampabay/news/2017/11/06/new-port-richey-pharmacy-owner-pleads-guilty-in.html.
9McMorris, “New Port Richey Pharmacy Owner Pleads Guilty.”
10Ibid.
11Nathan Hale, “3 Sentenced in Fla. for $175 Health Care Fraud Scheme,” Law360, March 24, 2017, https://www.law360.com/articles/905509/3sentenced-in-fla-for-175m-health-care-fraud-scheme.
12Ryan Moore, “Feds: Hub City Doctor, Christmas Tree Farm Named in Federal Pharmacy Investigation,” WDAM-TV, February 15, 2017, http://www.wdam.com/story/34516678/feds-hub-city-doctor-christmas-tree-farm-named-in-federal-pharmacy-investigation.
13United States v. Real Property Located at 19 Crane Park, Hattiesburg, Lamar County, Mississippi, Improvements, and Fixtures Thereon, et al., No. 3:16cv27 TSL-RHW (S.D. Miss., February 10, 2017).
14Ibid.
15Ibid.
16Lici Beveridge, “Details Emerge in Alleged Compounding Pharmacy Scheme,” Hattiesburg American, February 15, 2017, http://www.hattiesburgamerican.com/story/news/crime/2017/02/15/details-emerge-alleged-compounding-pharmacy-scheme/97940600/.
17Tom McLaughlin, “Feds Seize Homes in Gulf Breeze, WaterColor, Sandpiper Cove as Part of TRICARE Fraud Case,” Northwest Florida Daily News, June 8, 2016, http://www.nwfdailynews.com/news/20160608/fedsseize-homes-in-gulf-breeze-watercolor-sandpiper-cove-as-part-of-tricare-fraud-case; Lici Beveridge, “Complaint Outlines Depth of Alleged Pharmacy Fraud,” Clarion Ledger, February 19, 2017, http://www.clarionledger.com/story/news/local/2017/02/19/complaint-outlines-depth-alleged-pharmacy-fraud/98114652/.
18Ryan Moore, “2 Criminally Charged in 2016 Pharmacy Raids,” WDAM, July 13, 2017, http://www.wdam.com/story/35880218/2-criminally-chargedin-2016-pharmacy-raids.
19Amended Complaint, U.S. v. Par Pharmaceuticals, No. 06 C 06131, (N.D. Ill., July 7, 2011), http://i.bnet.com/blogs/par-complaint1.pdf.
20Ibid.
21Ibid.
22Ibid.
23Ibid.
24Ibid.
25Ibid.
26Ibid.
27U.S. Department of Justice, United States Attorney for the Northern District of Illinois, “CVS Caremark Corp. to Pay $36.7 Million to U.S., 23 States, and D.C. to Settle Medicaid Prescription Drug Fraud Allegations,” news release, March 18, 2008, https://www.justice.gov/archive/opa/pr/2008/March/08_crt_214.html.
28Jim Edwards, “Hard to Swallow: Walgreens Wrote ‘One Liners’ to Sell Illegal Price Hikes to Patients,” CBS Money Watch, September 9, 2011, http://www.bnet.com/blog/drug-business/hard-to-swallow-walgreens-wrote-8220one-liners-8221-to-sell-illegal-price-hikes-to-patients/9629.
29Ibid.
30Ibid.
31Amended Complaint, U.S. v. Par Pharmaceuticals, No. 06 C 06131, (N.D. Ill., July 7, 2011), http://i.bnet.com/blogs/par-complaint1.pdf.
32Ibid.
33U.S. Department of Justice, Office of Public Affairs, “Nation’s Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million to Settle False Claims Act Cases,” news release, November 3, 2009, http://www.justice.gov/opa/pr/nation-s-largest-nursing-home-pharmacy-and-drug-manufacturer-pay-112-million-settle-false.
34John Kennedy, “Par Pharmaceutical Beats FCA Prescription-Switch Claims,” Law 360, August 18, 2017, https://www.law360.com/articles/955531/par-pharmaceutical-beats-fca-prescription-switch-claims.
35Dawn M. Gencarelli, “Average Wholesale Price for Prescription Drugs: Is There a More Appropriate Pricing Mechanism?,” National Health Policy Forum Issue Brief no.775, George Washington University, June 7, 2002.
36 Chris George, “Seven States Consider Lawsuit Against Drug Companies for Fraud,” Wyoming Tribune-Eagle, April 25, 2001, p. A1 (list of drugs by DOJ that are overpriced).
37First Amended Complaint, Citizens for Consumer Justice, et al., v. Abbott Laboratories, Inc., et al., No. 01-12257 PBS, (D. Mass. March 18, 2002), at 35, ¶¶ 150–51.
38Amended Master Consolidated Class Action Complaint, In re Pharmaceutical Industry Average Wholesale Price Litigation, M.D.L. No. 1456, 01-12257-PBS, July 25, 2003, at 338, https://www.courtlistener.com/opinion/2309518/in-repharmaceutical-industry-average-wholesale-price-litigation/.
39Abby Alpert, Mark Duggan, and Judith Hellerstein, “Perverse Reverse Price Competition: Average Wholesale Prices and Medicaid Pharmaceutical Spending,” Journal of Public Economics 108 (2013): 44–62.
40Prepared Statement of William J. Scanlon, Director, Health Care Issues, United States General Accounting Office, before the Subcommittee on Health and the Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce, House of Representatives, 107th Cong., 1st Sess., Medicare Drug Reimbursements: A Broken System for Patients and Taxpayers (Washington: Government Printing Office, September 21, 2001), https://www.gpo.gov/fdsys/pkg/CHRG-107hhrg75756/html/CHRG-107hhrg75756.htm.
41Sentencing Memorandum of the United States, U.S. v. TAP Pharmaceutical Products, Inc., Criminal Action No. 01-CR-10354-WGY, U.S. District Court for the District of Massachusetts, Eastern Division, December 4, 2001, http://www.prescriptionaccesslitigation.org/pdf/20020123-Sentencing-Memo.pdf.
42U.S. Department of Justice, “Astrazeneca Pharmaceuticals LP Pleads Guilty to Healthcare Crime; Company Agrees to Pay $355 Million to Settle Charges,” news release, June 20, 2003, https://www.justice.gov/archive/opa/pr/2003/June/03_civ_371.htm.
43Joshua Partlow and Marc Kaufman, “U.S., Drug Company Settle Scam Charges,” Washington Post, June 21, 2003, p. E1.
44Ibid.
45 “Health Care Fraud Report,” BNA 7, no. 6 (March 19, 2003): 215.
46GlaxoSmithKline, “Statement Concerning AWP Complaint Filed by New York’s Attorney General,” February 13, 2003, on file with authors.
47John E. Calfee and Michael S. Greve, “The New Pharmaceutical Litigation: What Is It and Where Is It Going?,” American Enterprise Institute press briefing, June 18, 2002.
48Ibid.
49Testimony of George F. Grob, Deputy Inspector General for Health and Human Services, before the Committee on Energy and Commerce, House of Representatives, 107th Cong., 1st Sess., Medicare Drug Reimbursements: A Broken System for Patients and Taxpayers, (Washington: Government Printing Office, September 21, 2001), https://www.gpo.gov/fdsys/pkg/CHRG-107hhrg75756/html/CHRG-107hhrg75756.htm (stating that the Office of the Inspector General has been investigating drug prices since the mid-1980s).
50Defendants’ Memorandum of Law in Support of Their Motion to Dismiss the Commonwealth’s Amended Complaint, p. 14, filed in Commonwealth of Kentucky, Ex Rel. Albert Chandler, III, Attorney General v. Warrick Pharmaceuticals Corporation, Schering-Plough Corporation, Schering Corporation, and Dey, Inc., Civil Action No. 03-CI-1135 (Kentucky—Franklin Circuit Court, Division II), February 6, 2004, https://awp.doj.wi.gov/sites/default/files/states-documents/Kentucky/MotionsBriefs/KY_Abbott_Warrick-Dey_Brief_Supporting_Motion_Dismiss_Amended_complaint-02-06-2004.pdf.
51U.S. Department of Health and Human Services, Office of the Inspector General, ACN 06-40216, “Changes to the Medicaid Prescription Drug Program Could Save Millions,” 1984; U.S. Department of Health and Human Services, Office of the Inspector General, A-06-89-00037, “Use of Average Wholesale Prices in Reimbursing Pharmacies in Medicaid and the Medicare Catastrophic Coverage Act Prescription Drug Program,” 1989.
52U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-94-00390, “Medicare Payments for Nebulizer Drugs,” February 1996, http://oig.hhs.gov/oei/reports/oei-03-94-00390.pdf.; U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-04-00393, “Suppliers’ Acquisition Costs for Albuterol Sulfate,” June 1996, http://oig.hhs.gov/oei/reports/oei-03-94-00393.pdf; U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-94-00392, “A Comparison of Albuterol Sulfate Prices,” June 1996, https://oig.hhs.gov/oei/reports/oei-03-94-00392.pdf; U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-94-00391, “Questionable Medicare Payments for Nebulizer Drugs,” March 1997, https://oig.hhs.gov/oei/reports/oei-03-9400391.pdf.
53U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-97-00290, “Excessive Medicare Payments for Prescription Drugs,” December 1997, https://oig.hhs.gov/oei/reports/oei-03-97-00290.pdf.
54U.S. Department of Health and Human Services, Office of the Inspector General, OEI-03-00-00311, “Medicare Reimbursement of Albuterol,” June 2000, https://oig.hhs.gov/oei/reports/oei-03-00-00311.pdf.
55Statement of William J. Scanlon Director, Health Care Issues, U.S. Government Accountability Office, GAO-01-1142T, “Medicare Part B Drugs: Program Payments Should Reflect Market Prices,” September 21, 2001, http://www.gao.gov/assets/110/108994.pdf.
56“Concerns about Average Wholesale Price-Based Reimbursement Raised Again,” Oncology, November 1, 2001, http://www.physicianspractice.com/practice-management/concerns-about-average-wholesale-price-basedreimbursement-raised-again.
57See Gardiner Harris, “Plan Would Slash What Medicare Pays for Cancer Drugs,” New York Times, July 27, 2004, (estimating that Medicare will save $16 billion over a decade by eliminating AWP-based payment for cancer drugs); U.S. Department of Health and Human Services, Office of Inspector General, The 2002 Red Book (Washington: Government Account Office, 2002), pp. 14 and 69, https://oig.hhs.gov/publications/docs/redbook/2002%20Red%20Book.pdf ($1.6 billion estimate). Testimony of George F. Grob, Deputy Inspector General for Health and Human Services, before the Committee on Energy and Commerce, House of Representatives, 107th Cong., 1st Sess., Medicare Drug Reimbursements: A Broken System for Patients and Taxpayers (Washington: Government Printing Office, September 21, 2001), https://www.gpo.gov/fdsys/pkg/CHRG107hhrg75756/html/CHRG-107hhrg75756.htm (estimating overpayments are $1 billion–$2 billion).
58Letter from Pete Stark, Ranking Member, Subcommittee on Health, U.S. House of Representatives, to Alan F. Holmer, President, Pharmaceutical Research and Manufacturers of America, September 28, 2000, reprinted in Congressional Record, 20114-20116, September 20, 2000, https://books.google.com/books?id=b4xdPiDceH8C&lpg=PA20114&ots=0SkgfSXjuq&dq=which%20congressman%20prevent%20medicare%20from%20abandoning%20awps&pg=PA20115#v=onepage&q=which%20congressman%20prevent%20medicare%20from%20abandoning%20awps&f=false.
59Hearing on President’s Fiscal Year 1998 Budget Proposal for Medicare, Medicaid, and Welfare Before the Senate Committee on Finance, 105th Cong. 265 (1997) (written response of Secretary Donna Shalala to questions of Senator Hatch) (App. 52).
60H. Rep. No. 105-149, at 1354, Balanced Budget Act of 1997, Committee on the Budget, House of Representatives, 105th Cong., 1st Sess., https://www.congress.gov/congressional-report/105th-congress/house-report/149.
61This history is set out in Defendants’ Memorandum of Law in Support of Their Motion to Dismiss the Commonwealth’s Amended Complaint, pp. 17–19, filed in Commonwealth of Kentucky, ex rel. Albert Chandler, III, Attorney General vs. Warrick Pharmaceuticals Corporation, Schering-Plough Corporation, Schering Corporation, and Dey, Inc., Civil Action No.03-CI-1135 (Kentucky–Franklin Circuit Court, Division II), February 6, 2004, available at https://awp.doj.wi.gov/sites/default/files/states-documents/Kentucky/MotionsBriefs/KY_Abbott_Warrick-Dey_Brief_Supporting_Motion_Dismiss_Amended_complaint-02-06-2004.pdf.
62Robert Pearl, “America’s Broken Health Care System: The Role of Drug, Device Manufacturers,” Forbes.com, April 24, 2014, http://www.forbes.com/sites/robertpearl/2014/04/24/americas-broken-health-care-system-the-role-of-drug-device-manufacturers/.
63Peter Whoriskey and Dan Keating, “An Effective Eye Drug Is Available for $50. But Many Doctors Choose a $2,000 Alternative,” Washington Post, December 7, 2013, http://www.washingtonpost.com/business/economy/an-effective-eye-drug-is-available-for-50-but-many-doctors-choose-a-2000alternative/2013/12/07/1a96628e-55e7-11e3-8304-caf30787c0a9_story.html.
64Ibid.
65Ibid.
66Centers for Medicare and Medicaid Services, Medicare Drug Spending Dashboard, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Dashboard/2015-Medicare-Drug-Spending/medicare-drug-spending-dashboard-2015-data.html.
67Whoriskey and Keating, “An Effective Eye Drug.”
68Ibid.
1Peter Waldman, David Armstrong, and Sydney Freedberg, “Deaths Linked to Cardiac Stents Rise as Overuse Seen,” Bloomberg Business, September 25, 2013, http://www.bloomberg.com/news/articles/2013-09-26/deaths-linked-tocardiac-stents-rise-as-overuse-seen.
2Ibid.
3Mary Ann Roser, “State Medical Board Accuses Well-Known Cardiologist of Unnecessary Heart Procedures and Patient’s Death,” Statesman.com, November 21, 2010, http://www.statesman.com/news/news/local/state-medicalboard-accuses-well-known-cardiolog-1/nRTHX/.
4Ibid.
5Ibid.
6Waldman, Armstrong, and Freedberg, “Deaths Linked to Cardiac Stents Rise.”
7Ibid.
8David Fleshler, “Broward Health to Pay $69.5 Million on Federal Charges,” Sun-Sentinel, September 15, 2015, http://www.sun-sentinel.com/local/broward/fl-hospital-settlement-20150915-story.html; Jeff Overley, “Ga. Hospital Inks $35M FCA Deal Over Doc Pay, Billing,” Law360.com, September 4, 2015, http://www.law360.com/articles/699791/ga-hospital-inks-35m-fca-deal-overdoc-pay-bill.
9Waldman, Armstrong, and Freedberg, “Deaths Linked to Cardiac Stents Rise.”
10Kathleen Stergiopoulos and David L. Brown, “Initial Coronary Stent Implantation with Medical Therapy vs. Medical Therapy Alone for Stable Coronary Artery Disease: Meta-Analysis of Randomized Controlled Trials,” Archives of Internal Medicine 172, no. 4 (2012): 312–19, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1108733.
11Kathleen Stergiopoulos, William E. Boden, Pamela Hartigan, et al., “Percutaneous Coronary Intervention Outcomes in Patients with Stable Obstructive Coronary Artery Disease and Myocardial Ischemia: A Collaborative Meta-Analysis of Contemporary Randomized Clinical Trials,” JAMA Internal Medicine 174, no. 2 (2014): 232–40, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1783047.
12Peggy Peck, “COURAGE at 15: Still No Edge for Stenting,” MedPage Today, November 11, 2015, http://www.medpagetoday.com/cardiology/pci/54659.
13Peter Waldman, “Doctors Use Euphemism for $2.4 Billion in Needless Stents,” Bloomberg, October 29,2013, http://www.bloomberg.com/news/articles/2013-10-30/doctors-use-euphemism-for-2-4-billion-in-needless-stents.
14U.S. Senate, “Senator Everett McKinley Dirksen Dies,” September 7, 1969, https://www.senate.gov/artandhistory/history/minute/Senator_Everett_Mckinley_Dirksen_Dies.htm.
15Nicole Lou, “Criteria Reduce Inappropriate PCI,” MedPage Today, November 10, 2015, http://www.medpagetoday.com/Cardiology/PCI/54625.
16Nicole Lou, “Registry: Too Many Heart Caths before Noncardiac Surgery,” MedPage Today, March 28, 2016, http://www.medpagetoday.com/Cardiology/PCI/56981?xid=nl_mpt_DHE_2016%AD03%AD29&eun=g452253d0r.
17Waldman, Armstrong, and Freedberg, “Deaths Linked to Cardiac Stents Rise.”
18Shelley Wood, “DeMaio Resolves Unnecessary Stenting Charges with Board,” Medscape HeartWire, November 28, 2011, http://www.medscape.com/viewarticle/754271.
19Ibid.
20Ibid.
21Shawn J. Soper, “Doctor Sentenced to 8 Years in Stent Case,” Dispatch/Maryland Coast Dispatch, November 25, 2011, http://mdcoastdispatch.com/2011/11/23/doctor-sentenced-to-8-years-in-stent-case/; Bob Herman, “Retired Cardiologist Convicted, Faces up to 35 Years in Prison for Unnecessary Stents, Fraudulent Billing,” Becker’s Hospital Review, July 27, 2011, http://www.beckershospitalreview.com/hospital-key-specialties/retired-cardiologist-convicted-faces-up-to-35-years-in-prison-for-unnecessary-stents-fraudulent-billing.html; Molly Gamble, “Trial Begins for Maryland Cardiologist Accused of Implanting 200 Unnecessary Stents,” Becker’s Hospital Review, July 13, 2011, http://www.beckershospitalreview.com/hospital-management-administration/trial-begins-for-marylands-dr-john-mclean-over-stent-implants.html; Tricia Bishop, “Salisbury Stent Doctor Sentenced to Federal Prison,” Baltimore Sun, November 10, 2011, http://articles.baltimoresun.com/2011-11-10/health/bs-md-mclean-sentenced-20111108_1_stent-patients-unnecessary-coronary-stents-federal-prison.
22One case was tried, to a mixed conclusion. Glenn Weinberg, a Baltimore businessman, claimed to have lost millions of dollars in income because he had to scale back his career after Dr. Midei implanted three unnecessary stents. At trial, Weinberg won on liability, but the jurors deadlocked on the issue of damages, and a mistrial was declared. Jessica Anderson, “Juror Says Midei Panel Split over Damages,” Baltimore Sun, November 7, 2013, http://articles.baltimoresun.com/2013-11-07/news/bs-md-midei-folo-20131107_1_mark-midei-stents-maryland-live; Jessica Anderson and Scott Calvert, “Jury Weighing Damages in $150 Million Stent Suit,” Baltimore Sun, November 1, 2013, http://articles.baltimoresun.com/2013-11-01/news/bs-md-co-midei-damages-closings-20131101_1_midei-and-st-mark-midei-maryland-live; Jessica Anderson, “Midei Breached Medical Care Standards with Stents, Jury Finds,” Baltimore Sun, October 23, 2013, http://articles.baltimoresun.com/2013-10-23/news/bs-md-midei-verdict-20131023_1_other-former-midei-patients-mark-mideistents.
23Ian Duncan, “$37 Million Settlement Deal Reached in Midei Stent Case,” Baltimore Sun, April 7, 2014, http://articles.baltimoresun.com/201404-07/news/bs-md-stent-settlement-20140407_1_midei-glenn-weinbergunnecessary-heart-stent-procedures.
24Ibid. One of us (DAH) was an expert for MidAtlantic Cardiovascular Associates in a case brought by a group of cardiac surgeons (Cardiac Surgery Associates) after unsuccessful merger negotiations. For further background, see Joyce Frieden, “Dispute Splits Cardiologists, Cardiac Surgeons,” Internal Medicine News, March 15, 2004, https://www.thefreelibrary.com/Dispute+splits+cardiologists,+cardiac+surgeons.-a0115499688.
25Associated Press, “Md. Hospital to Pay $22M in Unnecessary Stent Case,” Bloomberg Businessweek, November 9, 2010, http://www.businessweek.com/ap/financialnews/D9JCSLD80.htm; Margaret Dick Tocknell, “St. Joseph Medical Center Settles Stent Cases,” HealthLeaders Media, May 7, 2013, http://www.healthleadersmedia.com/content/LED-291861/St-Joseph-Medical-Center-Settles-Stent-Cases.
26Drug-eluting stents are coated with a medication that helps prevent future cardiac events.
27Larry Husten, “Mark Midei Can’t Get a Job Taking Blood Pressure at a Walmart,” Forbes, April 8, 2012, https://www.forbes.com/sites/larryhusten/2012/04/08/mark-midei-cant-get-a-job-taking-blood-pressure-at-a-walmart/#2dcbe-3a26c17; Larry Husten, “Senate Report on Mark Midei and Abbott: 30 Stents in 1 Day, Pig Roasts, and More,” CardioBrief, December 6, 2010, http://cardiobrief.org/2010/12/06/senate-report-on-mark-midei-and-abbott-30-stents-in-1-day-pigroasts-and-more/; Maryland State Board of Physicians, “Final Decision and Order,” July 13, 2011, http://www.mbp.state.md.us/BPQAPP/orders/d3004207.131.pdf.
28Ibid.
29Molly Gamble, “Former Cardiologist at St. Joseph’s Hospital in Kentucky Pleads Guilty to Overstenting,” Becker’s Hospital Review, June 6, 2013, http://www.beckershospitalreview.com/legal-regulatory-issues/former-cardiologist-at-st-josephs-hospital-in-kentucky-pleads-guilty-to-overstenting.html.
30Bill Estep, “Hundreds of Patients Allege Needless Heart Procedures Done at Saint Joseph-London,” Lexington Herald-Leader, September 6, 2012, http://www.kentucky.com/2012/09/06/2326087_hundreds-of-patients-allege-needless.html?rh=1#storylink=cpy; Andrew Wolfson “Hundreds Sue Hospital Over Heart Procedures,” Courier-Journal (Kentucky), February 16, 2013, http://www.courier-journal.com/story/news/2014/05/28/hundreds-sue-hospital-over-heart-procedures/9683369/.
31Terry Dickson, “Waycross Hospital Pays $840,000 in Lawsuit over Unqualified Physician,” Florida Times-Union, January 20, 2012, http://jacksonville.com/news/crime/2012-01-19/story/waycross-hospital-pays-840000-lawsuit-over-unqualified-physician; United States’ Complaint, U.S. ex rel. Lana Rogers v. Najam Azmat, M.D., and Satilla Health Services, Inc., d/b/a Satilla Regional Medical Center, No. CV507-92 (S.D. Ga. July 7, 2010), http://www.vernialaw.com/FCA%20Documents/Pleadings/US%20ex%20rel%20Rogers%20v%20Azmat%20SDGA.pdf; Sydney P. Freedberg, “Mother Dies Amid Abuses in $110 Billion U.S. Stent Assembly Line,” Bloomberg.com, October 9, 2013, http://www.bloomberg.com/news/articles/2013-10-10/mother-dies-Amid-abuses-in-110-billion-u-s-stent-assembly-line; Jan Skutch, “Doctor Sentenced in Garden City Pill-Mill Scam,” Savannah Morning News, August 9, 2014, http://savannahnow.com/news/2014-08-08/doctor-sentenced-federal-court.
32United States’ Complaint, U.S. ex rel. Lana Rogers v. Najam Azmat, M.D., and Satilla Health Services, Inc., d/b/a Satilla Regional Medical Center, No. CV507-92 (S.D. Ga. July 7, 2010), http://www.vernialaw.com/FCA%20Documents/Pleadings/US%20ex%20rel%20Rogers%20v%20Azmat%20SDGA.pdf.
33Freedberg, “Mother Dies Amid Abuses.”
34R. G. Dunlap, “Doctor Followed an Unsettled Path to Lexington,” Louisville Courier-Journal, December 18, 2011, http://archive.courier-journal.com/article/20111218/NEWS01/101240008/Doctor-followed-an-unsettled-path-Lexington.
35Ibid.
36Ibid.
37Ibid.
38Ibid.
39Ibid.
40Ibid.
41Ibid.
42Ibid.
43Ibid.
44Joe Carlson, “Beating the System: Physician Faces Charges after Years of Allegations, Lawsuits in Multiple States,” Modern Healthcare, March 16, 2013, http://www.modernhealthcare.com/article/20130316/MAGAZINE/303169974; Joe Carlson, “Georgia Suspends Medical License of Jailed Surgeon ‘Dr. Hazmat,’” Modern Healthcare, April 2, 2013, http://www.modernhealthcare.com/article/20130402/NEWS/304029948.
45Ibid.
46Ibid.
47Ibid.
48Ajay J. Kirtane, Hemal Gada, Sripal Bangalore, Dean J. Kereiakes, and Gregg W. Stone, “TCT-845 Percutaneous Coronary Intervention Is Associated with Lower Mortality Compared with Optimal Medical Therapy in Patients with Stable Ischemic Heart Disease and Objective Evidence of Ischemia or Abnormal Fractional Flow Reserve: A Meta-Analysis of Randomized Controlled Trials,” Journal of the American College of Cardiology 62, no. 18 (2013): B255s, https://core.ac.uk/download/pdf/82727836.pdf.
49Shelley Wood, “Stents, ICDs, Inappropriate? Then, under New Audit Program, CMS Won’t Pay,” Medscape, December 3, 2011, http://www.medscape.com/viewarticle/791095.
50Ibid.
51Ibid.
52Stephen Klaidman, Coronary: A True Story of Medicine Gone Awry (New York: Scribner, 2007).
53Ibid.
54Ibid.
55Ibid.
56Ibid.
57Anupam B. Jena, Vinay Prasad, Dana P. Goldman, and John Romley, “Mortality and Treatment Patterns among Patients Hospitalized with Acute Cardiovascular Conditions during Dates of National Cardiology Meetings,” JAMA Internal Medicine 175, no. 2 (2015): 237–44, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2038979.
58Ibid.
59Rasha Al-Lamee, David Thompson, Hakim-Moulay Dehbi, et al. “Percutaneous Coronary Intervention in Stable Angina (ORBITA): A Double-Blind, Randomised Controlled Trial” (published online November 2), Lancet (2017), http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32714-9/fulltext?elsca1=tlxpr.
60David L. Brown and Rita F. Redberg, “Last Nail in the Coffin for PCI in Stable Angina” (published online November 2), Lancet (2017), http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32757-5/fulltext.
61Gina Kolata, “‘Unbelievable’: Heart Stents Fail to Ease Chest Pain,” New York Times, November 2, 2017, https://www.nytimes.com/2017/11/02/health/heart-disease-stents.html.
62Brown and Redberg, “Last Nail in the Coffin.”
63Gina Kolata, “Why ‘Useless’ Surgery Is Still Popular,” New York Times, August 3, 2016, https://www.nytimes.com/2016/08/04/upshot/the-right-toknow-that-an-operation-is-next-to-useless.html.
64See Shannon Brownlee, “Newtered: Gingrich’s Congress Emasculated the One Agency Capable of Controlling Health Care Costs and Improving Quality,” Washington Monthly, October 2007, 2015, http://www.washingtonmonthly.com/features/2007/0710.brownlee.html.On questionable spinal fusion surgeries, including surgeries performed by doctors who received payments from a device manufacturer, see John Carreyrou and Tom McGinty, “Top Spine Surgeons Reap Royalties, Medicare Bounty,” Wall Street Journal, December 20, 2010, http://www.wsj.com/articles/SB10001424052748703395204576024023361023138.
65See, e.g., Jeff Overley “‘Extreme’ Dental Billing Abounds in Calif., OIG Says,” Law360, May 18, 2015, http://www.law360.com/articles/657144/extreme-dental-billing-abounds-in-calif-oig-says; Lacie Glover, “Dental Billing Fraud Is More Common Than You Think,” FoxNews.com, January 9, 2015, http://www.foxnews.com/health/2015/01/09/dental-billing-fraud-is-more-commonthan-think/; “Report: Indiana Dentists Were Paid Too Much for Services,” Herald Bulletin, November 6, 2014, http://www.heraldbulletin.com/news/local_news/report-indiana-dentists-were-paid-too-much-for-services/article_32de315d-9d71-58ec-b82c-425d7adeeb9c.html.
66Steven Reinberg, “Many Older Americans May Get Unneeded Breast, Prostate Cancer Screenings,” HealthDay News, January 21, 2016, https://consumer.healthday.com/senior-citizen-information-31/senior-citizen-news-778/many-older-americans-may-get-unneeded-breast-prostate-cancer-screenings-707268.html.
67John Fauber, “Study: Two-Thirds of New Cancer Drugs Not Found to Extend Life,” Milwaukee-Wisconsin Journal Sentinel, October 19, 2015, http://www.jsonline.com/news/health/study-two-thirds-of-new-cancer-drugs-dont-extend-life-b99599343z1-334332891.html.
68Dong W. Chang and Martin F. Shapiro, “Association between Intensive Care Unit Utilization during Hospitalization and Costs, Use of Invasive Procedures, and Mortality,” JAMA Internal Medicine 76, no. 10 (2016): 1492-99.
69Louis L. Nguyen, Ann D. Smith, Rebecca E. Scully, et al. “Provider-Induced Demand in the Treatment of Carotid Artery Stenosis: Variation in Treatment Decisions between Private Sector Fee-for-Service vs. Salary-Based Military Physicians,” JAMA Surgery 152, no. 6 (2017): 565–72, https://jamanetwork.com/journals/jamasurgery/article-abstract/2606979.
70David Epstein, “When Evidence Says No, but Doctors Say Yes,” ProPublica, February 22, 2017, https://www.propublica.org/article/when-evidence-says-nobut-doctors-say-yes.
71Interventional cardiologist Samin Sharma reportedly earned $4.8 million in 2012. Larry Husten, “What Ails Mt. Sinai Hospital Ails the Entire US Healthcare System,” Forbes.com, March 6, 2014, http://www.forbes.com/sites/larryhusten/2014/03/06/what-ails-mt-sinai-hospital-ails-the-entire-us-healthcare-system/. See also Larry Husten, “Million Dollar Bonuses for Five Ohio State University Electrophysiologists,” Forbes.com, April 16, 2012, http://www.forbes.com/sites/larryhusten/2012/04/16/million-dollar-bonusesfor-five-ohio-state-university-electrophysiologists.
72For a recent example of a settlement of a federal investigation alleging that a hospital paid unlawful kickbacks to a cardiology practice, see Ayla Ellison, “NY Hospital to Pay $18.8M to Settle Kickback Allegations,” Becker’s Hospital Review, May 15, 2015.
73Sanjaya Kumar and David B. Nash, Demand Better! Revive Our Broken Healthcare System, 1st edition (Bozeman, MT: Second River Healthcare Press, 2011).
1The Second City Network, “Completely Honest Ob/Gyn,” YouTube video, 2:21. Posted by “The Second City,” October 30, 2011, http://www.youtube.com/watch?v=xG6K5hbPJKs.
2Childbirth Connection, “Why Is the National U.S. Cesarean Section Rate So High?” National Partnership for Women and Families, August 2016, http://www.nationalpartnership.org/research-library/maternal-health/why-is-the-c-section-rate-so-high.pdf.
3See M. Joffe, J. Chapple, C. Paterson, and R. W. Beard, “What Is the Optimal Caesarean Section Rate? An Outcome Based Study of Existing Variation,” Journal of Epidemiology and Community Health 48, no. 4 (1994): 406–11.
4Jeffrey Clemens and Joshua D. Gottlieb, “Do Physicians’ Financial Incentives Affect Medical Treatment and Patient Health?,” American Economic Review 104, no. 4 (2014): 1320–49.
5Center for Medical Consumers, “Cuts in Doctor-Payments Cut Unproven ADT Use,” November 12, 2010, https://medconsumers.wordpress.com/2010/11/12/cuts-in-doctor-payments-cut-unproven-adt-use/.
6Vahakn B. Shahinian, Yong-Fao Kuo, Scott M. Gilbert, et al, “Reimbursement Policy and Androgen-Deprivation Therapy for Prostate Cancer,” New England Journal of Medicine 363, no. 19 (2010): 1822–32, doi:10.1056/NEJMsa 0910784, http://www.nejm.org/doi/full/10.1056/NEJMsa0910784.
7Peter Waldman, “Prostate Patients Suffer as Money Overwhelms Best Therapy,” Bloomberg.com, November 6, 2012, http://www.bloomberg.com/news/2012-1106/prostate-patients-suffer-as-money-overwhelms-optimal-therapy.html.
8Ibid.
9John Carreyou and Maurice Tamman, “A Device to Kill Cancer, Lift Revenue,” Wall Street Journal, December 7, 2010, http://www.wsj.com/articles/SB10001424052748703904804575631222900534954.
10Melody Petersen, “AstraZeneca Pleads Guilty in Cancer Medicine Scheme,” New York Times, June 21, 2003, http://www.nytimes.com/2003/06/21/business/astrazeneca-pleads-guilty-in-cancer-medicine-scheme.html. See Chapter 3 for more details.
11Waldman, “Prostate Patients Suffer.”
12Charles Bankhead, “New Ventures May Help Make Up for Lost Reimbursement,” Urology Times, December 1, 2004, http://urologytimes.modernmedicine.com/urology-times/news/clinical/practice-management/new-venturesmay-help-make-lost-reimbursement?id=&sk=&date=&pageID=2#sthash.3tYajwTk.dpuf.
13Ibid.
14Ibid.
15Ibid.
16Ibid.
17Jean M. Mitchell, “Urologists’ Use of Intensity-Modulated Radiation Therapy for Prostate Cancer,” New England Journal of Medicine 369, no. 17 (2013): 1629–37, http://www.nejm.org/doi/full/10.1056/NEJMsa1201141. See also Zosia Chustecka, “Financial Incentives Driving Prostate Cancer Testing and IMRT?,” Medscape, April 18, 2012, http://www.medscape.com/viewarticle/761871.
18Gene Emery, “Costly Prostate Treatment Common When Docs Own the Machine,” Reuters, October 23, 2013, http://www.reuters.com/article/2013/10/23/us-prostate-therapy-idUSBRE99M1C920131023.
19Waldman, “Prostate Patients Suffer.”
20“Some Doctors Rake in Big Profits by Pushing Prostate Cancer Treatments,” Newsmax, November 6,2012, https://www.newsmax.com/Health/Health-News/ Some-Doctors-May-Put-Profit-Ahead-of-Prostate-Cancer-Patients-prostate-cancer-treatment-intensity-modulated-radiation-therapy-IMRT-and-prostate-cancer/2012/11/06/id/484403/. See also Jay Hancock, “After Urologists Get Machine, Cancer Treatments Soared,” Baltimore Sun, January 17, 2012, http://articles.baltimoresun.com/2012-01-17/health/bs-bz-hancock-chesapeake-urology-20120114_1_imrt-prostate-cancer-cancer-treatments.
21Waldman, “Prostate Patients Suffer.”
22Ibid.
23Ibid.
24Ibid.
25Jean M. Mitchell, “Urologists’ Self-Referral for Pathology of Biopsy Specimens Linked to Increased Use and Lower Prostate Cancer Detection,” Health Affairs 31, no. 4, (2012): 741–49.
26Mark Hoithaus, “Pathology, IMRT Studies Heat Up Self-Referral Debate,” Urology Times 40, no. 6 (2012): 1, http://urologytimes.modernmedicine.com/urology-times/news/modernmedicine/modern-medicine-news/pathologyimrt-studies-heat-self-referral-deb?id=&sk=&date=&&pageID=1#sthash.Ptd8g35g.dpuf. See also “Urologists Denounce New England Journal of Medicine Article Regarding Prostate Cancer Treatment,” Imaging Technology News, October 24, 2013, https://www.itnonline.com/content/urologists-denounce-new-englandjournal-medicine-article-regarding-prostate-cancer-treatment.
27Hoithaus, “Pathology, IMRT Studies.”
28Ibid. Dr. Kapoor laid out his methodological critique in a letter to the editors of Health Affairs. See Deepak A. Kapoor and David Penson, “Letter to the Editor in response to Jean Mitchell’s study, Urologists’ Self-Referral for Pathology of Biopsy Specimens Linked to Increased Use and Lower Prostate Cancer Detection,” Health Affairs 31, no. 4 (2012): 741–49, http://lugpa.org/evidence-notfinances-drives-urologists-care-a-critique-of-jean-mitchells-article/.
29Mireille Jacobson, Craig C. Earle, Mary Price, and Joseph P. Newhouse, “How Medicare’s Payment Cuts for Cancer Chemotherapy Drugs Changed Patterns of Treatment,” Health Affairs 29, no. 7 (2010): 1391–99, http://content.healthaffairs.org/content/29/7/1391.full.
30Reed Abelson, “Doctors Recouped Cuts in Medicare Pay, Study Finds,” New York Times, June 16, 2010, http://www.nytimes.com/2010/06/17/health/17drug.html.
31Ibid.
32Virgil Dickson, “CMS Cancels Part B Demo, Industry and Advocates Rejoice,” Modern Healthcare, December 16, 2016, http://www.modernhealthcare.com/article/20161217/magazine/312179879.
33Richard A. Hirth, Marc N. Turenne, John R. C. Wheeler, et al., “The Initial Impact of Medicare’s New Prospective Payment System for Kidney Dialysis,” American Journal of Kidney Diseases 62, no. 4 (2013): 662–69.
34Ibid.
35Andrew Pollak, “Lawsuit Says Drugs Were Wasted to Buoy Profit,” New York Times, July 25, 2011, http://www.nytimes.com/2011/07/26/health/26dialysis.html.
36Ibid.
37Ibid.
38Ibid.
39Ibid.
40Kevin Sack, “Unintended Consequence for Dialysis Patients as Drug Rule Changes,” New York Times, May 11, 2012, http://www.nytimes.com/2012/05/11/health/policy/dialysis-rule-changes-followed-by-transfusion-increases.html.
41Pollak, “Drugs Were Wasted to Buoy Profit.”
42Hirth, et al., “The Initial Impact of Medicare’s New Prospective Payment System.”
43Ibid.
44Ibid.
45Pollak, “Drugs Were Wasted to Buoy Profit.”
46Sack, “Unintended Consequence for Dialysis Patients.”
47Ibid.
48Ibid.
49Scott Bronstein and Drew Griffin, “Dialysis Company Accused of Giant Medicare Fraud,” CNN.com, November 30, 2012, http://www.cnn.com/2012/11/30/health/medicare-fraud-case/index.html.
50Jennifer Brown, “Denver-Based DaVita Sets Aside $300 Million to Settle Kickback Probes,” Denver Post, May 9, 2013, http://www.denverpost.com/ci_23210434/denver-based-davita-sets-aside-300m-settle-kickback#ixzz2lauSuELW.
51U.S. Department of Justice, “DaVita to Pay $450 Million to Resolve Allegations That It Sought Reimbursement for Unnecessary Drug Wastage,” news release, June 24, 2015, https://www.justice.gov/opa/pr/davita-pay-450-million-resolveallegations-it-sought-reimbursement-unnecessary-drug-wastage.
1“See the Billboard Featuring a Mechanic with Integrity and Pass It On,” Values.com, http://www.values.com/inspirational-sayings-billboards/26-Integrity.
2Cheryl Clark, “1 in 5 ICU Patients Get ‘Futile’ Care,” HealthLeaders Media, September 10, 2013, http://healthleadersmedia.com/content.cfm?content_id=296097&page=1&topic=PHY##.
3Sarah Jane Reed and Steven Pearson, “Antibiotic Use for Acute Bronchitis, Choosing Wisely—Recommendation Analysis: Prioritizing Opportunities for Reducing Inappropriate Care,” Institute for Clinical and Economic Review, 2016, https://icer-review.org/wp-content/uploads/2016/01/FINAL-AntibioticsNovember-28.pdf;“High Rates of Unnecessary Prescribing of Antibiotics for Sore Throat and Bronchitis Observed across the United States,” Brigham and Women’s Hospital, October 3, 2013, http://www.brighamandwomens.org/about_bwh/publicaffairs/news/pressreleases/PressRelease.aspx?PageID=1566.
4Sarah Wickline Wallan, “CDC: Many Flu Patients Still Getting Antibiotics at Outpatient Clinics,” MedPage Today, October 13, 2015, http://www.medpagetoday.com/MeetingCoverage/IDWeek/54070?xid=nl_mpt_DHE_20151014&eun=g452253d0r.
5Ibid. (quoting Michael Barnett and Jeffrey Linder, “Antibiotic Prescribing to Adults with Sore Throat in the United States, 1997–2010,” JAMA Internal Medicine 174, no. 1 (January 1, 2014): 138–40.)
6Jessica Glenza, “Doctors in US Incorrectly Prescribe Antibiotics in Nearly a Third of Cases,” Guardian, May 3, 2016, https://www.theguardian.com/society/2016/may/03/us-doctors-antibiotic-prescriptions-study; American College of Physicians website, “Antibiotic Resistance,” https://web.archive.org/web/20090305101402/http://www.acponline.org/patients_families/diseases_conditions/antibiotic_resistance/.
7Shannon Brownlee, “Why Doctors Uselessly Prescribe Antibiotics for a Common Cold,” Time, April 16, 2012, http://ideas.time.com/2012/04/16/why-doctors-uselessly-prescribe-antibiotics-for-a-common-cold/#ixzz2iTWarHY2.
8Michael L. Barnett and Jeffrey A Linder, “Antibiotic Prescribing to Adults with Sore Throat in the United States, 1997–2010,” JAMA Internal Medicine 174, no. 1 (2014): 138–40, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1745694.
9Ibid.
10Joel J. Heidelbaugh, Margaret Riley, and Judith M. Habetler, “10 Billing & Coding Tips to Boost Your Reimbursement,” Journal of Family Practice, November 2008, http://www.mdedge.com/jfponline/article/63368/practicemanagement/10-billing-coding-tips-boost-your-reimbursement.
11Laurence Baker, M. Kate Bundorf, and Anne Royalty, “Private Insurers’ Payments for Routine Physician Office Visits Vary Substantially across the United States,” Health Affairs 32, no. 9 (September 1, 2013): 1583–90, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2013.0309.
12Heidelbaugh, Riley, and Habetler, “10 Billing & Coding Tips to Boost Your Reimbursement.”
13Rita F. Redberg, “Squandering Medicare’s Money,” New York Times, May 25, 2011, http://www.nytimes.com/2011/05/26/opinion/26redberg.html.
14David H. Newman, “Believing in Treatments That Don’t Work,” New York Times, April 12, 2009, http://well.blogs.nytimes.com/2009/04/02/the-ideologyof-health-care/.
15See J. B. Thorlund, C. B. Juhl, E. M. Roos, and L. S. Lohmander, “Arthroscopic Surgery for Degenerative Knee: Systematic Review and Meta-Analysis of Benefits and Harms,” BMJ 350 (2015): h2747, http://www.bmj.com/content/350/bmj.h2747. CMS and private insurers reduced coverage for knee surgeries shown to be ineffective. Thereafter, the rate of arthroscopic knee surgery for osteoarthritis declined. But an offsetting increase occurred in the frequency of the same surgery for other conditions, such as meniscal damage. The authors speculated that “physicians may have begun to perform more meniscectomies in patients with osteoarthritis to circumvent insurers’ coverage restrictions.” David Howard, Robert Brophy, and Stephen Howell, “Evidence of No Benefit from Knee Surgery for Osteoarthritis Led to Coverage Changes and Is Linked to Decline in Procedures,” Health Affairs 31, no. 10 (2012): 2242–49, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2012.0644.
16Newman, “Believing in Treatments That Don’t Work.”
17Ibid.
18Justin W. Timbie, D. Steven Fox, Kristin V. Busum, and Eric C. Schneider, “Five Reasons That Many Comparative Effectiveness Studies Fail to Change Patient Care and Clinical Practice,” Health Affairs 31, no. 10 (October 2012): 2168–75, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2012.0150.
19Gina Kolata, “Good or Useless, Medical Scans Cost the Same,” New York Times, March 1, 2009, http://www.nytimes.com/2009/03/02/health/02scans.html.
20Ibid.
21Ibid.
22Richard J. Ablin and Ronald Piana, The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster (New York: St. Martin’s Press, 2014).
23Ibid.
24Ibid.
25Kolata, “Good or Useless.”
26Rob Stein, “Healthy Men Don’t Need PSA Testing for Prostate Cancer, Panel Says,” Washington Post, October6,2011, https://www.washingtonpost.com/national/health-science/healthy-men-dont-need-psa-testing-for-prostate-cancerpanel-says/2011/10/06/gIQAAxFMRL_story.html?utm_term=.78b94ef45849. See also Gerald L. Andriole, David Crawford, Robert L. Grubb III, et al., “Mortality Results from a Randomized Prostate-Cancer Screening Trial,” New England Journal of Medicine 360, no. 13 (March 26, 2009): 1310–19, http://www.nejm.org/doi/full/10.1056/NEJMoa0810696.
27Tara Parker-Pope, “Mammogram’s Role as Savior Is Tested,” New York Times, October 24, 2011, http://well.blogs.nytimes.com/2011/10/24/mammogramsrole-as-savior-is-tested/.
28Ibid.
29Nikola Biller-Andorno and Peter Jüni, “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board,” New England Journal of Medicine 370, no. 21 (May 22, 2014): 1965–67, http://www.nejm.org/doi/full/10.1056/NEJMp1401875.
30David J. Beard, Jonathan L. Rees, Jonathan A. Cook, et al., “Arthroscopic Subacromial Decompression for Subacromial Shoulder Pain (CSAW): A Multicentre, Pragmatic, Parallel Group, Placebo-Controlled, Three-Group, Randomized Surgical Trial,” Lancet, November 20, 2017, http://dx.doi.org/10.1016/S0140-6736(17)32457-1. See also Patti Neighmond, “Popular Surgery to Ease Chronic Shoulder Pain Called into Question,” NPR, November 20, 2017, https://www.npr.org/sections/health-shots/2017/11/20/565406503/popularsurgery-to-ease-chronic-shoulder-pain-called-into-question?utm_campaign%E2%80%A6.
31Ablin and Piana, The Great Prostate Hoax.
32Vinay Prasad, Victor Gall, and Adam Cifu, “The Frequency of Medical Reversal,” JAMA Internal Medicine 171, no. 18 (October 10, 2011): 1675–76, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1105961.
33Vinay Prasad, Andrae Vandross, Caitlin Toomey, et al., “A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices,” Mayo Clinic Proceedings 88, no. 8 (August 2013): 790–98, http://www.mayoclinicproceedings.org/article/S0025-6196(13)00405-9/abstract.
34Cheryl Clark, “‘Perverse Incentives’ Perpetuate Use of Disproven Medical Treatments,” HealthLeaders Media, August 6, 2013, http://healthleadersmedia.com/content.cfm?content_id=294909&page=1&topic=HEP.
35E. Haavi Morreim, “The Futility of Medical Necessity,” Regulation 24, no. 2 (Summer 2001): 22–26.
36“One of the many anomalies of medical economics is that ‘demand,’ normally set by consumers, is in medicine largely determined by the producer, the physician, who decides whether hospitalization, prescriptions, tests, surgery, referrals, and further visits are needed.” Paul Starr, “Medicine and the Waning of Professional Sovereignty,” Daedalus 107, no. 1 (1978): 175–93.
37Mark A. Hall and Gerald F. Anderson, “Health Insurers’ Assessment of Medical Necessity,” Pennsylvania Law Review 140, no. 5 (May 1992): 1637–712, 1638.
38U.S. Bipartisan Commission on Comprehensive Health Care (The Pepper Commission), A Call for Action: Final Report (Washington: Government Printing Office, 1990), p. 41, https://catalog.hathitrust.org/Record/003025536.
39Sanjaya Kumar and David B. Nash, Demand Better! Revive Our Broken Healthcare System, 1st edition (Bozeman, MT: Second River Healthcare Press, 2011), reprinted in Sanjaya Kumar and David B. Nash, “Health Care Myth Busters: Is There a High Degree of Scientific Certainty in Modern Medicine?,” Scientific American, March 25, 2011, http://www.scientificamerican.com/article/demandbetter-health-care-book/.
40“What Conclusions Has Clinical Evidence Drawn about What Works, What Doesn’t Based on Randomized Controlled Trial Evidence?,” BMJ Clinical Evidence, http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html.
41Michele G. Sullivan, “Urologists Back PSA Screening; Rail Against USPSTF’s Position,” Family Practice News, May 25, 2012, http://www.familypracticenews.com/index.php?id=2934&type=98&tx_ttnews[tt_news]=134177&cHash=da03e20e36; Steven Salzburg, “PSA Tests Might Hurt a Lot More Than You Think,” Forbes, January 24, 2012, http://www.forbes.com/sites/stevensalzberg/2012/06/24/psa-tests-might-hurt-a-lot-more-than-you-think/. See also Sarah Kliff, “Many Doctors Think PSA Tests Don’t Work. But They’ll Keep Doing Them Anyway,” Washington Post, May 29,2012, http://www.washingtonpost.com/blogs/ezra-klein/post/many-doctors-think-psa-tests-dont-work-but-theyll-keep-doing-them-anyway/2012/05/29/gJQAOl0qyU_blog.html.
42Maggie Mahar, “The Doctor Who Invented PSA Test Calls It ‘A Profit-Driven Public Health Disaster’. . . Why This Is Good News,” Health Beat, March 11, 2010, http://www.healthbeatblog.com/2010/03/the-doctor-who-invented-psatest-calls-it-a-profitdriven-public-health-disaster-why-this-is-good-new/.
43W. Douglas Weaver, Timothy J. Gardner, and Joseph D. Babb, “The Role of Appropriate Use Criteria for Coronary Revascularization,” Journal of the American College of Cardiology 53, no. 6 (2009): 554–55, http://dx.doi.org/10.1016/j.jacc.2009.01.001.
44Manesh R. Patel, Gregory J. Dehmer, John W. Hirshfeld, Peter K. Smith, and John A. Spertus, “ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization,” Journal of the American College of Cardiology 53, no. 6 (2009): 530–53, https://ac.els-cdn.com/S0735109708033457/1-s2.0-S0735109708033457-main.pdf?_tid3D2ccfa0f4-fc65-11e7-93cf-00000aab0f27&acdnat3D1516289893_27eca5fdfc-44273283dedaa933b6f6ac; Weaver, Gardner, and Babb, “The Role of Appropriate Use Criteria.”
45Pranav Puri, Bobette Patterson, and Jennifer Carroll, “The Economic Impact of Implementation of Appropriate Use Criteria on Volume of PCI Cases and Medical Cost Savings at a Large Community Hospital: 2 Year Trends,” Journal of the American College of Cardiology 65, no. 10, Supplement, 17 (2015): A1582, http://dx.doi.org/10.1016/S0735-1097(15)61582-0.
46Paul S. Chan, Manesh R. Patel, Lloyd W. Klein, et al., “Appropriateness of Percutaneous Coronary Intervention,” JAMA 306, no. 1 (2011): 53–61, http://jamanetwork.com/journals/jama/fullarticle/1104058.
47Robert C. Hendel, Manesh R. Patel, Joseph M. Allen, et al., “Appropriate Use of Cardiovascular Technology: 2013 ACCF Appropriate Use Criteria Methodology Update: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force,” Journal of the American College of Cardiology 61, no. 12, (2013):1305–17, http://dx.doi.org/10.1016/j.jacc.2013.01.025.
48Peter Waldman, “Doctors Use Euphemism for $2.4 Billion in Needless Stents,” Bloomberg, October 29, 2013, http://www.bloomberg.com/news/articles/2013-10-30/doctors-use-euphemism-for-2-4-billion-in-needlessstents.
49Chan et al., “Appropriateness of Percutaneous Coronary Intervention.”
50Opinion and Order, Amarin Pharma et al. v. U.S. FDA et al., 15 Civ. 3588 (PAE) (SDNY August 7, 2015).
51Marc A. Rodwin, “Rooting Out Institutional Corruption to Manage Inappropriate Off-Label Drug Use,” Journal of Law, Medicine & Ethics 41, no. 3 (2012): 654, 656 (citing David C. Radley, Stan N. Finkelstein, and Randall S. Stafford, “Off-Label Prescribing among Office-Based Physicians,” Archives of Internal Medicine 166, no. 9 (2006): 1021–26). See also Tewodros Eguale, David L. Buckeridge, Nancy E. Winslade, et al., “Drug, Patient, and Physician Characteristics Associated with Off-Label Prescribing in Primary Care,” Archives of Internal Medicine 172, no. 10 (2012): 781–88.
52Marc A. Rodwin, “Rooting Out Institutional Corruption to Manage Inappropriate Off-Label Drug Use,” Journal of Law, Medicine & Ethics 41, no. 3 (2012): 654–64.
53Larry Husten, “No Benefit for a Commonly Used Cardiac Device,” Forbes, April 29, 2015, http://www.forbes.com/sites/larryhusten/2015/04/29/no-benefit-for-a-commonly-used-cardiac-device/. The study referred to is Patrick Mismetti, Silvy Laporte, Olivier Pellerin, et al., “Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs. Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism: A Randomized Clinical Trial,” JAMA 313, no. 16 (2015): 1627–35, https://jamanetwork.com/journals/jama/fullarticle/2279714.
54R. H. White, E. Geraghty, A. Brunson, et al., “High Variation between Hospitals in Vena Cava Filter Use for Venous Thromboembolism,” JAMA Internal Medicine 173, no. 7 (2013): 506–12, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1669098.
55Vinay Prasad, Jason Rho, and Adam Cifu, “The Inferior Vena Cava Filter: How Could a Medical Device Be So Well Accepted without Any Evidence of Efficacy?,” JAMA Internal Medicine 173, no. 7 (2013): 493–95, https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1669099. See also V. Prasad, J. Rho, and A. Cifu, “Further Thoughts on Why There Are Good Data Supporting the Inferior Vena Cava Filter,” JAMA Internal Medicine 174, no. 1 (2014): 164–65, doi:10.1001/jamainternmed.2013.13176.
56Mitchell H. Katz, “Inferior Vena Cava Filters: The Harms Are Clear, the Benefits Less So: Comment on ‘The Inferior Vena Cava Filter,’” JAMA Internal Medicine 173, no. 7 (2013): 495, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1669106.
57American Medical Association, “2013 Reimbursement for IVC Filter Placement, Repositioning and Retrieval,” 2012, Bio2Medical, http://www.bio2medical.com/wp-content/uploads/2013/07/Codes-for-Website-Chart1.pdf.
58Peter Waldman, “Doctors Use Euphemism for $2.4 Billion in Needless Stents,” Bloomberg, October 30,2013, https://www.bloomberg.com/news/articles/2013-10-30/doctors-use-euphemism-for-2-4-billion-in-needless-stents.
59Robert Preidt, “Older Men Gain Little from PSA Test: Study,” Consumer Health-Day, October 4, 2013, http://consumer.healthday.com/cancer-information-5/mis-cancer-news-102/older-men-gain-little-from-psa-test-study-680775.html; Charles Bankhead, “Prostate Biopsy Triggers Tx in Older Men,” MedPage Today, April 15, 2013, http://www.medpagetoday.com/HematologyOncology/ProstateCancer/38464.
60Shannon Brownlee, “Newtered: Gingrich’s Congress Emasculated the One Agency Capable of Controlling Health Care Costs and Improving Quality,” Washington Monthly, October 2007, http://www.washingtonmonthly.com/features/2007/0710.brownlee.html.
61Sanjaya Kumar and David B. Nash, Demand Better! Revive Our Broken Healthcare System, 1st ed. (Bozeman, MT: Second River Healthcare Press, 2011), reprinted in Sanjaya Kumar and David B. Nash, “Health Care Myth Busters: Is There a High Degree of Scientific Certainty in Modern Medicine?,” Scientific American, March 25, 2011, http://www.scientificamerican.com/article/demandbetter-health-care-book/.
62Ibid.
63Ibid.
64See Gina Kolata, “Mammogram Debate Took Group by Surprise,” New York Times, November 20, 2009, http://www.nytimes.com/2009/11/20/health/20prevent.html?_r=0.
65Lisa Szabo, “Mammogram Coverage Won’t Change, Companies Say,” USAToday, November 19, 2009, http://usatoday30.usatoday.com/news/health/2009-11-19-1Amammogram19_ST_N.htm.
66Tiffany O’Callaghan, “Mammogram Recommendations Spark Controversy, Confusion,” TIME.com, November 17, 2009, http://healthland.time.com/2009/11/17/new-mammogram-recommendations-spark-controversy-and-confusion/#ixzz2ijlVZFwX.
67Ibid.
68Stephanie Condon, “GOP Rep. on Mammograms: ‘This Is How Rationing Begins,’” CBSNews.com, November 18, 2009, http://www.cbsnews.com/8301503544_162-5699555-503544.html.
69Ibid.
70Ibid.
71Ibid. Democratic Congresswoman Rosa DeLauro defended the Task Force. “If we can cut through the Republicans’ political gamesmanship on this issue, the new breast cancer recommendations, as always, were an attempt to put the best possible evidence in the hands of women and their doctors, so they can assess their own risk and benefit.”
72Randolph E. Schmid, “Mammograms Still Vital in Saving Lives, Health and Human Services Secretary Kathleen Sebelius Says,” Nola.com, November 18, 2009, http://www.nola.com/health/index.ssf/2009/11/mammograms_still_vital_in_savi.html.
73U.S. Department of Health and Human Services, “Statement from Secretary Kathleen Sebelius Regarding Breast Cancer Awareness Month,” October 5, 2010, http://www.hhs.gov/news/press/2010pres/10/20101005a.html.
74Merrill Goozner, “So Much for Comparative Effectiveness,” The Health Care Blog, November 20, 2009, http://thehealthcareblog.com/blog/2009/11/20/so-much-for-comparative-effectiveness/.
75U.S. Preventive Services Task Force, “Grade Definitions After May 2007,” http://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions#grade-definitions-after-may-2007.
76The official assessment can be found at U.S. Preventive Services Task Force, “Grade Definitions after May 2007.”
77Maggie Mertens, “Senate Passes Mikulski’s Overhaul Amendment on Women’s Health,” NPR News, December 3, 2009, http://www.npr.org/sections/health-shots/2009/12/senate_passes_womens_health_am.html.
78Nicholas Bagley, “Who Says PCORI Can’t Do Cost Effectiveness?,” The Incidental Economist (blog), October 14, 2013, http://theincidentaleconomist.com/wordpress/who-says-pcori-cant-do-cost-effectiveness/.
79Katharine Cooper Wulff, Franklin G. Miller, and Steven D. Pearson, “Can Coverage Be Rescinded When Negative Trial Results Threaten a Popular Procedure? The Ongoing Saga of Vertebroplasty,” Health Affairs 30, no. 12 (2011): 2269–76.
1Frances Robles and Eric Lipton, “Political Ties of Top Billers for Medicare,” New York Times, April 9, 2014, http://www.nytimes.com/2014/04/10/business/doctor-with-big-medicare-billings-is-no-stranger-to-scrutiny.html.
2Ibid.
3Phil Kerpen, “Menendez Has Set a New Low for Blatant Corruption in the U.S.,” N.Y. Post, September 30, 2017, http://nypost.com/2017/09/30/menendezhas-set-a-new-low-for-blatant-corruption-in-the-us/.
4Carol D. Leonnig and Jerry Markon, “Sen. Menendez Contacted Top Officials in Friend’s Medicare Dispute,” Washington Post, February 6,2013, http://www.wash-ingtonpost.com/politics/sen-menendez-contacted-top-officials-in-friends-medicare-dispute/2013/02/06/e01bf928-6fd4-11e2-aa58-243de81040ba_story.html.
5Ibid.
6Ibid; Jonathan Tamari, “Justice Filing Confirms Justice Dept. Investigation,” Philly.com, January 31, 2014, http://www.philly.com/philly/news/politics/Menendez-filing-confirms-Justice-Dept-investigation.html.
7Julia Edwards, “Senator Menendez of New Jersey Indicted on Corruption Charges,” Washington Post, April 1, 2015; Herb Jackson, “Menendez Says He’s ‘Angry and Ready to Fight’ after Being Indicted on Corruption Charges,” Record, April 1, 2015; Herb Jackson, “Salomon Melgen, Sen. Menendez’s Friend, Indicted in Medicare Fraud Scheme,” Record, April 14, 2015.
8Carl Hiaasen, “It Wasn’t Corruption—It Was a Bro-Mance,” Miami Herald, April 18, 2015, http://www.miamiherald.com/opinion/opn-columns-blogs/carl-hiaasen/article18797418.html#storylink=cpy.
9Curt Anderson, “Florida Eye Doctor Salomon Melgen Found Guilty of Medicare Fraud,” Time.com, April 28, 2017, http://time.com/4760046/salomonmelgeneyedoctormedicarefraudguilty/.
10Adam Berger, “Retina Surgeon’s AMD Regimen at Center of Medicare Fraud Case,” Ophthalmology Times, May 27, 2017, http://modernretina.modernmedicine.com/modern-retina/news/retina-surgeon-s-amd-regimen-center-medicarefraud-case.
11Nicholas Pugliese, “Mistrial Declared in Bob Menendez Trial after Jury Deadlocks,” USA Today, November 16, 2017, https://www.usatoday.com/story/news/politics/2017/11/16/jury-bob-menendez-trial-says-its-deadlocked/870635001/.
12Brian Klepper, “Congress Has a Little Drug Problem,” Health Care Blog, March 16, 2016, http://thehealthcareblog.com/blog/2016/03/16/congress-hasa-drug-problem/.
13Peter Schweizer, “Politicians’ Extortion Racket,” New York Times, October 21, 2013, http://nyti.ms/15YFkwi; Thomas J. DiLorenzo, “Regulatory Extortion,” Independent Institute, March 1, 2000, http://www.independent.org/publications/article.asp?id=184.
14Laura Meckler, “Obama’s Health Expert Gets Political,” Wall Street Journal, July 24, 2009, http://www.wsj.com/articles/SB124839406488477649.
15Peter Baker, “Obama Was Pushed by Drug Industry, E-mails Suggest,” New York Times, June 8, 2012, http://www.nytimes.com/2012/06/09/us/politics/e-mails-reveal-extent-of-obamas-deal-with-industry-on-health-care.html?pagewanted=all&_r=1. See also David D. Kirkpatrick, “White House Affirms Deal on Drug Costs,” New York Times, August 5, 2009, at http://www.nytimes.com/2009/08/06/health/policy/06insure.html; Tom Hamburger, “Obama Gives Powerful Drug Lobby a Seat at the Table,” Los Angeles Times, August 4, 2009, http://www.latimes.com/health/la-na-healthcare-pharma4-2009aug04-story.html; Paul Blumenthal, “The Legacy of Billy Tauzin: The White House-PhRMA Deal,” Sunlight Foundation, February 12, 2010, https://sunlightfoundation.com/blog/2010/02/12/the-legacy-of-billy-tauzin-the-white-house-phrma-deal/.
16Michael F. Cannon, “A Closer Look at Those Industry Deals,” Kaiser Health News, July 16, 2009, https://khn.org/news/071609cannon/.
17Chris Frates, “Payoffs for States Get Reid to 60,” Politico, December 19, 2009, http://www.politico.com/story/2009/12/payoffs-for-states-get-reid-to-60-030815.
18Shelley Wood, “Stents, ICDs, Inappropriate? Then, under New Audit Program, CMS Won’t Pay,” Medscape, December 3, 2011, http://www.medscape.com/viewarticle/791095. See also Sana M. Al-Khatib, Anne Hellkamp, Jeptha Curtis, et al., “Non–Evidence-Based ICD Implantations in the United States,” JAMA 305, no. 1 (2011): 43–49, https://jamanetwork.com/journals/jama/fullarticle/644551; Brenda Goodman, “Study: Implanted Cardiac Defibrillators Overused,” WebMD Health News, January 4, 2011, http://www.webmd.com/heart-disease/news/20110104/study-overuse-of-implanted-cardiac-defibrillators.
19Denise Grady, “Many Defibrillators Implanted Unnecessarily, Study Says,” New York Times, January 4, 2011, http://www.nytimes.com/2011/01/05/health/05device.html?_r=0.
20Larry Husten, “CMS Tightening the Screws on Unnecessary Procedures in Florida and 10 Other States,” Forbes, December 4, 2011, http://www.forbes.com/sites/larryhusten/2011/12/04/cms-tightening-the-screws-on-unnecessaryprocedures-in-florida-and-10-other-states/.
21Ibid.; Walter Eisner, “Wall Street’s ‘Friday Mediscare,’” Orthopedics This Week, December 12, 2011, http://ryortho.com/2011/12/wall-streetrsquos-ldquofridaymediscarerdquo/.
22Joe Carlson, “Scaling Back Scrutiny: Fla. Hospitals Welcome Prepayment Review Shift,” Modern Healthcare, January 21, 2012, http://www.modernhealthcare.com/article/20120121/MAGAZINE/301219960.
23Rosemary Gibson and Janardan Prasad Singh, Medicare Meltdown: How Wall Street and Washington Are Ruining Medicare and How to Fix It (Lanham, MD: Rowman & Littlefield, 2013), p. 57.
24For more information about the SGR, see Medicare Payment Advisory Commission “Medicare Sustainable Growth Rate System Fact Sheet,” March 2012, http://www.medpac.gov/documents/fact-sheets/mar12_sgrfactsheet.pdf?sfvrsn=0. For information on a proposed alternative to the SGR, see Letter from Douglas W. Elmendorf, Director of Congressional Budget Office, to Michael B. Enzi, Ranking Member, Committee on Health, Education, Labor, and Pensions, U.S. Senate, June 21, 2010, https://www.cbo.gov/sites/default/files/111th-congress-2009-2010/reports/06-21-high-risk_insurance_pools.pdf.
25William B. Millard, “SGR Out, MACRA In,” Annals of Emergency Medicine 67, no. 2 (2016): A15–A22, https://www.emra.org/uploadedFiles/EMRA/Events/LAC17_Journal-Club_Annals-%20MACRA.pdf.
26Richard Himmelfarb, Catastrophic Politics: The Rise and Fall of the Medicare Catastrophic Coverage Act of 1988 (University Park: Pennsylvania State University Press, 1995).
27Thomas Waldron, “Trial Shines Light on ‘Bell-Ringing’ Concept,” Baltimore Sun, July 2, 2000, http://articles.baltimoresun.com/2000-07-02/news/0007020077_1_lobbyist-fulton-bill.
28Paul Keckley, Saul B. Helman, Chuck Peck, and Kevin Cornish, “Medical Necessity and Unnecessary Care—The Full Story,” Pulse Weekly (Navigant Healthcare), January 26, 2015, http://www.naviganthrp.com/medical-necessityunnecessary-care-full-story/.
29Donald M. Berwick and Andrew D. Hackbarth, “Eliminating Waste in US Health Care,” JAMA 307, no. 14, (2012): 1513–16, doi:10.1001/jama.2012.362. See also Debra Sherman, “Stemming the Tide of Overtreatment in U.S. Healthcare,” Reuters, February 16, 2012, http://www.reuters.com/article/2012/02/16/us-overtreatment-idUSTRE81F0UF20120216.
30Institute of Medicine, Mark Smith, Robert Saunders, Leigh Stuckhardt, and J. Michael McGinnis, eds., Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (Washington: The National Academies Press, 2012), p. 14, https://www.ncbi.nlm.nih.gov/books/NBK207212/.
31Robin Hanson, “Cut Medicine in Half,” Cato Unbound, September 10, 2007, https://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medicine-half.
32Ibid.
33“Doctors Speak Out about Unnecessary Care as Cost Put at $800 Billion a Year,” Science Daily, October 3, 2012, http://www.sciencedaily.com/releases/2012/10/121003083033.htm.
34“Early Trends among Seven Recommendations from the Choosing Wisely Campaign,” JAMA Internal Medicine 175, no. 12 (2015): 1913–20, https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2457401; Scott Harris, “Disappointing Results Seen Thus Far for Choosing Wisely,” MedPage Today, October 14, 2015, http://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/54096?xid=nl_mpt_DHE_20151015&.
35Shannon Brownlee, “Taking Action to Reduce Overuse,” IHI Improvement Blog, September 17, 2015, http://www.ihi.org/communities/blogs/_layouts/15/ihi/community/blog/itemview.aspx?List=7d1126ec-8f63-4a3b-9926-c44ea3036813&ID=163.
1Lance Williams, Stephen K. Doig, and Christina Jewett, “Heart Failure Cases Surge among Prime Hospital’s Medicare Patients,” California Watch, November 27, 2011, http://californiawatch.org/health-and-welfare/heartfailure-cases-surge-among-prime-hospital-s-medicare-patients-13703.
2Lance Williams, “IE Hospital Investigated for Medicare Fraud,” ABCNews, November 28, 2011, http://abclocal.go.com/kabc/story?section=news/local/inland_empire&id=8446927.
3Williams, Doig, and Jewett, “Heart Failure Cases Surge.”
4Ibid.
5William Heisel, “Kwashiorkor Research Shows Prime Healthcare’s Cases Must Be Off Base,” USC Annenberg Center for Health Journalism, January 23, 2012, http://www.reportingonhealth.org/blogs/2012/01/23/kwashiorkor-researchshows-prime-healthcares-cases-must-be-base.
6William Heisel, “Kwashiorkor in Surf City: 5 Tips from California Watch’s Medicare Billing Investigation,” USC Annenberg Center for Health Journalism, March 9, 2011, http://www.reportingonhealth.org/blogs/kwashiorkor-surf-city5-tips-california-watchs-medicare-billing-investigation.
7Lance Williams and Stephen K. Doig, “Prime Hospital Abruptly Stops Billing Medicare for Rare Ailment,” The Center for Investigative Reporting, California Watch, December 20, 2012, http://californiawatch.org/dailyreport/primehospital-abruptly-stops-billing-medicare-rare-ailment-18751.
8Lance Williams, Stephen K. Doig, and Christina Jewett, “Hospital’s Heart Diagnoses Surge after Pay Changed,” California Watch, SFGate, November 28,2011, http://www.sfgate.com/news/article/Hospital-s-heart-diagnoses-surge-afterpay-changed-2296567.php.
9Joe Carlson, “$700M in Kwashiorkor Charges Trigger OIG Audit: HHS Finds 217 Cases of Kwashiorkor at Two Hospitals Weren’t Legitimate,” Modern Healthcare, February 12, 2014, http://www.modernhealthcare.com/article/20140212/NEWS/302129957.
10The reports are available at The Center for Public Integrity, “Cracking the Codes,” https://www.publicintegrity.org/health/medicare/cracking-codes.
11Joe Eaton and David Donald, “Hospitals Grab at Least $1 Billion in Extra Fees for Emergency Room Visits,” Center for Public Integrity, September 20, 2012, https://www.publicintegrity.org/2012/09/20/10811/hospitals-grab-least-1billion-extra-fees-emergency-room-visits.
12Ibid.
13Ibid.
14Ibid.
15Ibid.
16Peter K. Lindenauer, Tara Lagu, Meng-Shiou Shieh, Penelope S. Pekow, and Michael B. Rothberg, “Association of Diagnostic Coding with Trends in Hospitalizations and Mortality of Patients with Pneumonia, 2003–2009,” JAMA 307, no. 12, (2012): 1405–13.
17Mary Brophy Marcus, “Reported Decline in U.S. Pneumonia Deaths May Be False: Study,” HealthDay, April 3, 2012, http://consumer.healthday.com/senior-citizen-information-31/misc-death-and-dying-news-172/reporteddecline-in-u-s-pneumonia-deaths-may-be-false-study-663421.html.
18John Goodman, “What Health Policy Analysts Can Learn from Development Economics,” Health Affairs Blog, October 13, 2015, http://healthaffairs.org/blog/2015/10/13/what-health-policy-analysts-can-learn-from-developmenteconomics/; David Himmelstein and Steffie Woolhandler, “Quality Improvement: ‘Become Good at Cheating and You Never Need to Become Good at Anything Else,’” Health Affairs Blog, August 27, 2015, http://healthaffairs.org/blog/2015/08/27/quality-improvement-become-good-at-cheating-and-you-never-need-to-become-good-at-anything-else/; Joe Carlson, “Faulty Gauge? Readmissions Are Down, but Observational-Status Patients Are Up—and That Could Skew Medicare Numbers,” Modern Healthcare, June 8, 2013, http://www.modernhealthcare.com/article/20130608/MAGAZINE/306089991.
19Ankur Gupta, Larry A. Allen, Deepak L. Bhatt, et al., “Association of the Hospital Readmissions Reduction Program Implementation with Readmission and Mortality Outcomes in Heart Failure,” JAMA Cardiology, November 12, 2017, https://jamanetwork.com/journals/jamacardiology/article-abstract/2663213. For criticisms of the study, see Casey Ross, “The Data Are In, But Debate Rages: Are Hospital Readmission Penalties a Good Idea?,” STAT, December 11, 2017, https://www.statnews.com/2017/12/11/hospital-readmissions-debate/.
20John Commins, “Lower Readmissions Linked to Higher Risk of Death,” HealthLeaders Media, November 13, 2017, http://www.healthleadersmedia.com/quality/lower-readmissions-linked-higher-risk-death?spMailingID=12384704&spUserID=MTY3ODg4NjI3Mjk1S0&s%E2%80%A6#.
21Ge Bai and Gerard F. Anderson, “Extreme Markup: The Fifty US Hospitals with the Highest Charge-to-Cost Ratios,” Health Affairs 34, no. 6 (2015): 922–28, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2014.1414. See also Lena H. Sun, “50 Hospitals Charge Uninsured More than 10 Times Cost of Care, Study Finds,” Washington Post, June 8, 2015.
22Michael Batty and Benedic Ippolito, “Mystery of the Chargemaster: Examining the Role of Hospital List Prices in What Patients Actually Pay,” Health Affairs 36, no. 4 (April 2017): 689–96, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0986. See also John Gregory, “Hospital Chargemaster Rates Linked to Higher Payments, but Not Higher Quality Care,” Health Exec, April 4,2017, http://healthexec.com/topics/finance/hospital-chargemaster-rates-linked-higher-payments-not-higher-quality-care; Glenn A. Melnick and Katya Fonkych, “Hospital Pricing and the Uninsured: Do the Uninsured Pay Higher Prices?,” Health Affairs, March 2008, http://content.healthaffairs.org/content/27/2/w116.full.pdf. Physicians also use chargemaster pricing. There, the uninsured pay such inflated prices, they appear to be more profitable than insured patients, even after accounting for the uninsured who do not pay. See Jonathan Gruber and David Rodriguez, “How Much Uncompensated Care Do Doctors Provide?,” Journal of Health Economics, September 2007, https://economics.mit.edu/files/6423. (“Our best estimate is that physicians provide negative uncompensated care to the uninsured, earning more on uninsured patients than on insured patients with comparable treatments.”)
23Rhonda L. Rundle and Anna Wilde Matthews, “Tenet Reaped Outsize Gains from Flaw in Medicare System,” Wall Street Journal, November 11, 2002, http://www.wsj.com/articles/SB1036780906876999788.
24U.S. Department of Justice, “Tenet Healthcare Corporation to Pay U.S. More than $900 Million to Resolve False Claims Act Allegations,” June 29, 2006, http://www.justice.gov/archive/opa/pr/2006/June/06_civ_406.html; U.S. Securities and Exchange Commission, “SEC Charges Tenet Healthcare Corporation and Four Former Senior Executives with Concealing Scheme to Meet Earnings Targets by Exploiting Medicare System,” April 2, 2007, https://www.sec.gov/news/press/2007/2007-60.htm.
25Fred Mogul, “Feds Dock Beth Israel Medical Center $13M for ‘Turbocharging’ Medicare,” WNYC, March 1,2012, http://www.wnyc.org/story/190040-feds-dock-beth-israel-13m-turbocharging-medicare/.
26Keith Goldberg, “NYC Hospital Pays $13M for Medicare Turbocharging,” Law360, March 1,2012, https://www.law360.com/articles/314845/nyc-hospital-pays-13m-for-medicare-turbocharging.
27Nina Bernstein, “Beth Israel to Pay $13 Million for Inflating Medicare Fees,” New York Times, March 1, 2012, http://www.nytimes.com/2012/03/02/nyregion/beth-israel-admits-inflating-fees-for-medicare-patients.html.
28Office of the U.S. Attorney General, Southern District of New York, “Manhattan U.S. Attorney Recovers $11.75 Million in Medicare False Claims Act Lawsuit Against Lenox Hill Hospital,” May 4, 2012, http://www.justice.gov/archive/usao/nys/pressreleases/May12/lenoxhillsettlement.html.
29Christopher Weaver, Anna Wilde Mathews, and Tom McGinty, “Medicare Overpays as Hospital Prices Rise: Soaring Bills for Sickest Patients Can Throw Payment Formula out of Whack,” Wall Street Journal, April 15, 2015, http://www.wsj.com/articles/medicare-overpays-as-hospital-prices-rise-1429151451.
30Ibid.
31See Chapter 8 for a longer discussion of federal support for EHRs. See also Brian Schilling, “The Federal Government Has Put Billions into Promoting Electronic Health Record Use: How Is It Going?,” The Commonwealth Fund, Quality Matters, June/July 2011.
32Christopher Cheney, “MU Fraud on the Rise, OIG Warns,” HealthLeaders Media, February 14, 2014; Brooks Egerton and Miles Moffeit, “Texas Hospitals Got $18 Million from Federal Agency Despite Safety Issues,” Dallas Morning News, August 2013, http://www.dallasnews.com/investigations/patient-safety/headlines/20130824-texas-hospitals-got-18-million-from-federal-agency-despite-safety-issues.ece?nclick_check=1; Miles Moffeit, “Former Texas Hospital Chain Owner Found Guilty of Medicare Fraud,” Dallas Morning News, July 24, 2014, http://www.dallasnews.com/news/metro/20140724-former-texas-hospital-chain-owner-found-guilty-of-medicare-fraud.ece.
33Reed Abelson, Julie Creswell, and Griff Palmer, “Medicare Bills Rise as Records Turn Electronic,” New York Times, September 21, 2012, http://www.nytimes.com/2012/09/22/business/medicare-billing-rises-at-hospitalswith-electronic-records.html?_r=0.
34Ibid.
35Ibid.
36Ibid.
37Cristopher S. Brunt, “CPT Fee Differentials and Visit Upcoding under Medicare Part B,” Health Economics 20, no. 7 (2011): 831–41, http://onlinelibrary.wiley.com/doi/10.1002/hec.1649/abstract.
38Abelson, Creswell, and Palmer, “Medicare Bills Rise as Records Turn Electronic.”
39“Letter from Obama Administration on Healthcare Billing,” New York Times, September 24, 2012, http://www.nytimes.com/interactive/2012/09/25/business/25medicare-doc.html.
40AllAboutFrogs.org, “The Scorpion and the Frog,” http://allaboutfrogs.org/stories/scorpion.html.
41Matthew Wynia, D. S. Cummins, J. B. VanGeest, and I. B. Wilson, “Physician Manipulation of Reimbursement Rules for Patients—Between a Rock and a Hard Place,” JAMA 2000, 283(14):1858–65. https://jamanetwork.com/journals/jama/fullarticle/192577.
42Robert Lowes, “Managed Care: Can Lying Be Good Medicine?,” Medical Economics, October 11, 2002, http://medicaleconomics.modernmedicine.com/medical-economics/news/clinical/obstetrics-gynecology-womens-health/managed-care-can-lying-be-good-m?page=full.
43Cristopher S. Brunt, “CPT Fee Differentials and Visit Upcoding under Medicare Part B,” Health Economics 20, no. 7 (2011): 831–41, http://onlinelibrary.wiley.com/doi/10.1002/hec.1649/abstract.
44Ibid.
45Anemona Hartocollis, “Out of Prison, Doctor Hopes to Regenerate His Lost Fame,” New York Times, May 14, 2006, http://www.nytimes.com/2006/05/14/nyregion/14doctor.html?pagewanted=all&_r=0.
46Ibid.
47Eric Konigsberg, “The OB-GYN Who Loves Women,” New York Magazine, http://nymag.com/nymetro/health/features/3422/.
48Ibid.
49Jennifer Steinhauer and Sherri Day, “Doctor Convicted of Insurance Fraud in Fertility Procedures,” New York Times, January 10, 2001, at http://www.nytimes.com/2001/01/10/nyregion/doctor-convicted-of-insurance-fraud-in-fertilityprocedures.html.
50Christina Bramlet, “IRC Study: Public Less Accepting of Insurance Fraud,” April 1, 2013, PROPERTYCASUALTY360.com, http://www.propertycasualty360.com/2013/04/01/irc-study-public-less-accepting-of-insurance-fraud.
51U.S. Department of Health and Human Services, Office of the Inspector General, “Coding Trends of Medicare Evaluation and Management Serivces,” May 2012, OEI-04-10-00180, https://oig.hhs.gov/oei/reports/oei-04-10-00180.pdf.
52Laurence Baker, M. Kate Bundorf, and Anne Royalty, “Private Insurers’ Payments for Routine Physician Office Visits Vary Substantially across the United States,” Health Affairs 32, no. 9 (2013): 1583–90, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2013.0309.
53Todd Spangler, “U.S.Senate Hearing on Medicare Fraud Focuses on Michigan Cancer Doctor,” Detroit Free Press, March 26, 2014, http://archive.freep.com/article/20140326/NEWS06/303260119/medicare-fraud-senate-michigan-oakland-county-cancer-doctor. See also Charlie Langton, “New Charge Filed Against Disgraced Cancer Doctor Farid Fata,” CBSDetroit, November 22, 2013, http://detroit.cbslocal.com/2013/11/22/new-charge-filed-against-disgracedcancer-doctor-farid-fata/.
54Robert Allen, “Cancer Doc Patients Say 45 Years in Prison Not Enough,” Detroit Free Press, July 10, 2015, http://www.freep.com/story/news/local/michigan/oakland/2015/07/10/fata-sentence-handed-down/29952245/.
55Trudi Bird, “Michigan Doctor Held on $9 Million Bond for Misdiagnosing Cancer Patients in Medicare Scam,” NY Daily News, August 16, 2013, http://www.nydailynews.com/news/national/doctor-held-9-million-bond-misdiagnosing-cancer-medicare-scam-article-1.1428639.
56Rene Stutzman, “Leesburg Eye Doctor Gets 10Years in Prison for Fake Eye Operations,” Orlando Sentinel, March 13, 2017, http://www.orlandosentinel.com/news/breaking-news/os-leesburg-eye-doctor-sentenced-for-fraud-20170310story.html.
57Zachary R. Dowdy, “LI Physician Faces Medicare Fraud Charges,” Newsday, March 25, 2014, http://www.newsday.com/long-island/nassau/li-physician-facesmedicare-fraud-charges-1.7502319.
58John Marzulli, “Brooklyn Surgeon in Medicare Billing Scheme Preyed on ‘Elderly,’” New York Daily News, July 12, 2016, http://www.nydailynews.com/new-york/nyc-crime/brooklyn-surgeon-extracted-1m-medicare-billing-scheme-article-1.2708302.
59U.S. Department of Justice, Office of Public Affairs, “New York Doctor Convicted of Multimillion-Dollar Health Care Fraud,” July 29, 2016, https://www.justice.gov/opa/pr/new-york-doctor-convicted-multimillion-dollarhealth-care-fraud.
60Trudi Bird, “Michigan Doctor Held on $9 Million Bond for Misdiagnosing Cancer Patients in Medicare Scam,” NY Daily News, August 16, 2013, http://www.nydailynews.com/news/national/doctor-held-9-million-bond-misdiagnosing-cancer-medicare-scam-article-1.1428639.
61Robert Pear, “Report Links Dead Doctors to Payments by Medicare,” New York Times, July 9, 2008, http://www.nytimes.com/2008/07/09/washington/09fraud.html?_r=0.
62Ibid.
63Associated Press, “Report: Medicare Claims Were Paid in Names of Dead Providers: Related Issues Cost $1B in 2009,” PTManager Blog, December 16, 2011, http://www.ptmanager.com/ptmanagerblog/2011/12/16/report-medicareclaims-were-paid-in-names-of-dead-providers.html.
64Jorgen Wouters, “Doctor Billed the Feds Millions for Treating Dead Patients,” Daily Finance, June 8, 2011, http://www.dailyfinance.com/2011/06/08/doctorbilled-the-feds-millions-for-treating-dead-patients.
65U.S. Department of Justice, Office of Public Affairs, “Administrator and Biller of Illinois Physician Group Convicted in $4.5 Million Medicare Fraud Scheme,” May 18, 2015, http://www.justice.gov/opa/pr/administrator-andbiller-illinois-physician-group-convicted-45-million-medicare-fraud-scheme.
66U.S. Department of Health and Human Services, Office of Inspector General, “Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance,” August 2013, OEI-04-11-00680, https://oig.hhs.gov/oei/reports/oei-04-11-00680.pdf.
67U.S. Department of Health and Human Services, Office of Inspector General, “Improper Payments for Evaluation and Management Services Cost Medicare Billions in 2010,” OEI-04-10-00181, 2014, http://oig.hhs.gov/oei/reports/oei-04-10-00181.pdf.
68Charles Ornstein, “Medicare Overpays Billions for Office Visits, Patient Evaluations,” ProPublica, May 29, 2014, http://www.propublica.org/article/medicare-overpays-billions-for-office-visits-patient-evaluations; Charles Ornstein and Ryann Grochowski Jones, “Top Billing: Meet the Docs Who Charge Medicare Top Dollar for Office Visits,” ProPublica, May 15, 2014, http://www.propublica.org/article/billing-to-the-max-docs-charge-medicare-top-rate-for-office-visits.
69Ibid.
1Atul Gawande, “The Cost Conundrum,” New Yorker, June 1, 2009, http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande.
2Brooke Murphy, “20 Things to Know about Balance Billing,” Becker’s Hospital Review, February 17, 2016.
3Morgan Haefner, “Texas Governor Signs Legislation on Surprise Billing, Mediation Efforts,” Becker’s Hospital Review, May 31, 2017, http://www.beckershospitalreview.com/finance/texas-governor-signs-legislation-on-surprise-billing-mediation-efforts.html.
4Consumer Reports National Research Center, “Surprise Medical Bills Survey: 2015 Nationally-Representative Online Survey,” May 5, 2015, http://consumersunion.org/wp-content/uploads/2015/05/CY-2015-SURPRISE-MEDICAL-BILLS-SURVEY-REPORT-PUBLIC.pdf.
5Karen Politz, “Surprise Medical Bills,” Kaiser Family Foundation, March 17, 2016, http://kff.org/private-insurance/issue-brief/surprise-medical-bills/.
6Zack Cooper and Fiona Scott Morton, “Out-of-Network Emergency-Physician Bills—An Unwelcome Surprise,” New England Journal of Medicine 375 (November 17, 2016): 1915–18, http://www.nejm.org/doi/full/10.1056/NEJMp1608571.
7Christopher Garmon and Benjamin Chartock, “One in Five Inpatient Emergency Department Cases May Lead to Surprise Bills,” Health Affairs 36, no. 1 (2017): 77–181.
8Zack Cooper, Fiona Scott Morton, and Nathan Shekita, “Surprise! Out-of-Network Billing for Emergency Care in the United States,” NBER Working Paper no. 23623, July 2017, National Bureau of Economic Research, http://www.nber.org/papers/w23623.
9Haley Sweetland Edwards, “The Hidden Cost of ‘Surprise’ Medical Bills,” Time, March 3, 2016.
10Ge Bai and Gerard F. Anderson, “Extreme Markup: The Fifty US Hospitals with the Highest Charge-to-Cost Ratios,” Health Affairs 34, no. 6 (2015): 922–28, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2014.1414. See also Lena H. Sun “50 Hospitals Charge Uninsured More than 10 Times Cost of Care, Study Finds,” Washington Post, June 8, 2015.
11Brooke Murphy, “20 Things to Know about Balance Billing,” Becker’s Hospital Review, February 17, 2016.
12Ge Bai and Gerard F. Anderson, “Variation in the Ratio of Physician Charges to Medicare Payments by Specialty and Region,” JAMA 317, no. 3 (2017): 315–18, https://jamanetwork.com/journals/jama/fullarticle/2598253. See also Andrew M. Seaman, “Doctors May Accept Low Fee from Medicare, but Not from All Patients,” Reuters, January 17, 2017, http://www.reuters.com/article/us-health-cost-medical-idUSKBN15136T.
13Margot Sanger-Katz and Reed Abelson, “First Comes the Emergency. Then Comes the Surprise Out-of-Network Bill,” New York Times, November 16, 2016, http://nyti.ms/2f1P1la.
14Elisabeth Rosenthal, “After Surgery, Surprise $117,000 Medical Bill from Doctor He Didn’t Know,” New York Times, September 20, 2014, https://www.nytimes.com/2014/09/21/us/drive-by-doctoring-surprise-medical-bills.html.
15Ibid.
16Haley Sweetland Edwards, “How You Could Get Hit with a Surprise Medical Bill,” Time, March 7, 2016.
17Betsy Imholz, “Letter to the Editor,” New York Times, July 4,2016, http://www.nytimes.com/2016/07/04/opinion/when-the-cost-of-a-medical-emergency-adds-up.html.
18Brooke Murphy, “20 Things to Know about Balance Billing,” Becker’s Hospital Review, February 17, 2016.
19Sanger-Katz and Abelson, “First Comes the Emergency.”
20Bob Herman, “Billing Squeeze: Hospitals in Middle as Insurers and Doctors Battle over Out-of-Network Charges,” Modern Healthcare, August 29, 2015, http://www.modernhealthcare.com/article/20150829/MAGAZINE/308299987.
21Sweetland Edwards, “Surprise Medical Bills.”
22Ayla Ellison, “Patients Hit with Surprise Bills for 22% of In-Network ER Visits,” Becker’s Hospital Review E-weekly, November 17, 2016.
23Murphy, “20 Things to Know.”
24Mark Hall, Paul Ginsburg, and Steven M Lieberman, “How to Get Rid of Surprise Medical Bills,” Brookings, October 13,2016, https://www.brookings.edu/opinions/how-to-get-rid-of-surprise-medical-bills/.
25Herman, “Billing Squeeze.”
26Sweetland Edwards, “Surprise Medical Bills.”
27Michael F. Cannon, “Ascertaining Costs and Benefits of Colonoscopy More Difficult Than the Procedure Itself,” JAMA Internal Medicine, June 21, 2016, https://object.cato.org/sites/cato.org/files/articles/cannon-jama-internalmedicine.pdf.
28Ilene MacDonald, “1 in 4 Physician Practices Now Hospital-Owned,” FierceHealthcare, September 7, 2016, http://www.fiercehealthcare.com/practices/1-4-physician-practices-now-hospital-owned.
29Avalere Health, “Medicare Payment Differentials across Outpatient Settings of Care,” February 2016, http://www.physiciansadvocacyinstitute.org/Portals/0/assets/docs/Payment-Differentials-Across-Settings.pdf.
30Ibid.
31Tammy Worth, “Hospital Facility Fees: Why Cost May Give Independent Physicians an Edge,” Medical Economics, August 6, 2014, http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/facility-fees/hospitalfacility-fees-why-cost-may-give-independent-ph?page=full.
32Statement of Mark E. Miller, Executive Director, Medicare Payment Advisory Commission, Before the Committee on Ways and Means, U.S. House of Representatives, Hospital Policy Issues, July 22, 2015, http://www.medpac.gov/docs/default-source/congressional-testimony/testimony-hospital-policy-issuesways-and-means-.pdf?sfvrsn=0.
33Margot Sanger-Katz, “When Hospitals Buy Doctors’ Offices, and Patient Fee Soar,” New York Times, February 6, 2015, http://nyti.ms/1zeXsM9.
34Worth, “Hospital Facility Fees.”
35Joseph Burns, “Medicare, Insurers Questioning Payment Differences Based on Where Care is Delivered,” Covering Health (blog), August 1, 2014, http://healthjournalism.org/blog/2014/08/medicare-insurers-questioning-payment-differences-based-on-where-care-is-delivered/.
36Gina Kolata, “Private Oncologists Being Forced Out, Leaving Patients to Face Higher Bills,” New York Times, November 23, 2014, https://www.nytimes.com/2014/11/24/health/private-oncologists-being-forced-out-leaving-patients-to-face-higher-bills.html.
37Sanger-Katz, “When Hospitals Buy Doctors’ Offices.”
38Ames Alexander, Karen Garloch, and David Raynor, “As Doctors Flock to Hospitals, Bills Spike for Patients,” Charlotte Observer, April 22, 2015, http://www.charlotteobserver.com/news/special-reports/prognosis-profits/article9085619.html#.VNKv3mR4pSU.
39Robert A. Berenson, Suzanne F. Delbanco, Stuart Guterman, et al., “Refining the Framework for Payment Reform,” Robert Wood Johnson Foundation, Urban Institute, September 2016, https://www.brookings.edu/wp-content/uploads/2016/09/rwjf_moni_payment-reform_berenson.pdf.
40Merritt Hawkins, “2016 Physician Inpatient/Outpatient Revenue Survey,” 2016, https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Surveys/Merritt_Hawkins-2016_RevSurvey.pdf.
41Cooper, Morton, and Shekita, “Surprise! Out-of-Network Billing.”
42Julie Creswell, Reed Abelson, and Margot Sanger-Katz, “The Company Behind Many Surprise Emergency Room Bills,” New York Times, July 24, 2017, https://www.nytimes.com/2017/07/24/upshot/the-company-behind-manysurprise-emergency-room-bills.html.
43Cooper, Morton, and Shekita, “Surprise! Out-of-Network Billing.”
44Creswell, Abelson, and Sanger-Katz, “Surprise Emergency Room Bills.”
45Ibid.
46Jeff Falk, “Study: Freestanding Emergency Departments in Texas Deliver Costly Care, ‘Sticker Shock,’” Rice University News & Media, March 23, 2017, http://news.rice.edu/2017/03/23/study-freestanding-emergency-departmentsin-texas-deliver-costly-care-sticker-shock/.
47Ibid.
48Ibid.
49Jenny Deam, “Academic Study Questioning ER Pricing Sparks Fight: Industry Challenges Data in Report Led by Houston Health Economist,” Houston Chronicle, May 10, 2017, http://www.houstonchronicle.com/business/medical/article/Academic-study-questioning-ER-pricing-sparks-fight-11137336.php.
50Joe Cantlupe, “More to the Story: Annals of Emergency Medicine Halts Urgent Care Study Publication over Data in Controversial Decision,” Health Data Buzz, May 8,2017, https://healthdatabuzz.com/2017/05/08/more-to-the-story-annals-of-emergency-medicine-journal-halts-urgent-care-study-publication-over-data-in-controversial-decision/.
51Ibid.
52Ibid.
53Vivian Ho, Leanne Metcalfe, Cedric Dark, et al., “Comparing the Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2016.12.006.
54Critics of the study include Paul D. Kivela, “Original Allegations about Data Integrity by Emergency Physicians,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.08.044; Paul D. Kivela, “Additional Information Regarding Request for Retraction of Ho Article,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.08.010; William P. Jaquis, Dean Wilkerson, Michael A. Granovsky, et al., “Emergency Physicians’ Rebuttal of Author’s Response,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.08.011; and Jeremiah D. Schuur, Donald M. Yealy, and Michael L. Callaham, “Comparing Freestanding Emergency Departments, Hospital-Based Emergency Departments, and Urgent Care in Texas: Apples, Oranges, or Lemons?” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.04.019; and Renee Y. Hsia, Jaime King, and Brendan G. Carr, “Don’t Hate the Player; Hate the Game,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.08.062.
For the researchers’ response to some of these criticisms, see Vivian Ho, Leanne Metcalfe, Cedric Dark, et al., “Author’s Response to Critic’s Allegations,” Annals of Emergency Medicine 70, no. 6 (2017), http://dx.doi.org/10.1016/j.annemergmed.2017.08.017.
1Donald G. McNeil Jr., “Palliative Care Extends Life of Lung Cancer Patients, Study Finds,” New York Times, August 18, 2010, http://www.nytimes.com/2010/08/19/health/19care.html. See also Stephen R. Connor, Bruce Pyenson, Kathryn Fitch, et al., “Comparing Hospice and Non-hospice Patient Survival among Patients Who Die Within a Three-Year Window,” Journal of Pain and Symptom Management 33, no. 3 (March 2007): 238–246, http://www.jpsmjournal.com/article/S0885-3924(06)00724-X/fulltext.
2Peter Waldman, “Hospice Providers Took Liberties to Grow Burgeoning Business,” Pittsburgh Post Gazette, December 11, 2011, http://www.post-gazette.com/news/nation/2011/12/11/Hospice-providers-took-liberties-to-growburgeoning-business/stories/201112110227.
3Ibid.
4Ibid.
5Ibid.
6John K. Iglehart, “A New Era of For-Profit Hospice Care—The Medicare Benefit,” New England Journal of Medicine 360 (June 25, 2009): 2701–03, http://www.nejm.org/doi/full/10.1056/NEJMp0902437, http://www.nejm.org/toc/nejm/360/26/.
7National Hospice and Palliative Care Organization, “Facts and Figures: Hospice Care in America,” 2016, https://www.nhpco.org/sites/default/files/public/Statistics_Research/2016_Facts_Figures.pdf.
8John Hargraves and Niall Brennan, “Medicare Hospice Spending Hit $15.8 Billion in 2015, Varied by Locale, Diagnosis,” Health Affairs 35, no. 10 (October 2016): 1902–07, doi:10.1377/hlthaff.2016.0650.
9U.S. Department of Health and Human Services, Office of Inspector General, HHS OIG Work Plan, FY 2013, (Washington, 2013), https://oig.hhs.gov/reports-and-publications/archives/workplan/2013/work-plan-2013.pdf.
10Ben Hallman and Nicky Forster, “The Business of Dying Has Never Been More Lucrative,” Huffington Post, July 24, 2015, https://www.huffingtonpost.com/entry/hospice-report_us_55b1307ee4b0a9b94853fc7a.
11Iglehart, “A New Era of For-Profit Hospice Care.”
12See also Hospice Services: Assessing Payment Adequacy and Updating Payments, MedPAC Report to the Congress, p. 282, March 2012.
13Peter Waldman, “Aunt Midge Not Dying in Hospice Reveals $14 Billion U.S. Market,” Bloomberg.com, December 5, 2011, http://www.bloomberg.com/news/articles/2011-12-06/hospice-care-revealed-as-14-billion-u-s-market.
14Kathleen Tschantz Unroe, Greg A. Sachs, Susan E. Hickman, et al., “Hospice Use among Nursing Home Patients,” Journal of the American Medical Directors Association 14, no. 4 (April 2013): 254–59, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820369/.
15Medicare Learning Network, “Hospice Payment System,” September 2016, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/downloads/hospice_pay_sys_fs.pdf.
16Peter Waldman and Gary Putka, “Hospice Turns Months-to-Live Patient into Years of Abusing Drugs,” Bloomberg.com, December 29, 2011, http://www.bloomberg.com/news/articles/2011-12-30/hospice-turns-months-to-live-patient-into-years-of-abusing-drugs.
17Waldman, “Aunt Midge Not Dying in Hospice.”
18Ibid. See also Peter Waldman, “Preparing Americans for Death Lets Hospices Neglect End of Life,” Bloomberg.com, July 21, 2011, http://www.bloomberg.com/news/articles/2011-07-22/preparing-americans-for-death-lets-for-profithospices-neglect-end-of-life.
19Waldman and Putka, “Months-to-Live Patient.”
20Waldman, “Preparing Americans for Death.”
21Randy Dotinga, “Slowly Dying Patients, an Audit and a Hospice’s Undoing,” Kaiser Health News, January 16, 2013, http://khn.org/news/san-diego-hospice/.
22Joanne Faryon, “Medicare Audit Forces San Diego Hospice to Close,” KPBS Public Media, February 13, 2013, http://www.kpbs.org/news/2013/feb/13/meidcare-audit-forces-sd-hospice-close/.
23Paul Sisson, “$112 Million Claim Filed Against SD Hospice,” San Diego Union-Tribune, June 18, 2013, http://www.sandiegouniontribune.com/news/health/sdut-hospice-bankruptcy-san-diego-millions-2013jun18-story.html.
24Wikipedia, “Diagnosis-Related Group,” https://en.wikipedia.org/wiki/Diagnosis-related_group.
25U.S. Department of Health and Human Services, Office of the Inspector General, Medicare Could Save Millions by Implementing a Hospital Transfer Payment Policy for Early Discharges to Hospice Care, May 2013, http://oig.hhs.gov/oas/reports/region1/11200507.pdf.
26Tresa Baldas, “Hospice Center Denies Paying Kickbacks for Corrupt Doctor’s Referrals,” Detroit Free Press, November 30, 2016, http://www.freep.com/story/news/local/michigan/detroit/2016/11/30/hospice-center-denies-payingkickbacks-cancer-patient-referrals/94677294/.
27U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, “MLN Matters: Update to Hospice Payment Rates, Hospice Cap, Hospice Wage Index, Quality Reporting Program and the Hospice Price for Fiscal Year(FY)2015,” August11,2014, http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8876.pdf.
28U.S. Department of Justice, Office of Public Affairs, “United States Files False Claims Act Lawsuit Against the Largest For-Profit Hospice Chain in the United States,” news release, May 2, 2013, http://www.justice.gov/opa/pr/united-statesfiles-false-claims-act-lawsuit-against-largest-profit-hospice-chain-united.
29U.S. Department of Justice “Chemed Corp. and Vitas Hospice Services Agree to Pay $75 Million to Resolve False Claims Act Allegations Relating to Billing for Ineligible Patients and Inflated Levels of Care,” October 30, 2017, https://www.justice.gov/opa/pr/chemed-corp-and-vitas-hospice-services-agreepay-75-million-resolve-false-claims-act.
30United States’ Complaint at ¶ 47, United States v. VITAS Hospice Services, L.L.C., No. 4:13-cv-00449 (W.D. Mo., May 2, 2013).
31Tom McLaughlin, “Largest US Hospice Company Sued for Medicare Fraud,” Panama City News Herald, May 9, 2013, http://www.newsherald.com/news/crime-public-safety/largest-us-hospice-company-sued-for-medicare-fraud-1.140101.
32Aaron Sharockman, “Rick Scott and the Fraud Case of Columbia/HCA,” PolitiFact Florida, June 11, 2010, http://www.politifact.com/florida/article/2010/jun/11/rick-scott-and-fraud-case-columbiahca/.
33J. D. Wolverton, “Rick Scott & Health Care Fraud,” Dailykos.com, October 17, 2010, http://www.dailykos.com/story/2010/10/17/911096/-Rick-Scott-Health-Care-Fraud.
34U.S. Department of Health and Human Services, Office of the Inspector General, Medicare Hospice: Use of General Impatient Care, OEI-02-10-00490, 2013, http://oig.hhs.gov/oei/reports/oei-02-10-00490.pdf.
35U.S. Attorney’s Office, Northern District of Illinois, “Illinois Hospice Executive Charged with Federal Health Care Fraud for Allegedly Falsely Elevating Level of Patients’ Care,” news release, January 27, 2014, https://www.fbi.gov/chicago/press-releases/2014/illinois-hospice-executive-charged-with-federalhealth-care-fraud-for-allegedly-falsely-elevating-level-of-patients-care.
36Ibid.
37U.S. Department of Justice, U.S. Attorney’s Office, Northern District of Illinois, “Director of Lisle-Based Hospice Company Convicted in Scheme to Fraudulently Bill Medicare for Medically Unnecessary Services,” news release, March 9, 2016, https://www.justice.gov/usao-ndil/pr/director-lisle-basedhospice-company-convicted-scheme-fraudulently-bill-medicare-0.
38Joe Carlson, “Unusual Billing Patterns Spur Probe of Inpatient Hospice Care,” Modern Health Care, May 6, 2013, http://www.modernhealthcare.com/article/20130506/NEWS/305069968. See also Office of the Inspector General, “Medicare Hospice: Use of General Inpatient Care,” OEI-02-1 0-00490, May 3, 2013, http://oig.hhs.gov/oei/reports/oei-02-10-00490.pdf.
39Indictment, United States v. Kolodesh, No. 11-464 (E.D. Pa. August 17, 2011), http://www.justice.gov/archive/usao/pae/News/2011/Oct/kolodesh_indictment.pdf.
40Waldman, “Aunt Midge Not Dying in Hospice.”
41Ibid.
42Kay Lazar and Matt Carroll, “A Rampant Prescription, a Hidden Peril,” Boston Globe, April 29, 2012, http://www.boston.com/news/local/massachusetts/articles/2012/04/29/nursing_home_residents_with_dementia_often_given_antipsychotics_despite_health_warnings/.
43Ina Jaffe and Robert Benincasa, “Old and Overmedicated: The Real Drug Problem in Nursing Homes,” NPR, December 8, 2014, http://www.npr.org/sections/health-shots/2014/12/08/368524824/old-and-overmedicated-the-real-drug-problem-in-nursing-homes.
44Jaffe and Benincasa, “Old and Overmedicated.”
45Jan Goodwin, “Antipsychotics in Nursing Homes,” AARP Bulletin, July/August 2014, https://www.aarp.org/health/drugs-supplements/info-2014/antipsychotics-overprescribed.html.
46U.S. Department of Justice, Office of Public Affairs “U.S. Files Suit Against Johnson & Johnson for Paying Kickbacks to Nation’s Largest Nursing Home Pharmacy,” news release, January 15, 2015, http://www.justice.gov/opa/pr/usfiles-suit-against-johnson-johnson-paying-kickbacks-nation-s-largest-nursing-home-pharmacy.
47U.S. Department of Justice, Office of Public Affairs, “Two Atlanta-Based Nursing Home Chains and Their Principals Pay $14 Million to Settle False Claims Act Case,” news release, February 26, 2010, http://www.justice.gov/opa/pr/2010/February/10-civ-204.html.
48Sava may be a repeat offender. In 2015, the U.S. government joined three whistleblower lawsuits that accuse Sava, which collected more than a billion dollars in payments from Medicare, of charging for rehabilitation services that were not needed and delaying residents’ discharges to maximize revenues. See Dani Kass, “DOJ Steps in on FCA Suit Against National Nursing Co.,” Law360, October 29, 2015, https://www.law360.com/articles/720696.
49U.S. Department of Justice, Office of Public Affairs, “Nation’s Largest Nursing Home Pharmacy and Drug Manufacturer to Pay $112 Million to Settle False Claims Act Cases,” news release, November 3, 2009, http://www.justice.gov/opa/pr/nation-s-largest-nursing-home-pharmacy-and-drug-manufacturer-pay-112-million-settle-false.
50U.S. Department of Justice, Office of Public Affairs, “Johnson & Johnson to Pay More than $2.2 Billion to Resolve Criminal and Civil Investigations,” news release, November 4, 2013, https://www.justice.gov/opa/pr/johnson-johnsonpay-more-22-billion-resolve-criminal-and-civil-investigations.
51U.S. Department of Justice, “Nation’s Largest Nursing Home Pharmacy.” See also Complaint of the United States, U.S. ex rel. Bernard Lisitza and David Kammerer v. Johnson & Johnson, et al., No.07-10288-RGS, (D. MA, January 15,2010), https://www.justice.gov/sites/default/files/opa/legacy/2013/11/04/jj-complaint-ma.pdf.
52Ibid.
53David S. Hilzenrath, “Justice Suit Accuses Johnson & Johnson of Paying Kickbacks,” Washington Post, January 16, 2010, http://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011503903.html.
54Testimony from Daniel R. Levinson, Inspector General, Department of Health and Human Services, before the United States Senate Special Committee on Aging, “Overprescribed: The Human and Taxpayers’ Costs of Antipsychotics in Nursing Homes,” November 30, 2011, https://oig.hhs.gov/testimony/docs/2011/levinson_testimony_11302011.pdf.
55Ibid.
56Ibid.
57Institute of Medicine, Improving the Quality of Care in Nursing Homes (Washington: The National Academies Press, 1986), https://doi.org/10.17226/646.
58Harris Meyer, “Drugmakers’ Payments Draw Heat,” BusinessWeek, November 4, 2009, http://www.businessweek.com/bwdaily/dnflash/content/nov2009/db2009114_700374.htm.
59U.S. Department of Justice, Office of Public Affairs, “Two Atlanta-Based Nursing Home Chains and Their Principals Pay $14 Million to Settle False Claims Act Case,” news release, February 26, 2010, http://www.justice.gov/opa/pr/two-atlanta-based-nursing-home-chains-and-their-principals-pay-14million-settle-false-claims.
60U.S. Department of Justice, “Johnson & Johnson to Pay More than $2.2 Billion.”
61Kaiser Family Foundation, “Overview of Nursing Facility Capacity, Financing, and Ownership in the United States in 2011,” June 28, 2013, http://kff.org/medicaid/fact-sheet/overview-of-nursing-facility-capacity-financing-and-ownership-in-the-united-states-in-2011/.
62Kim Sloan, “Former Nursing Home Owner, George Houser, Sentenced to 20Years in Prison,” Northwest Georgia News, August 14, 2012, http://www.northwestgeorgianews.com/rome/former-nursing-home-owner-george-houser-sentenced-to-years-in/article_e5323661-e335-5bcd-8df4-67148d50a2fa.html.
63U.S. Attorney’s Office, Northern District of Georgia, “Former Nursing Home Operator Sentenced to Prison for 20 Years for Health Care Fraud and Tax Fraud,” Federal Bureau of Investigation, news release, August 13, 2012, https://www.justice.gov/archive/usao/gan/press/2012/08-14-12.html.
64Ibid.
65Sloan, “Former Nursing Home Owner Sentenced.”
66Ibid.
67U.S. Attorney’s Office, Northern District of Georgia, “Atlanta Man Convicted of Billing for Worthless Services While Operating ‘Horrendous’ Nursing Homes,” news release, April 3, 2012, https://www.justice.gov/archive/usao/gan/press/2012/04-03-12.html.
68Caitlin Ostroff, “Rehabilitation Center at Holly Hills Cited for Building Violations,” Miami Herald, September 27, 2017, http://www.miamiherald.com/news/local/community/broward/article175766806.html. See also Bob Norman, “Hollywood Nursing Home Should Never Have Been Licensed, State Senator Says,” Local-10News, October 26, 2017, https://www.local10.com/news/local-10-investigates/hollywood-nursing-home-should-never-have-been-licensed-senator-says.
69Ibid.
70Bob Norman, “Owner of Nursing Home Where Eight Died Has History of Fraud Allegations: Hospital Involved in Alleged Billion Dollar Scheme,” Local-10News, September 13, 2017, https://www.local10.com/weather/hurricaneirma/owner-of-nursing-home-where-8-died-has-history-of-fraud-allegations.
71Complaint of the United States, U.S.A. v. Jack Jacobo Michel, M.D. et al., 1:04-cv-21579-AJ (S.D. FL—June 30, 2004).
72Ibid.
73Ibid.
74U.S. Department of Justice, “Miami Hospital Pays $15.4 Million to Resolve Fraud Case for Kickbacks and Medically Unnecessary Treatments,” news release, November 30, 2006, https://www.justice.gov/archive/opa/pr/2006/November/06_civ_803.html.
75Ibid.
76Norman, “Owner of Nursing Home Where Eight Died.”
77Dan Christensen, “Gov Scott, His Lobbyist Pal, a Nursing Home Deal and a Curious Change of Heart at AHCA,” FloridaBulldog.org, November 6, 2011, http://www.floridabulldog.org/2017/11/gov-scott-his-lobbyist-pal/.
78Ibid.
79Amy Sherman, “Rick Scott ‘Oversaw the Largest Medicare Fraud’ in U.S. History, Florida Democratic Party Says,” PolitiFact Florida, March 3, 2014, http://www.politifact.com/florida/statements/2014/mar/03/florida-democratic-party/rick-scott-rick-scott-oversaw-largest-medicare-fra/.
80Christensen, “Gov Scott, His Lobbyist Pal, a Nursing Home Deal.”
81Arek Sarkissian, “Nursing Home Deaths: Owner’s Hospital Was Paid $48 Million for State Prisoner Health,” News-Press, September 26, 2107, http://www.news-press.com/story/news/politics/2017/09/26/nursing-home-deathsowners-hospital-paid-48-million-state-prisoner-health/706489001/.
82Norman, “Hollywood Nursing Home Should Never Have Been Licensed.”
1Sean Dooley and Lynn Redmond, “Doctor Jailed for Prescribing Drugs at Starbucks Defends Himself,” ABC News, November 13, 2013, http://abcnews.go.com/Health/doctor-jailed-illegally-prescribing-drugs-starbucks-defends-actions/story?id=20803865; Hailey Branson-Potts, “O.C. Doctor to Get Sentence for Illegal Pain Prescriptions,” Los Angeles Times, April 4, 2013, http://articles.latimes.com/2013/apr/04/local/la-me-0405-starbucks-doctor-20130405.
2Dooley and Redmond, “Doctor Jailed for Prescribing Drugs at Starbucks.”
3Branson-Potts, “O.C. Doctor to Get Sentence.”
4Dooley and Redmond, “Doctor Jailed for Prescribing Drugs at Starbucks.”
5Ibid.
6Paul Jesilow, G. Geis, and H. Pontell, “Fraud by Physicians Against Medicaid.” JAMA 266, no. 23 (1991): 3318–22.
7Parija Kavilanz, “Prescription Drugs Worth Millions to Dealers,” CNNMoney, June 1, 2011, http://money.cnn.com/2011/06/01/news/economy/prescription_drug_abuse/index.htm.
8Lizette Alvarez, “Florida Laws Shutting ‘Pill Mills,’” New York Times, August 31, 2011, http://www.nytimes.com/2011/09/01/us/01drugs.html.
9Partnership for Drug-Free Kids, “Generic OxyContin Hits Black Market,” May 24, 2014, http://www.drug-rehabs.com/addiction/oxycontin/blackmarket/.
10Max Blau, “As New and Lethal Opioids Flood U.S. Streets, Crime Labs Race to Identify Them,” STAT, July 5, 2017, https://www.statnews.com/2017/07/05/opioid-identification-analogs/.
11Fred Schulte and Elizabeth Lucas, “Liquid Gold: Pain Doctors Soak Up Profits by Screening Urine for Drugs,” Kaiser Health News, November 6, 2017, https://khn.org/news/liquid-gold-pain-doctors-soak-up-profits-by-screeningurine-for-drugs/.
12Justin Zaremba, “Pharmacist Pleads Guilty to $1.5 Million Health Care Fraud Scheme, Illegally Selling Oxycodone,” NJ.com, January 25, 2014, http://www.nj.com/morris/index.ssf/2014/01/pharmacist_pleads_guilty_in_15_million_health_care_fraud.html.
13“Feds Seize Records from Several Miami Pharmacies,” CBS4 Miami, October 12, 2011, http://miami.cbslocal.com/2011/10/12/feds-seize-recordsfrom-several-miami-pharmacies/.
14Rebecca R. Ruiz, “U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud,” New York Times, July 13, 2017, https://www.nytimes.com/2017/07/13/us/politics/health-care-fraud.html.
15Lizette Alvarez, “Florida Laws Shutting ‘Pill Mills,’” New York Times, August 31, 2011, http://www.nytimes.com/2011/09/01/us/01drugs.html.
16Centers for Disease Control and Prevention, “Opioid Painkiller Prescribing Infographic,” CDC Vital Signs, July 1, 2014, https://www.cdc.gov/vitalsigns/opioid-prescribing/infographic.html.
17“The $272 Billion Swindle: Why Thieves Love America’s Health-Care System,” The Economist, May 31, 2014, https://www.economist.com/news/united-states/21603078-why-thieves-love-americas-health-care-system-272billion-swindle.
18Associated Press, “Drug Wholesalers Shipped 780M Pain Pills to West Virginia,” NBCWashington, December 18, 2016, http://www.nbcwashington.com/news/local/Drug-Wholesalers-Shipped-780M-Pain-Pills-to-West-Virginia-407331135.html.
19Eric Eyre, “Drug Firms Poured 780M Painkillers into WV Amid Rise of Overdoses,” Charleston Gazette-Mail, December 17,2016, http://www.wvgazettemail.com/news-health/20161217/drug-firms-poured-780m-painkillers-into-wv-amidrise-of-overdoses.
20Centers for Disease Control and Prevention, National Center for Health Statistics, “Drug Overdose Mortality by State,” February 22, 2017, https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm. See also Michael B. Sauter, “10 States with the Most Drug Overdoses,” 24/7 Wall St.com, June 24, 2016, http://247wallst.com/special-report/2016/06/24/10states-with-the-most-drug-overdoses/3/.
21Associated Press, “28 ODs in 4 Hours: How the Heroin Epidemic Choked a W.Va. City,” CBSNews.com, September 4. 2016, http://www.cbsnews.com/news/4-hours-in-huntington-va-how-the-heroin-epidemic-choked-a-city/.
22Christopher Ingraham, “Drugs Are Killing So Many People in West Virginia That the State Can’t Keep Up with the Funerals,” Washington Post, March 7, 2017, https://www.washingtonpost.com/news/wonk/wp/2017/03/07/drugs-are-killing-so-many-people-in-west-virginia-the-state-cant-keep-up-with-the-funerals/?utm_term=.b839358e5cfb.
23Gina Kolata and Sarah Cohen, “Drug Overdoses Propel Rise in Mortality Rates of Young Whites,” New York Times, January 16, 2016, http://www.nytimes.com/2016/01/17/science/drug-overdoses-propel-rise-in-mortality-rates-of-young-whites.html?action=click&contentCollection=Health&module=RelatedCoverage®ion=EndOfArticle&pgtype=article.
24Memorandum Opinion and Order, United States v. Charles York Walker Jr., No. 2:17-cr-00010, (S.D. W.Va. June 26, 2017), http://www.wvsd.uscourts.gov/sites/default/files/opinions/ORD%20-%20Walker%20-%20Plea%20Rejection%20FINAL%20COPY.pdf.
25Jake Zuckerman, “WV Governor Signs Medical Marijuana into Law,” Charleston Gazette-Mail, April 19, 2017, http://www.wvgazettemail.com/news-politics/20170419/wv-governor-signs-medical-marijuana-into-law.
26Ronnie Cohen, “Would Legalizing Medical Marijuana Help Curb the Opioid Epidemic?,” Reuters.com, March 27, 2017, http://www.reuters.com/article/us-health-addiction-medical-marijuana-idUSKBN16Y2HV.
27“Convictions of ‘Dr. Feelgood’ Stand,” Patriot Ledger, April 15, 2009, http://www.patriotledger.com/apps/pbcs.dll/article?AID=/20090415/News/304159546.
28Tracy Weber and Charles Ornstein, “Fraud Rx: Medicare Makes Moves to Tighten Oversight of Dirty Doctors,” Pacific Standard, February 7, 2014, http://www.psmag.com/health-and-behavior/fraud-rx-medicare-makes-moves-tighten-over-sight-dirty-doctors-73910.
29Charles Ornstein, “Florida Doctor Pleads Guilty to Fraud—Years after Complaints about His Prescribing,” ProPublica, June 23, 2016, https://www.propublica.org/article/florida-doctor-pleads-guilty-fraud-years-after-complaintsprescribing.
30U.S. Government Accountability Office, GAO-09-1004T, “Medicaid: Fraud and Abuse Related to Controlled Substances Identified in Selected States,” 2009, http://www.gao.gov/products/GAO-09-1004T.
31U.S. Government Accountability Office, GAO-12-104T, “Medicare Part D: Instances of Questionable Access to Prescription Drugs,” 2011, http://www.gao.gov/products/GAO-12-104T.
32Ibid.
33Ibid.
34U.S. Government Accountability Office, “Medicare Part D.”
35Anupam B. Jena, Dana Goldman, Lesley Weaver, and Pinar Karaca-Mandic, “Opioid Prescribing by Multiple Providers in Medicare: Retrospective Observational Study of Insurance Claims,” BMJ 348 (2014): g1393.
36Lenny Bernstein, “Half a Million Medicare Recipients Were Prescribed Too Many Opioid Drugs Last Year,” Washington Post, July 13, 2017, https://www.washingtonpost.com/news/to-your-health/wp/2017/07/13/half-a-million-medicare-recipients-were-prescribed-too-many-opioid-drugs-last-year/?utm_term=.d0e0cc25aca6&wpisrc=nl_sb_smartbrief.
37Tracy Weber, Charles Ornstein, and Jennifer LaFleur, “Medicare Drug Program Fails to Monitor Prescribers, Putting Seniors and Disabled at Risk,” ProPublica, May 11, 2013, http://www.propublica.org/article/part-d-prescribercheckup-mainbar.
38Tracy Weber and Charles Ornstein, “‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan,” ProPublica, December 19, 2013, http://www.propublica.org/article/how-fraud-flourishes-in-medicares-drugplan.
39Shantanu Agrawal and Peter Budetti, “Physician Medical Identity Theft,” JAMA 307, no. 5 (2012): 459–60.
40Weber and Ornstein, “Let the Crime Spree Begin.”
41Deepak Chitnis, “Indian American Pharmacist in Michigan Mukesh Khunt Convicted for Healthcare Fraud,” American Bazaar, March 13, 2014, http://www.americanbazaaronline.com/2014/03/13/indian-american-pharmacist-michigan-mukesh-khunt-convicted-healthcare-fraud/; U.S. Attorney’s Office, Eastern District of Michigan, “Jury Convicts 38th Defendant in Health Care Fraud Scheme,” July 21, 2014, https://www.fbi.gov/detroit/press-releases/2014/jury-convicts-38th-defendant-in-health-care-fraud-scheme.
42Charles Ornstein, “Even after Doctors Are Sanctioned or Arrested, Medicare Keeps Paying,” ProPublica, April 16, 2014, http://www.propublica.org/article/even-after-doctors-are-sanctioned-or-arrested-medicare-keeps-paying.
43Tracy Weber and Charles Ornstein, “Caught Up in a Medicare Drug Fraud,” ProPublica, December 31, 2013, http://www.propublica.org/article/caught-up-ina-medicare-drug-fraud.
44Charles Ornstein, “Following Abuses, Medicare Tightens Reins on Its Drug Program,” NPR.org, May 20, 2014, http://www.npr.org/sections/healthshots/2014/05/20/314227055/following-abuses-medicare-tightens-reins-onits-drug-program.
45Charles Ornstein, “Fraud Still Plagues Medicare Drug Program, Watchdog Finds,” ProPublica, June 23, 2015, http://www.propublica.org/article/fraud-stillplagues-medicare-drug-program-watchdog-finds.
1See Centers for Medicare and Medicaid Services, “CFO Audit: Improvement in Medicare,” news release, March 26, 1999, http://cms.hhs.gov/media/press/release.asp?Counter=358. See also David A. Hyman, “HIPAA and Health Care Fraud: An Empirical Perspective,” Cato Journal 22 (2002).
2Interview with Dr. Malcolm K. Sparrow, AARP Bulletin, October 1997, http://www.aarp.org/bulletin/oct97/sparrow1.htm. See also Malcolm K. Sparrow, License to Steal: How Fraud Bleeds America’s Health Care System, 2nd edition (Boulder, CO: Westview Press, 2000).
3U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services Office of Enterprise Data and Analytics, 2016 CMS Statistics, March 2017, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Statistics-Reference-Booklet/Downloads/2016_CMS_Stats.pdf.
4Centers for Medicare and Medicaid Services, CMS Releases Prescriber-Level Medicare Data for First Time, April 30, 2015, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-30.html.
5“The $272 Billion Swindle: Why Thieves Love America’s Health-Care System,” The Economist, May 31, 2014, https://www.economist.com/news/unitedstates/21603078-why-thieves-love-americas-health-care-system-272-billionswindle.
6U.S. Department of Justice, “Annual Report of the Departments of Health and Human Services and Justice, Health Care Fraud and Abuse Program FY 2014,” March 19, 2015, (Appendix at 90), http://oig.hhs.gov/publications/docs/hcfac/FY2014-hcfac.pdf.
7U.S. Department of Health and Human Services, “Departments of Justice and Health and Human Services Announce over $27.8 Billion in Returns from Joint Efforts to Combat Health Care Fraud,” news release, March 19, 2015, http://www.hhs.gov/news/press/2015pres/03/20150319a.html. Similar figures appear in earlier reports. See U.S. Department of Health and Human Services, Office of Inspector General, “Reports and Publications (Health Care Fraud and Abuse Control Program Report section),” http://oig.hhs.gov/reports-and-publications/hcfac/index.asp.
8Weber and Ornstein, “Let the Crime Spree Begin.”
9Tristram Korten, “How to Commit Medicare Fraud in Six Easy Steps,” Fast Company, December 2011, http://www.fastcompany.com/1795066/howcommit-medicare-fraud-six-easy-steps.
10U.S. Department of Justice, Office of Public Affairs, “Justice Department Recovers over $4.7 Billion From False Claims Act Cases in Fiscal Year 2016,” December 14, 2016, https://www.justice.gov/opa/pr/justice-departmentrecovers-over-47-billion-false-claims-act-cases-fiscal-year-2016.
11Jack Cloherty and Pierre Thomas, “Biggest Medicare Fraud in History Busted, Say Feds,” ABC News, February 28, 2012, http://abcnews.go.com/Blotter/biggest-medicare-fraud-history-busted-feds/story?id=15809129; U.S. Department of Justice, Office of Public Affairs, “Dallas Doctor Arrested for Alleged Role in Nearly $375 Million Health Care Fraud Scheme,” February 28, 2012, http://www.justice.gov/opa/pr/dallas-doctor-arrested-alleged-role-nearly-375-million-health-care-fraud-scheme.
12Kevin Krause, “Former Rockwall Doctor Guilty of Nation’s Biggest Home Health Care Fraud,” Dallas Morning News, April 13, 2016, http://crimeblog.dallasnews.com/2016/04/formerrockwalldoctorguiltyofnationsbiggesthomehealthcarefraud.html/; Kevin Krause, “Doctor with History of Maiming Patients Sentenced to 35 Years in $373 Million Home Health Scheme,” Dallas Morning News, August 10, 2017, https://www.dallasnews.com/news/crime/2017/08/09/doctor-maimed-patients-bilked-taxpayers-record-370-million-gets-35-years-prison.
13Ibid.
14Bradford Pearson, “North Texas Men Convicted of Healthcare Fraud,” D CEO Healthcare, October 22, 2013, http://healthcare.dmagazine.com/2013/10/22/north-texas-men-convicted-of-healthcare-fraud/.
15U.S. Department of Justice, Office of Public Affairs, “Two Owners of Miami Home Health Company Each Sentenced to More Than Six Years in Prison for $20 Million Health Care Fraud Scheme,” news release, June 21, 2012, http://www.justice.gov/opa/pr/two-owners-miami-home-health-company-each-sentenced-more-six-years-prison-20-million-health; U.S. Department of Justice, Office of Public Affairs, “Owner and Employee of Miami Home Health Company Plead Guilty in $22 Million Health Care Fraud Scheme,” news release, January 26, 2012, http://www.justice.gov/opa/pr/owner-and-employee-miamihome-health-company-plead-guilty-22-million-health-care-fraud-scheme.
16U.S. Department of Justice, Office of Public Affairs, “Doctor and Home Health Agency Owner Plead Guilty in Connection with Detroit Fraud Scheme,” news release, May 8, 2012, http://www.justice.gov/opa/pr/doctor-and-homehealth-agency-owner-plead-guilty-connection-detroit-fraud-scheme.
17U.S. Attorney’s Office, District of Columbia, “More Than 20 People Arrested Following Investigations into Widespread Health Care Fraud in D.C. Medicaid Program,” news release, February 20, 2014, https://www.fbi.gov/washingtondc/press-releases/2014/more-than-20-people-arrested-following-investigationsinto-widespread-health-care-fraud-in-d.c.-medicaid-program.
18Barbara Martinez, “Home Care Yields Medicare Bounty,” Wall Street Journal, April 26, 2010, http://www.wsj.com/news/articles/SB10001424052748703625304575116040870004462. See also Michael Lipkin, “Amedisys to Pay $150M to Settle DOJ Medicare Billing Suits,” Law360, April 23, 2014, http://www.law360.com/articles/531089/amedisys-to-pay-150m-to-settle-doj-medicare-billing-suits.
19Martinez, “Home Care Yields Medicare Bounty.”
20U.S. Attorney’s Office, Southern District of Florida, “Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme,” July 22, 2016, https://www.justice.gov/usao-sdfl/pr/three-individuals-charged1-billion-medicare-fraud-and-money-laundering-scheme.
21Yedidya Borenstein, “Philip Esformes Charged in Unprecedented $1B Medicare Fraud Case in Miami,” Jewish Voice, July 27, 2015, http://jewishvoiceny.com/index.php?option=com_content&view=article&id=15247:philip-esformes-chargedin-unprecedented-1b-medicare-fraud-case-in-miami&catid=110&Itemid=774; Dan Mangan, “$1 Billion Alleged Medicare Fraud, Money Laundering Scheme Leads to Florida Arrests,” CNBC.com, July 22, 2016, http://www.cnbc.com/2016/07/22/1billion-alleged-medicare-fraud-money-laundering-scheme-leads-to-florida-arrests.html; Alex Zielinski, “Elder Care Company Placed Thousands of Seniors into Nursing Homes to Defraud Medicare and Medicaid,” ThinkProgress, July 25, 2016, https://thinkprogress.org/elder-care-company-placed-thousands-of-seniors-into-nursing-homes-to-defraud-medicare-and-medicaid-3b074ef2de2b.
22U.S. Attorney’s Office, Southern District of Florida, “Three Individuals Charged.”
23Bill Singer, “UPDATE: The Epidemic of Florida Medicare Fraud,” Forbes, September 19, 2011, http://www.forbes.com/sites/billsinger/2011/09/19/update-the-epidemic-of-florida-medicare-fraud/.
24Ibid.
25U.S. Department of Justice, Office of Public Affairs, “Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme,” news release, June 30, 2011, http://www.justice.gov/opa/pr/miami-area-psychiatristpleads-guilty-role-200-million-medicare-fraud-scheme.
26Jay Weaver, “Miami Man Gets 15 Years in Nation’s Biggest Medicare Therapy Scam,” Miami Herald, October 21, 2014, http://www.miamiherald.com/news/local/community/miami-dade/article3208683.html.
27Dan Eggen, “Health-Care Exec’s Medicare Fraud Scheme Included Lobbying Washington,” Washington Post, October 5, 2011, https://www.washingtonpost.com/politics/health-executive-lobbied-in-washington-to-advance-medicarefraud-scheme/2011/09/28/gIQA7dRXNL_story.html.
28U.S. Attorney’s Office, Southern District of Florida, “South Florida Doctor and Other Professionals Charged with Health Care Fraud at Biscayne Milieu Health Center Inc.,” news release, October 2, 2014, https://www.fbi.gov/miami/press-releases/2014/south-florida-doctor-and-other-professionals-charged-wthhealth-care-fraud-at-biscayne-milieu-health-center-inc.
29U.S. Department of Justice, Office of Public Affairs, “Eight Individuals and a Corporation Convicted at Trial in Florida in $50 Million Medicare Fraud,” news release, August 24, 2012, https://www.justice.gov/opa/pr/eight-individualsand-corporation-convicted-trial-florida-50-million-medicare-fraud.
30U.S. Department of Justice, Office of Public Affairs, “Jury Convicts All Seven Defendants in $97 Million Medicare Fraud Scheme,” news release, March 12, 2014, http://www.justice.gov/opa/pr/jury-convicts-all-sevendefendants-97-million-medicare-fraud-scheme.
31U.S. Department of Justice, Office of Public Affairs, “Former President of Riverside General Hospital Sentenced to 45 Years in Prison in $158 Million Medicare Fraud Scheme,” news release, June 9, 2015, http://www.justice.gov/opa/pr/former-president-riverside-general-hospital-sentenced-45-years-prison-158-million-medicare.
32Terri Langford, “FBI Arrests Historic Houston Hospital’s CEO, Son, 5 Others,” Houston Chronicle, October 4, 2012, http://www.chron.com/news/houston-texas/article/FBI-arrests-historic-Houston-hospital-s-CEO-son-3918870.php.
33Kent Moore, “Changes Coming to Medicare Payments for Durable Medical Equipment,” Family Practice Management, May 14, 2013, http://blogs.aafp.org/fpm/gettingpaid/entry/changes_coming_to_medicare_payment.
34U.S. Government Accountability Office, GAO-12-820, Health Care Fraud: Types of Providers Involved in Medicare, Medicaid, and the Children’s Health Insurance Program Cases, 2012, http://www.gao.gov/assets/650/647849.pdf (table 5).
35Lindsay Wise, “Medicare Fraud Targets Seniors, Scooters: ‘I Don’t Need It. I Don’t Want It,’” McClatchyDC, May 7, 2013, http://www.mcclatchydc.com/news/politics-government/congress/article24748903.html.
36Jay Weaver, “Prosecutors Called Their Business ‘All-Fraud,’” Miami Herald, August 4, 2008, http://www.miamiherald.com/news/special-reports/watchdogreport/article1929737.html.
37“Former Pastor Sentenced for Role in $11 Million Medicare Fraud Scheme,” Arizona Daily Independent, October 20, 2013, https://arizonadailyindependent.com/2013/10/20/former-pastor-sentenced-for-role-in-11-million-medicarefraud-scheme/.
38U.S. Department of Justice, Office of Public Affairs, “Los Angeles Church Pastor Sentenced to Serve 36 Months in Prison for $14.2 Million Medicare Fraud Scheme,” February 27, 2012, http://www.justice.gov/opa/pr/los-angeles-churchpastor-sentenced-serve-36-months-prison-142-million-medicare-fraud-scheme.
39U.S. Attorney’s Office, District of Kansas, “Texas Man Convicted of Medicare Fraud in Kansas,” February 16, 2012, https://www.fbi.gov/kansascity/press-releases/2012/texas-man-convicted-of-medicare-fraud-in-kansas.
40Wise, “Medicare Fraud Targets Seniors.”
41“Woman Arrested for Health Care Fraud,” 12 News KBMT & K-JAC, October 18, 2011, http://www.12newsnow.com/story/15724681/womanarrested-for-health-care-fraud.
42Statement by Daniel R. Levinson, Office of the Inspector General, U.S. Department of Health and Human Services (HHS) on Preventing Health Care Fraud: New Tools and Approaches to Combat Old Challenges before U.S. Senate Committee on Finance, March 2, 2011, http://www.hhs.gov/asl/testify/2011/03/t20110302i.html.
43Statement by Lewis Morris, Chief Counsel, Office of Inspector General, U.S. Department of Health and Human Services, on Reducing Fraud, Waste, and Abuse in Medicare before Committee on Ways and Means, Subcommittee on Health and Subcommittee on Oversight, United States House of Representatives, June 15, 2010, http://www.hhs.gov/asl/testify/2010/06/t20100615c.html.
44Terri Langford, “Private Ambulances Take Medicare, Taxpayers for a Ride,” Houston Chronicle, July 26, 2013, http://www.chron.com/news/houston-texas/article/Some-Ems-companies-taking-Medicare-for-a-ride-2220817.php.
45“Editorial: Medicare Fraud Must End,” Houston Chronicle, October 20, 2011, http://www.chron.com/opinion/editorials/article/Medicare-fraud-mustend-2228816.php.
46Langford, “Private Ambulances.”
47Ibid.
48Matthew Spina, “Rural/Metro Faces Accusations of Overbilling in NY,” Buffalo News, January 16, 2012, http://www.boundtreeuniversity.com/news/1220552-Rural-Metro-faces-accusations-of-overbilling-in-NY/. See also U.S. Attorney’s Office, District of Arizona, “Rural/Metro to Pay $2.8 Million to Resolve False Claims Allegations,” December 26, 2013, http://www.justice.gov/usao-az/pr/attachment2013-099ruralmetrosettlement-agreement-pdf.
49Rebecca LeFever, “Harrisburg Company, Owner and York Employee Face Medicare Fraud Charges,” Ydr.com, January 13, 2012, http://www.ydr.com/ci_19735405. See also U.S. Attorney’s Office, Middle District of Pennsylvania, “Health Care Fraud,” June 2, 2015, http://www.justice.gov/usao-mdpa/health-care-fraud.
50Susan Trautsch, “Ambulance Transport Company Settles on Alleged Medicare Fraud,” South Carolina Radio Network, December 2, 2010, http://www.southcarolinaradionetwork.com/2010/12/02/ambulance-transport-provider-settles-on-alleged-medicare-fraud/.
51Tony Gonzalez, “Health Fraud Prosecutions Net $100 Million in Tennessee This Year,” Kingsport Times-News, December 4, 2011, http://www.timesnews.net/article/9039090/health-fraud-prosecutions-net-100-million-in-tennessee-this-year. See also U.S. Attorney’s Office, Middle District of Tennessee, “Former Owners of Murfreesboro Ambulance Service Sentenced to Federal Prison for Defrauding Medicare,” January 17, 2014, https://www.fbi.gov/memphis/press-releases/2014/former-owners-of-murfreesboro-ambulance-servicesentenced-to-federal-prison-for-defrauding-medicare.
52Michael Owens, “Saltville Rescue Squad Accused of Fraud,” HeraldCourier .com, February 3, 2012, http://www.heraldcourier.com/news/saltville-rescuesquad-accused-of-fraud/article_1772200b-757a-5aae-ac07-86fc207f85ab.html; Laurence Hammack, “Saltville Rescue Squad President Convicted of Health Care Fraud,” Roanoke Times, September 19, 2012, http://www.roanoke.com/webmin/news/saltville-rescue-squad-president-convicted-of-health-care-fraud/article_742d438b-ff0a-5a92-b1e3-7d3e3a998ab7.html.
53U.S. Department of Justice, Office of Public Affairs, “New York City Ambulance Companies Pay U.S. $2.85 Million to Resolve Claims for Fraudulent Medicare Appeals,” June 4, 2010, http://www.justice.gov/opa/pr/new-york-cityambulance-companies-pay-us-285-million-resolve-claims-fraudulent-medicare.
54Linnet Myers, “FBI: Medical Fraud Luring Crime Rings,” Chicago Tribune, March 22, 1995, http://articles.chicagotribune.com/1995-03-22/news/9503220190_1_health-care-fraud-fbi-director-louis-freeh-medical-fraud.
55Lewis Morris, “Combating Fraud in Health Care: An Essential Component of Any Cost Containment Strategy,” Health Affairs 28, no. 5 (2009): 1351–56, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.28.5.1351.
56U.S. Department of Justice, Office of Public Affairs, “Members and Associates of Organized Crime Enterprise, Others Indicted for Health Care Fraud Crimes Involving More Than $163 Million,” October 13, 2010, http://www.justice.gov/opa/pr/73-members-and-associates-organized-crime-enterprise-others-indicted-health-care-fraud-crimes.
57Daniel Beekman, “10 Yrs. for Armenian Mobster,” NY Daily News, August 15, 2013, http://www.nydailynews.com/new-york/10-yrs-armenianmobster-article-1.1428461.
58Chris Adams, “Even as Prosecutions Rise, Medicare Fraud Often Runs Rampant,” Kansas City Star, March 26, 2014, http://www.kansascity.com/news/local/article343418/Even-as-prosecutions-rise-Medicare-fraud-often-runsrampant.html.
59Ibid.
60Statement of Aghaegbuna ‘Ike’ Odello, Hearing on Improved Efforts to Combat Health Care Fraud, before the Subcommittee on Health of the Committee on Ways and Means, March 2, 2011, http://waysandmeans.house.gov/hearing-on-improving-efforts-to-combat-health-care-fraud/.
61Jay Weaver, “A Former Scam Artist Tells How It Works,” Miami Herald, August 5, 2008, http://www.miamiherald.com/news/special-reports/watchdogreport/article1929762.html.
62Jay Weaver, “Feds Fear Medicare Fraud Suspect May Flee Abroad,” Miami Herald, May 6, 2012, http://www.miamiherald.com/2012/05/05/2784943/feds-fear-medicare-fraud-suspect.html.
63Christie Smythe and Henry Meyer, “Russian Diplomats Accused of Bilking Medicaid,” Bloomberg.com, December 6, 2013, http://www.bloomberg.com/news/articles/2013-12-06/russian-diplomats-accused-of-bilking-medicaid.
64Paul Rubin, “Rent a Patient,” Phoenix New Times, April 24, 2003, http://www.phoenixnewtimes.com/news/rent-a-patient-6408607.
65Paul Rubin, “Out of Patients,” Phoenix New Times, May 29, 2003, http://www.phoenixnewtimes.com/content/printView/6408437.
66Kristen Hallam, “Health Insurers Allege ‘Rent-A-Patient’ Fraud,” Washington Post, March 12, 2005, http://www.washingtonpost.com/wp-dyn/articles/A28484-2005Mar11.html.
67U.S. Department of Justice, Office of Public Affairs, “Detroit-Area Clinic Owner Pleads Guilty in Connection with Medicare Fraud Scheme,” news release, December 6, 2011, http://www.justice.gov/opa/pr/detroit-area-clinic-ownerpleads-guilty-connection-medicare-fraud-scheme.
68Alex Robinson, “Second Doc Pleads Guilty in Flushing Clinic Fraud,” TimesLedger, March 4, 2014, http://www.timesledger.com/stories/2014/9/medicarefraud2_tl_2014_02_28_q.html.
69Kelli Kennedy, “Professional Patients Aid Massive Medicare Fraud in Fla.,” Boston Globe, December 25, 2008, http://www.boston.com/news/nation/articles/2008/12/25/professional_patients_aid_massive_medicare_fraud_in_fla/?page=full.
70Ibid.
71Jay Weaver, “Medicare Fraud Rampant in South Florida,” Miami Herald, August 3, 2008, http://www.miamiherald.com/news/special-reports/watchdogreport/article1929719.html.
72Ibid.
73U.S. Department of Health and Human Services, “Medicare Fraud Strike Force Charges 90 Individuals for Approximately $260 Million in False Billing,” news release, May 13, 2014, http://www.hhs.gov/news/press/2014pres/05/20140513b.html.
74Marilyn May, “Medicare Fraud Takedown: A Closer Look,” Healio.com, June 30, 2015, http://www.healio.com/ophthalmology/regulatory-legislative/news/online/%7B449aca05-0903-4b0b-af9e-458c9a83ea04%7D/medicarefraud-takedown-a-closer-look.
75Ibid.
76Rebecca R. Ruiz, “U.S. Charges 412, Including Doctors, in $1.3 Billion Health Fraud,” New York Times, July 13, 2017, https://mobile.nytimes.com/2017/07/13/us/politics/health-care-fraud.html; Jesse Pound, “Austin, Houston Doctors among 35 Texans Charged in $1.3 Billion Medicare Fraud Sting,” San Antonio Express-News, July 13, 2017, http://www.expressnews.com/business/article/AustinHouston-doctors-among-35-Texans-charged-11287987.php.
1The website for the Heart Attack Grill Restaurant, http://www.heartattackgrill.com.
2Marshall Allen and ProPublica, “How Many Die from Medical Mistakes in U.S. Hospitals?” Scientific American, September 20, 2013, http://www.scientificamerican.com/article/how-many-die-from-medical-mistakes-in-us-hospitals/.
3Committee on Quality of Health Care in America and Institute of Medicine, To Err Is Human: Building a Safer Health System, ed. Linda T. Kohn, 1st edition (Washington: National Academies Press, 2000).
4HealthGrades, “Patient Safety in American Hospitals,”2004, www.ihf-fih.org/sp/content/download/530/4009/file/Patient%20Safety%20in%20American%20Hospitals.pdf.
5John T. James, “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care,” Journal of Patient Safety 9, no. 3 (September 2013): 122–28, doi:10.1097/PTS.0b013e3182948a69.
6Martin A. Makary and Michael Daniel, “Medical Error—The Third Leading Cause of Death in the US,” BMJ 353 (2016): i2139, doi: https://doi.org/10.1136/bmj.i2139.
7Ibid. See also Hannah Nichols, “The Top 10 Leading Causes of Death in the United States,” Medical News Today, February 23, 2017, https://www.medicalnewstoday.com/articles/282929.php.
8John T. James, “A New, Evidence-Based Estimate of Patient Harms Associated with Hospital Care,” Journal of Patient Safety 9, no. 3 (September 2013): 122–28, doi:10.1097/PTS.0b013e3182948a69.
9John C. Goodman, Pamela Villarreal, and Biff Jones, “The Social Cost of Adverse Medical Events, and What We Can Do about It,” Health Affairs 30, no. 4 (2011): 590–95, doi:10.1377/hlthaff.2010.1256.
10David C. Classen, Roger Resar, Frances Griffin, et al., “‘Global Trigger Tool’ Shows That Adverse Events in Hospitals May Be Ten Times Greater than Previously Measured.” Health Affairs 30, no. 4 (2011): 581–89, doi:10.1377/hlthaff.2011.0190. See also Cheryl Clark, “1 in 3 Hospitalized Patients Suffers an Adverse Event,” HealthLeaders Media, April 7, 2011, http://www.healthleadersmedia.com/print/QUA-264653/1-in-3-Hospitalized-Patients-Suffers-an-Adverse-Event (quoting David Classen, MD).
11Jill Van Den Bos, Karan Rustagi, Travis Gray, et al., “The $17.1 Billion Problem: The Annual Cost of Measurable Medical Errors,” Health Affairs 30, no. 4 (2011): 596–603, doi:10.1377/hlthaff.2011.0084.
12Goodman, Villareal, and Jones, “The Social Cost of Adverse Medical Events.”
13Barbara Starfield, “Is US Health Really the Best in the World?,” JAMA 284, no. 4 (2000): 483–85, doi:10.1001/jama.284.4.483 (citing studies).
14Catharine Paddock, “Medicare Will Not Pay for Hospital Mistakes and Infections, New Rule,” Medical News Today, August 20, 2007, http://www.medicalnewstoday.com/articles/80074.php. A study published in 2014 suggests that hospitals are doing better at preventing HAIs. See Shelley S. Magill, Jonathan R. Edwards, Wendy Bamberg, et al., “Multistate Point-Prevalence Survey of Health Care–Associated Infections,” New England Journal of Medicine 370, no. 13 (2014): 1198–208, doi:10.1056/NEJMoa1306801.
15Peter Pronovost, Dale Needham, Sean Berenholtz, et al., “An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU,” New England Journal of Medicine 355, no. 26 (2006): 2725–32, doi:10.1056/NEJMoa061115. The protocol also encouraged physicians to avoid the femoral artery and to remove catheters that were no longer needed.
16Ibid., 2729. The 0escribed in slightly different ways in different places. See, for example, Nancy Kass, Peter J. Pronovost, Jeremy Sugarman, et al., “Controversy and Quality Improvement: Lingering Questions about Ethics, Oversight, and Patient Safety Research,” Joint Commission Journal on Quality and Patient Safety/Joint Commission Resources 34, no. 6 (June 2008): 349–53. The actual Johns Hopkins checklist, and many others, can be found at http://gawande.com/the-checklist-manifesto.
17Atul Gawande, “The Checklist,” New Yorker, December 10, 2007, http://www.newyorker.com/magazine/2007/12/10/the-checklist.
18Ibid.
19Atul Gawande, “A Lifesaving Checklist,” New York Times, December 30, 2007, http://www.nytimes.com/2007/12/30/opinion/30gawande.html.
20Ibid.
21David Maxfield, Joseph Grenny, Ramon Lavandero, and Linda Groah, “The Silent Treatment: Why Safety Tools and Checklists Aren’t Enough,” 2011, http://silenttreatmentstudy.com/silent/The%20Silent%20Treatment.pdf.
22Gawande, “The Checklist.”
23Gawande, “A Lifesaving Checklist.”
24Gawande, “The Checklist.”
25Peter Pronovost and Eric Vohr, Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out, 1st ed. (New York: Plume, 2011).
26Ibid.
27Cheryl Clark, “How One Hospital Zapped Infection Rates,” HealthLeaders Media, March 8, 2013, http://healthleadersmedia.com/content.cfm?topic=QUA&content_id=289932##.
28Reed Abelson, “Go to the Wrong Hospital and You’re 3 Times More Likely to Die,” New York Times, December 14, 2016, https://www.nytimes.com/2016/12/14/business/hospitals-death-rates-quality-vary-widely.html.
29Ibid.
30J. K. Wall, “The Low Hanging Fruit Is Lying on the Ground,” The Health Care Blog, July 29, 2015, http://thehealthcareblog.com/blog/2015/07/29/the-lowhanging-fruit-is-lying-on-the-ground/.
31Molly Joel Coye, “No Toyotas in Health Care: Why Medical Care Has Not Evolved to Meet Patients’ Needs,” Health Affairs 20, no. 6 (2001): 44–56.
32Charles Ornstein, “Accreditors Can Keep Their Hospital Inspection Reports Secret, Feds Decide,” ProPublica, August 3, 2017, https://www.propublica.org/article/accreditors-can-keep-their-hospital-inspection-reports-secret-fedsdecide.
33David A. Hyman and Charles Silver, “The Poor State of Health Care Quality in the U.S.: Is Malpractice Liability Part of the Problem or Part of the Solution?,” Cornell Law Review 90, no. 4 (2005): 893.
34Ornstein, “Accreditors.”
35The figures and quotations in this paragraph are taken from Cheryl Clark, “Hospitals Profit on Bloodstream Infections,” HealthLeaders Media, May 23, 2013, http://healthleadersmedia.com/content.cfm?topic=QUA&content_id=292493. The citation for the study is Eugene Hsu, Della Lin, Samuel J. Evans, et al., “Doing Well by Doing Good: Assessing the Cost Savings of an Intervention to Reduce Central Line-Associated Bloodstream Infections in a Hawaii Hospital,” American Journal of Medical Quality: The Official Journal of the American College of Medical Quality 29, no. 1 (2014): 13–19, doi:10.1177/1062860613486173.
36Hsu et al., “Doing Well by Doing Good.”
37Ibid.
38Sunil Eappen, Bennett H. Lane, Barry Rosenberg, et al., “Relationship between Occurrence of Surgical Complications and Hospital Finances,” JAMA 309, no. 15 (2013): 1599–606, doi:10.1001/jama.2013.2773. The surgeries included in the study were craniotomy, colorectal resection, total or partial hip replacement, knee arthroplasty, coronary artery bypass graft, spinal surgery (laminectomy, excision of intervertebral disk, or spinal fusion), hysterectomy (abdominal or vaginal), appendectomy, and cholecystectomy or common bile duct exploration.
39Dan C. Krupka, Warren S. Sandberg, and William B. Weeks, “The Impact on Hospitals of Reducing Surgical Complications Suggests Many Will Need Shared Savings Programs with Payers,” Health Affairs 31, no. 11 (November 2012): 2571–578, doi:10.1377/hlthaff.2011.0605.
40Thomas C. Tsai, Felix Greaves, Jie Zheng, et al., “Better Patient Care at High-Quality Hospitals May Save Medicare Money and Bolster Episode-Based Payment Models,” Health Affairs 35, no. 9 (2016): 1681–89, doi:10.1377/hlthaff.2016.0361.
41Sheila Leatherman, Donald Berwick, Debra Iles, et al., “The Business Case for Quality: Case Studies and an Analysis,” Health Affairs 22, no. 2 (2003): 17–30, doi:10.1377/hlthaff.22.2.17. In the mid-2000s, the Commonwealth Fund published a series of studies emphasizing the lack of a business case for quality in the health care sector. They can be found at http://www.commonwealthfund.org/Search.aspx?searchtype=Publications&search=Business+Case+&filefilter=1.
42David A. Asch, Mark V. Pauly, and Ralph W. Muller, “Asymmetric Thinking about Return on Investment,” New England Journal of Medicine 374, no. 7 (2016): 606–08.
43L. Silvia Munoz-Price, Kristopher Arheart, Patrice Nordmann, et al., “Eighteen Years of Experience with Acinetobacter Baumannii in a Tertiary Care Hospital,” Critical Care Medicine 41, no. 12 (2013): 2733–42.
44L. Silvia Munoz-Price, Philip Carling, Timothy Cleary, et al., “Control of a Two-Decade Endemic Situation with Carbapenem-Resistant Acinetobacter Baumannii: Electronic Dissemination of a Bundle of Interventions,” American Journal of Infection Control 42, no. 5 (2014): 466–71, doi:10.1016/j.ajic.2013.12.024.
45Alexandra Wilson Pecci, “Nurses’ Unlikely Infection Control Tool Quashes HAI,” HealthLeaders Media, May 13, 2014, http://www.healthleadersmedia.com/nurse-leaders/nurses-unlikely-infection-control-tool-quashes-hai?page=0%2C1#.
46Ibid.
47Ibid.
48See Rene Letourneau, “9 in 10 Health Plans Still Tied to FFS Model,” Health-Leaders Media, March 27, 2013, http://www.healthleadersmedia.com/content/HEP-290546/9-in-10-Health-Plans-Still-Tied-to-FFS-Model.
49David A. Hyman and Charles Silver, “Healthcare Quality, Patient Safety, and the Culture of Medicine: ‘Denial Ain’t Just a River in Egypt,” New England Law Review 46, no. 3 (2012).
50J. K. Wall, “The Low Hanging Fruit Is Lying on the Ground,” Health Advice and More (blog), July 29, 2015, https://healthadviceandmore.wordpress.com/2015/07/29/the-low-hanging-fruit-is-lying-on-the-ground/ (quoting Indiana University management professor Mohan Tatikonda).
51Steve Cohen, “Can Obamacare Improve Patient Safety? Tort Reform Hasn’t,” Forbes, October 26, 2013, http://www.forbes.com/sites/stevecohen/2013/10/26/can-obamacare-improve-patient-safety-tort-reform-hasnt/. We chronicled the history of the improvement of anesthesia safety in Hyman and Silver, “Poor State of Health Care Quality.”
52David A. Hyman and Charles Silver, “Healthcare Quality, Patient Safety, and the Culture of Medicine: ‘Denial Ain’t Just a River in Egypt,’” New England Law Review 46, no. 3 (2012).
53Jeffrey B. Cooper, “Getting into Patient Safety: A Personal Story,” Agency for Healthcare Research and Quality, August 2006, http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=29.
54Bob Wachter, “Bureaucracy Run Amok: Can Checklists Kill?,” The Hospital Leader, January 11, 2008, http://thehospitalleader.org/bureaucracy-run-amokcan-checklists-kill/.
55Gawande, “A Lifesaving Checklist.”
56Gawande, “The Checklist.”
57Ibid.
58Ibid.
59Grace M. Lee, Christine W. Hartmann, Denise Graham, et al., “Perceived Impact of the Medicare Policy to Adjust Payment for Health-Care Associated Infections,” American Journal of Infection Control 40, no. 4 (2012). See also Catharine Paddock, “Medicare Will Not Pay for Hospital Mistakes and Infections, New Rule,” Medical News Today, August 20,2007, http://www.medicalnewstoday.com/articles/80074.php; and Vanessa Fuhrmans, “Insurers Stop Paying for Care Linked to Errors,” Wall Street Journal, January 15, 2008, http://online.wsj.com/news/articles/SB120035439914089727.
Whether the new Medicare policy has reduced the rate at which infections occur is being debated. Compare Grace M. Lee, Ken Kleinman, Stephen B. Soumerai, et al., “Effect of Nonpayment for Preventable Infections in U.S. Hospitals,” New England Journal of Medicine 367, no. 15 (2012): 1428–37, doi:10.1056/NEJMsa1202419, with Caroline P. Thirukumaran, Laurent G. Glance, Helena Temkin-Greener, et al., “Impact of Medicare’s Nonpayment Program on Hospital-Acquired Conditions,” Medical Care 55, no. 5 (2017): 447–55, doi:10.1097/MLR.0000000000000680.
1Johnny Fontane, “The Godfather Wiki,” http://godfather.wikia.com/wiki/Johnny_Fontane.
2Akanksha Jayanthi, “More than $31B Distributed in MU Payments to Date,” Becker’s Health IT & CIO Review, August 28, 2015, http://www.beckershospitalreview.com/healthcare-information-technology/more-than-31b-distributed-inmu-payments-to-date.html; Chun-Ju Saiao, Ashish K. Jha, Jennifer King, et al., “Office-Based Physicians Are Responding to Incentives and Assistance by Adopting and Using Electronic Health Records,” Health Affairs 32, no. 8 (2013): 1470–77, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2013.0323; Marsha R. Gold, Catherine G. McLaughlin, Kelly J. Devers, et al., “Obtaining Providers’ ‘Buy-In’ and Establishing Effective Means of Information Exchange Will Be Critical to HITECH’s Success,” Health Affairs 31, no. 3 (2012): 3514–26, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2011.0753; Mitch Wagner, “U.S. Allocates $1.2 Billion for Electronic Medical Records,” InformationWeek HealthCare, August 21, 2009, http://www.informationweek.com/healthcare/electronichealth-records/us-allocates-$12-billion-for-electronic-medical-records/d/did/1082464?; Jeff Overly, “E-Records to Draw Health Fraud Scrutiny after OIG Report,” Law360.com, January 8, 2014, http://0-www.law360.com.tallons.law.utexas.edu/articles/499522/e-records-to-draw-health-fraud-scrutiny-afteroig-report.
3Stephen T. Mennemeyer, Nir Menachemi, Saurabh Rahurkar, and Eric W. Ford, “Impact of the HITECH Act on Physicians’ Adoption of Electronic Health Records,” Journal of the American Medical Informatics Association 23, no. 2 (2015): 375–79, https://doi.org/10.1093/jamia/ocv103.
4Cheryl Clark, “It’s Impossible to Know What $1B in Federal Quality Spending Buys,” HealthLeaders Media, February 20, 2014, http://www.healthleadersmedia.com/quality/its-impossible-know-what-1b-federal-quality-spending-buys.
5Ibid.
6Institute of Medicine, “Report Brief, Crossing the Quality Chasm: A New Health System for the 21st Century,” National Academy of Sciences, March 2001, https://iom.nationalacademies.org/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.
7Dylan Tweney, “Infoporn: How Flatscreen TVs Get Cheaper,” Wired, April 26, 2011, http://www.wired.com/magazine/2011/04/st_infoporn_lcds/.
8Jeffrey A. Hart, “Flat Panel Displays,” in Innovation in Global Industries: U.S. Firms Competing in a New World (Collected Studies), ed. Jeffrey T. Macher and David C. Mowery (Washington: The National Academies Press, 2008), http://pubs.acs.org/cen/coverstory/83/8326electronics.html.
9“Adopting Technological Innovation in Hospitals: Who Pays and Who Benefits?,” American Hospital Association, October 2006, http://www.aha.org/content/00-10/061031-adoptinghit.pdf.
10David Goldhill, Catastrophic Care: How American Health Care Killed My Father—and How We Can Fix It (New York: Alfred A. Knopf, 2013), p. 85.
11David Dranove, “Unleashing Innovation in Healthcare Markets,” Code Red (blog), January 14, 2013, http://dranove.wordpress.com/2013/01/14/unleashinginnovation-in-healthcare-markets/.
12Barak D. Richman, Krishna Udayakumar, Will Mitchell, and Kevin A. Schulman, “Lessons from India in Organizational Innovation: A Tale of Two Heart Hospitals,” Health Affairs 27, no. 5 (2008): 1260–70, https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.5.1260.
13Goldhill, Catastrophic Care, p. 85.
14Judith H. Hibbard, Jessica Greene, Shoshanna Sofaer, et al., “An Experiment Shows That a Well-Designed Report on Costs and Quality Can Help Consumers Choose High-Value Health Care,” Health Affairs 31, no. 3, (2012): 560–68, https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2011.1168.
15Ha T. Tu and Johanna Lauer, “Word of Mouth and Physician Referrals Still Drive Health Care Provider Choice,” HSC Research Brief no. 9, Center for Studying Health System Change, December 2008, http://www.hschange.com/CONTENT/1028/.
16New York State Department of Health, “Adult Cardiac Surgery in New York State,” https://www.health.ny.gov/statistics/diseases/cardiovascular.
17Dana B. Mukamel, David L. Weimer, Jack Zwanziger, et al., “Quality Report Cards, Selection of Cardiac Surgeons, and Racial Disparities: A Study of the Publication of the New York State Cardiac Surgery Reports,” Inquiry 41, no. 4, (2004/2005): 435–46.
18Eric C. Schneider and Arnold M. Epstein, “Influence of Cardiac-Surgery Performance Reports on Referral Practices and Access to Care. A Survey of Cardiovascular Specialists,” New England Journal of Medicine 335, no. 4, (1996): 251–56; E. L. Hannan, Cathy C. Stone, Theodore L. Biddle, and Barbara A. DeBuono, “Public Release of Cardiac Surgery Outcomes Data in New York: What Do New York State Cardiologists Think of It?,” American Heart Journal 134, no. 6 (1997): 1120–28, http://www.sciencedirect.com/science/article/pii/S0002870397700346.
19Ashish K. Jha and Arnold M. Epstein, “The Predictive Accuracy of the New York State Coronary Artery Bypass Surgery Report-Card System,” Health Affairs 25, no. 3 (2006): 844–55, doi:10.1377/hlthaff.25.3.844.
20David L. Brown, Arnold M. Epstein, and Eric C. Schneider, “Influence of Cardiac Surgeon Report Cards on Patient Referral by Cardiologists in New York State after 20 Years of Public Reporting,” Circulation: Cardiovascular Quality and Outcomes 6, no. 6 (2013): 643–48.
21Laurence F. McMahon, “What to Do When It’s You: Bill Clinton and Hospital Report Cards,” American Journal of Managed Care 10, no.10 (2004):664, http://www.ajmc.com/journals/issue/2004/2004-10-vol10-n10/oct04-1900p664#sthash.na3O5bRD.dpuf.
22Xerox, Variation in Payment for Hospital Care in Rhode Island, prepared for the Rhode Island Office of the Health Insurance Commissioner and the Rhode Island Executive Office of Health and Human Services, December 19, 2012, http://www.ohic.ri.gov/documents/Hospital-Payment-Study-Final-GeneralDec-2012.pdf.
23Massachusetts Office of Attorney General, “Examination of Health Care Cost Trends and Cost Drivers,” June 22, 2011, http://www.mass.gov/ago/docs/healthcare/2011-hcctd.pdf; Massachusetts Division of Health Care Finance and Policy, “Massachusetts Health Care Cost Trends: Price Variation in Health Care Services,” June 3, 2011, http://archives.lib.state.ma.us/bitstream/handle/2452/113870/ocn753988593-main_report.pdf?sequence=1&isAllowed=y. See also Freedman Health Care, “Re-examining the Health Care Cost Drivers and Trends in the Commonwealth: A Review of State Reports(2008–2015),” February2016, http://www.mahp.com/assets/pdfs/MAHP-freedman-report.pdf.
24Massachusetts Health Policy Commission, “Provider Price Variation: Stakeholder Discussion Series Summary Report,” July 2016, http://www.mass.gov/anf/budget-taxes-and-procurement/oversight-agencies/health-policy-commission/publications/2016-ppv-summary-report.pdf.
25Massachusetts Division of Health Care Finance and Policy, “Massachusetts Health Care Cost Trends: Price Variation in Health Care Services,” June 3, 2011, http://archives.lib.state.ma.us/bitstream/handle/2452/113870/ocn753988593main_report.pdf?sequence=1&isAllowed=y.
26Chapin White, James D. Reschovsky, and Amelia M. Bond, “Understanding Differences between High- and Low-Price Hospitals: Implications for Efforts to Rein in Costs,” Health Affairs 33, no. 2 (2014): 324–31.
27Massachusetts Health Policy Commission, “Provider Price Variation,” p. 1; David Seltz, David Auerbach, Kate Mills, Marian Wrobel, and Aaron Pervin, “Addressing Price Variation in Massachusetts,” Health Affairs Blog, May 12, 2016, http://healthaffairs.org/blog/2016/05/12/addressing-price-variation-inmassachusetts/.
28Dave Barkholz, “Data Suggest New York Hospital Prices Depend on Leverage, not Quality,” Modern Healthcare, December 19, 2016, http://www.modernhealthcare.com/article/20161219/NEWS/161219910?template=print.
29Ibid. See also Gorman Actuarial, “Why Are Hospital Prices Different? An Examination of New York Hospital Reimbursement,” New York State Health Foundation, December 2016, http://nyshealthfoundation.org/resources-and-reports/resource/an-examination-of-new-york-hospital-reimbursement.
30Maggie Mahar, “‘The Third Rail of Payment Reform’—Tackling Wide Variations in How Much Providers Charge,” HealthBeat (blog), September 29, 2012, http://www.healthbeatblog.com/2012/09/the-third-rail-of-payment-reformtackling-wide-variations-in-how-much-providers-charge/#sthash.kr6aMA5R.pdf.
31Joseph Neff, Ames Alexander, and Karen Garloch, “Prognosis Profits: North Carolina’s Urban Hospitals Pile Up the Cash,” News Observer, April 22, 2012, http://www.newsobserver.com/news/special-reports/prognosis-profits/article16924640.html.
32Mahar, “The Third Rail of Payment Reform” (quoting Anna Mathews, “Same Doctor Visit, Double the Cost,” Wall Street Journal, August 26, 2012).
1Sean P. Keehan, Devin A. Stone, John A. Poisal, et al., “National Health Expenditure Projections, 2016–25: Price Increases, Aging Push Sector to 20 Percent of Economy,” Health Affairs 36, no.3 (2017): 553–63.
1The Pew Charitable Trusts, “Household Expenditures and Income,” March 30, 2016, http://www.pewtrusts.org/en/research-and-analysis/issuebriefs/2016/03/household-expenditures-and-income. See also U.S. Department of Labor, Bureau of Labor Statistics, Consumer Expenditures—2012, September 10, 2013, http://www.bls.gov/news.release/cesan.nr0.htm.
2Dan Munro, “Top Ten Healthcare Quotes for 2012,” Forbes.com, December 23, 2012, http://www.forbes.com/sites/danmunro/2012/12/23/top-ten-healthcare-quotes-for-2012-2/.
3Ibid.
4The Henry J. Kaiser Family Foundation, 2014 Employer Health Benefits Survey, September 10, 2014, http://kff.org/report-section/ehbs-2014-summary-of-findings/.
5Kevin F. Hallock, “The Relationship between Company Size and CEO Pay,” WorkSpan, February 2011, https://author.ilr.cornell.edu/ICS/InsightsAndConvenings/upload/02-11-Research-for-the-real-world.pdf; Kevin F. Hallock and Linda Barrington, “A Look at CEO Pay,” The GailFosler Group, December 9, 2010, http://www.gailfosler.com/a-look-at-ceo-pay.
6Nicholas D. Kristof, “The Wrong Side of History,” New York Times, November 18, 2009, http://www.nytimes.com/2009/11/19/opinion/19kristof.html?_r=0.
7David A. Hyman, Medicare Meets Mephistopheles (Washington: Cato Institute, 2006).
8Martin S. Feldstein, “The Rising Price of Physicians’ Services,” Review of Economics and Statistics 52, no. 2, (1970): 121–33, http://www.jstor.org/stable/1926113?seq=1#page_scan_tab_contents.
9Michael A. Morrisey, Health Insurance (Chicago: Health Administration Press, 2008).
10Feldstein, “The Rising Price of Physicians’ Services.”
11Martin S. Feldstein, The Rising Cost of Hospital Care, National Center for Health Services Research and Development (Washington: Information Resources Press, 1971). See also Martin Feldstein and Bernard Friedman, “Tax Subsidies, the Rational Demand for Insurance, and the Health Care Crisis,” Journal of Public Economics 7, no. 2 (1977): 155–78.
12Ibid.
13Amy N. Finkelstein, “The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare,” Quarterly Journal of Economics 122, no. 1 (2007): 1–37.
14Blue Cross Blue Shield, “Report Finds Significant Cost Variations in Knee and Hip Replacement Procedures across the U.S.,” https://www.bcbs.com/learn/bcbs-blog/report-finds-significant-cost-variations-knee-and-hip-replacementprocedures-across.
15“Australian Medical Association Criticises Proposal for Up-Front General Practitioner Fee,” ABCNews Australia, December 29, 2013, http://www.abc.net.au/news/2013-12-29/ama-criticises-proposals-for-new-gp-fee/5177522.
16For a survey of the studies that presents a decidedly more optimistic assessment of the connection between insurance and health than we do, see Benjamin D. Sommers, Atul A. Gawande, and Katherine Baicker, “Health Insurance Coverage and Health—What the Recent Evidence Tells Us,” New England Journal of Medicine 377 (August 10, 2017): 586–93, http://www.nejm.org/doi/full/10.1056/NEJMsb1706645#t=article.
17Katherine Baicker, Sarah L. Taubman, Heidi L. Allen, et al., “The Oregon Experiment—Effects of Medicaid on Clinical Outcomes,” New England Journal of Medicine 368, no. 18 (2013): 1713–22, http://www.nejm.org/doi/full/10.1056/NEJMsa1212321#t=article. An article appeared the year before in an economics journal: Amy N. Finkelstein, Sarah Taubman, Bill Wright, et al., “The Oregon Health Insurance Experiment: Evidence from the First Year,” Quarterly Journal of Economics 127, no. 3 (2012): 1057–106, https://academic.oup.com/qje/article-abstract/127/3/1057/1923446?redirectedFrom=PDF.
18Sarah L. Taubman, Heidi L. Allen, Bill J. Wright, et al., “Medicaid Increases Emergency-Department Use: Evidence from Oregon’s Health Insurance Experiment Science,” Science 343, no. 6168 (2014): 263–68, http://science.sciencemag.org/content/343/6168/263.
19Amy N. Finkelstein, Sarah L. Taubman, Heidi L. Allen, et al., “Effect of Medicaid Coverage on ED Use—Further Evidence from Oregon’s Experiment,” New England Journal of Medicine 375, no. 16 (2016): 1505–07, doi:10.1056/NEJMp1609533.
20Frank R. Lichtenberg, “The Effects of Medicare on Health Care Utilization and Outcomes,” in Frontiers in Health Policy Research, vol. 5, ed. Alan M. Garber (Cambridge: MIT Press, 2002), pp. 27–52, http://www.nber.org/chapters/c9857.pdf.
21Martin S. Feldstein, “The Welfare Loss of Excess Health Insurance,” Journal of Political Economy 81, no. 2 (1973): 251–80.
22U.S. Department of Commerce, U.S. Census Bureau, “Table HIB-1. Health Insurance Coverage Status and Type of Coverage by Sex, Race and Hispanic Origin: 1999 to 2012,” http://www.census.gov/data/tables/time-series/demo/health-insurance/historical-series/hib.html.
23U.S. Department of Commerce, U.S. Census Bureau, “Current Population Survey, 1988 to 2013 Annual Social and Economic Supplements,” https://www.census.gov/prod/techdoc/cps/cpsmar13.pdf.
24Ibid.
25Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census, “National Health Expenditures; Aggregate and Per Capita Amounts, Annual Percent Change and Percent Distribution: Selected Calendar Years 1960-2011,” 2011.
26Alexander J. Ryu, Teresa B. Gibson, M. Richard McKellar, and Michael E. Chernew, “The Slowdown in Health Care Spending in 2009–11 Reflected Factors Other than the Weak Economy and Thus May Persist,” Health Affairs 32, no.5 (2013): 835–40.
27Jeff Overley, “ACA Sign-Ups Hit 8M in Win for Health Care Industry,” Law360.com, April 22, 2014, http://www.law360.com/articles/528830/aca-sign-ups-hit-8m-in-win-for-health-care-industry.
28Robert Pear, “Health Insurance Companies Seek Big Rate Increases for 2016,” New York Times, July 3, 2015, http://www.nytimes.com/2015/07/04/us/health-insurance-companies-seek-big-rate-increases-for-2016.html?emc=edit_th_20150704&nl=todaysheadlines&nlid=15782921.
29Brian Blase, “Medicaid Not Big Enough? Obama Administration Proposes $100 Billion More Spending,” Forbes.com, April 4, 2016, http://www.forbes.com/sites/theapothecary/2016/04/04/medicaid-not-big-enough-obama-administrationproposes-100-billion-more-spending/#3046fc741e0f.
30Caroline Humer and Rodrigo Campos, “Trump Says Pharma ‘Getting Away with Murder,’ Stocks Slide,” Reuters, January 22, 2017, https://www.reuters.com/article/us-usa-trump-drugpricing/trump-says-pharma-getting-away-with-murder-stocks-slide-idUSKBN14V24J.
31David Besanko, David Dranove, and Craig Garthwaite, “Insurance and the High Prices of Pharmaceuticals,” NBER Working Paper no. 22353, National Bureau of Economic Research, June 2016.
32Ibid., p. 31.
33Wayne Winegarden, “The Economic Costs of Pharmacy Benefit Managers: A Review of the Literature,” Pacific Reasearch Institute, 2017, http://www.pacificresearch.org/wp-content/uploads/2017/06/PBM_Lit_Final.pdf.
34Julie Appleby, “Filling a Prescription? You Might Be Better off Paying Cash,” CNN, June 23, 2016, http://www.cnn.com/2016/06/23/health/prescriptiondrug-prices-pbm/index.html.
1American Medical Association, “AMA Urges Members of Congress to Oppose AHCA,” March 22, 2017, https://www.ama-assn.org/ama-urges-members-congress-oppose-ahca; Sy Mukherjee, “These 3 Powerful Groups Are Slamming the GOP’s Obamacare Replacement Plan,” Fortune, March 8, 2017, http://fortune.com/2017/03/08/gop-healthcare-plan-aarp-ama-aha/; American Academy of Pediatrics, “AAP Statement Opposing House Passage of American Health Care Act,” May 4, 2017, https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AHCAHousePassage.aspx; Mary Norine Walsh, “Cardiology Societies React to AHCA Bill,” Cardiology Today, May 4, 2017, https://www.healio.com/cardiology/practice-management/news/online/%7Ba1296b1a-ba49-4b6e-9f00-5eb33f06691a%7D/cardiology-societies-react-to-ahca-bill; American Nurses Association, “American Nurses Association Strongly Opposes New Health Care Reform Bill,” March 8, 2017, http://www.nursingworld.org/FunctionalMenuCategories/MediaResources/PressReleases/ANA-Strongly-Opposes-New-Health-Care-Reform-Bill.html.
2A typical mainstream critique appears in Matthew Fiedler, Henry J. Aaron, Loren Adler, and Paul B. Ginsburg, “Moving in the Wrong Direction—Health Care under the AHCA,” New England Journal of Medicine 376 (2017): 2405–07, doi:10.1056/NEJMp1706848.
3Michael F. Cannon, “The House GOP Leadership’s Health Care Bill Is ObamaCare-Lite—Or Worse,” Cato At Liberty (blog), March 7, 2017, https://www.cato.org/blog/house-gop-leaderships-health-care-bill-obamacare-lite-orworse.
4Ashley Kirzinger, Bryan Wu, and Mollyann Brodie, “Kaiser Health Tracking Poll: Health Care Priorities for 2017,” Kaiser Family Foundation, January 6, 2017, http://www.kff.org/health-costs/poll-finding/kaiser-health-tracking-pollhealth-care-priorities-for-2017/.
5“Tax Expenditures,” in “Some Background,” chap. 2 in Tax Policy Center’s Briefing Book, http://www.taxpolicycenter.org/briefing-book/what-are-largest-taxexpenditures. See also U.S. Department of Treasury, Tax Expenditures (FY2016), https://www.treasury.gov/resource-center/tax-policy/Documents/TaxExpenditures-FY2016.pdf; Committee for a Responsible Federal Budget, “The Tax Break-Down: Cafeteria Plans and Flexible Spending Accounts,” September 12, 2013, http://crfb.org/blogs/tax-break-down-cafeteria-plans-and-flexible-spendingaccounts.
6Bruce Bartlett, “Taxing Medicare Benefits,” New York Times, September17,2013, http://economix.blogs.nytimes.com/2013/09/17/taxing-medicare-benefits/?_r=0.
7Ibid. See also Bad Breaks All Around: The Report of The Century Foundation Working Group on Tax Expenditures (New York: The Century Foundation Press, 2002), https://s3-us-west-2.amazonaws.com/production.tcf.org/app/uploads/2002/09/01153641/20020901-bad-breaks-all-around-8.pdf.
8Martin Feldstein and Bernard Friedman, “Tax Subsidies, the Rational Demand for Insurance, and the Health Care Crisis,” Journal of Public Economics 7, no. 2 (1977): 155–78.
9Cannon, “ObamaCare-Lite—Or Worse.”
10Eric Bradner, “Democrats’ Medicare-for-All Litmus Test,” CNN.com, April 3, 2017, http://www.cnn.com/2017/04/03/politics/medicare-for-alldemocrats-bernie-sanders/index.html; Alexander Burns and Jennifer Medina, “The Single-Payer Party? Democrats Shift Left on Health Care,” New York Times, June 3, 2017, https://www.nytimes.com/2017/06/03/us/democratsuniversal-health-care-single-payer-party.html?emc=edit_th_20170604&nl=todaysheadlines&nlid=15782921&_r=0.
11Kristen Bialik, “More Americans Say Government Should Ensure Health Care Coverage,” Pew Research Center, January 3, 2017, http://www.pewresearch.org/fact-tank/2017/01/13/more-americans-say-government-should-ensure-health-care-coverage/.
12Joseph Wood, “Insurance Is Not the Problem. It’s Also Not the Solution,” The Health Care Blog, March 16, 2017, http://thehealthcareblog.com/blog/2017/03/16/theyllnevercare-insurance-is-not-the-problem-its-also-notthe-solution/.
13Bernie Sanders, “Medicare-for-All: Leaving No One Behind,” BernieSanders.com, https://berniesanders.com/issues/medicare-for-all/.
14Elisabeth Rosenthal, “As Hospital Prices Soar, a Stitch Tops $500,” New York Times, December 2, 2013, sec. Health, http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html.
15Diane Archer, “Medicare Is More Efficient Than Private Insurance,” Health Affairs Blog, September 20, 2011, http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/.
16“Total Number of Medicare Beneficiaries,” Kaiser Family Foundation, https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
17Robert A. Book, “Medicare Administrative Costs Are Higher, Not Lower, Than for Private Insurance,” The Heritage Foundation, June 25, 2009, http://www.heritage.org/health-care-reform/report/medicare-administrative-costs-are-higher-not-lower-private-insurance.
18Ibid.
19Robert Book, “Medicare-For-All Would Increase, Not Save, Administrative Costs,” Forbes, September 20,2017, https://www.forbes.com/sites/theapothecary/2017/09/20/medicare-for-all-would-increase-not-save-administrative-costs/#2f73830f60ba.
20Ibid.
21Sanders, “Medicare-for-All.”
22Ibid.
23Martin S. Feldstein, “Why Is Growth Better in the United States Than in Other Industrial Countries,” NBER Working Paper no. 23221, National Bureau of Economic Research, March 2017, http://www.nber.org/papers/w23221.
24David Squires and Chloe Anderson, “U.S. Health Care from a Global Perspective: Spending, Use of Services, Prices, and Health in 13 Countries,” Commonwealth Fund, October 2015, http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2015/oct/1819_squires_us_hlt_care_global_perspective_oecd_intl_brief_v3.pdf.
25Sanders, “Medicare-for-All.”
26Centers for Medicare and Medicaid Services, National Health Expenditure Data, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trendsand-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html.
27Jonathan Chait, “Obama’s Agenda and the Deficit,” New Republic, July 18, 2010, https://newrepublic.com/article/76344/the-future-the-obamaagenda.
28Ezra Klein, “Cost Control and the ACA,” Washington Post, July 19, 2010, http://voices.washingtonpost.com/ezra-klein/2010/07/cost_control_and_the_aca.html.
29John Holahan, Lisa Clemans-Cope, Matthew Buettgens, et al., “The Sanders Single-Payer Health Care Plan: The Effect on National Health Expenditures and Federal and Private Spending,” The Urban Institute, May 2016, http://www.urban.org/sites/default/files/publication/80486/200785-The-Sanders-Single-Payer-Health-Care-Plan.pdf.
30Michael Tanner, “Embracing the Hard Realities of Health-Care Reform,” National Review, June 7, 2017, http://www.nationalreview.com/article/448350/health-care-reform-reality-check-single-payer-model-economically-ruinous.
31Holahan et al., “The Sanders Single-Payer Health Care Plan.”
32Chris Conover, “Why Bernie Sanders’ Health Plan Will Cost at Least 40% More Than Advertised,” Forbes.com, January 20, 2016, https://www.forbes.com/sites/theapothecary/2016/01/20/why-bernie-sanders-health-plan-will-cost-atleast-40-more-than-advertised/#33c90ba14426.
33Alan Cole and Scott Greenberg, “Details and Analysis of Senator Bernie Sanders’s Tax Plan,” The Tax Foundation, January 28, 2016, https://taxfoundation.org/details-and-analysis-senator-bernie-sanders-s-tax-plan/.
34Danielle Kurtzleben, “Study: Sanders’ Proposals Would Add $18 Trillion to Debt over 10 Years,” NPR.org, May 9, 2016, http://www.npr.org/2016/05/09/477402982/study-sanders-proposals-would-add-18-trillion-to-debt-over-10-years.
1Barbara Hijek, “Meet Dr. Stein, the Big Daddy of Vasectomies,” Sun Sentinel, June 6, 2009, http://www.sun-sentinel.com/sfl-mtblog-2009-06-meet_the_big_daddy_of_vasectom_1-story.html; VasWeb, “Vasectomy & Reversal Centers of Florida,” http://www.vasweb.com.
2Heather Sullivan, “Vasectomy Madness: Procedures Rise during March Madness,” NBC12, March 12, 2012, http://www.nbc12.com/story/17138054/vasectomy-madness-procedures-rise-during-march-madness.
3Lindley Estates, “Va. Doctor Running Vasectomy Special Ahead of March Madness,” Free Lance-Star, March 16, 2016, http://www.richmond.com/news/virginia/va-doctor-running-vasectomy-special-ahead-of-march-madness/article_fe711d0b-f39c-5553-8e01-15947bddcbad.html.
4VasWeb, “Fees,” http://www.vasweb.com/vasectomy.html#Fees.
5David A. Hyman and Charles Silver, “Just What the Patient Ordered: The Case for Result-Based Compensation Arrangements,” Journal of Law, Medicine & Ethics 29, no. 2 (2001): 170–73.
6Missbutterbean, “2017 Cost of Flu Shots: CVS, Walgreens, Rite Aid, Walmart, Costco, Sam’s Club, & More,” January 13, 2017, http://www.missbutterbean.com/2017-flu-shots/;G.E.Miller, “Where to Get Free or the Cheapest Flu Shots,” 20 Something Finance, January 1, 2015, http://20somethingfinance.com/whereto-get-cheap-or-free-flu-shots/.
7Ariba Medical Spa, “Services We Offer,” http://www.aribamedicalspa.com/#!services/c14e8.
8Lou Carlozo, “How Much Does a Vasectomy Cost? Part 1: From $300 to $3,500-Plus,” Clear Health Costs, December 21, 2012, https://clearhealthcosts.com/blog/2012/12/how-much-does-a-vasectomy-cost-from-300-to-3500-plus/.
9CG Cosmetic Surgery, “Miami Summer Sale on Breast Implants,” February 26, 2011, https://www.cgcosmetic.com/blog/2011/02/26/summer-sale-breast-implants/.
10Westlake Plastic Surgery, “Breast Augmentation Special,” https://westlakeplasticsurgery.com/breast-augmentation-special?lmc_track=5123776186.
11Liz Segre, “Lasik Eye Surgery Cost,” AllAboutVision.com, July 27, 2017, http://www.allaboutvision.com/visionsurgery/cost.htm; QualSight, “LASIK Cost—How Much Is LASIK,” https://www.qualsight.com/how-much-is-lasik; Anna Helhoski, “How Much Does Lasik Cost?,” NerdWallet.com, February 18, 2015, http://www.nerdwallet.com/blog/health/healthcare-price-transparency/how-much-does-lasik-cost/.
12Ha T. Tu and Jessica H. May, “Self-Pay Markets in Health Care: Consumer Nirvana or Caveat Emptor?,” Health Affairs 26, no. 2 (2007): w217–w226, doi:10.1377/hlthaff.26.2.w217.
13Devon Herrick, “The Market for Medical Care Should Work Like Cosmetic Surgery,” National Center for Policy Analysis, May 21, 2013, http://www.ncpa.org/pub/st349.
14To his credit, Ezekiel Emanuel makes testable predictions about the impact of the ACA, one of which is that the prices commercial insurers pay for CT scans and MRIs “should decline by 25% to 50% by 2020.” Ezekiel Emanuel, Reinventing American Health Care (New York: PublicAffairs, 2014), p. 301.
15Devon Herrick, “Why Can’t the Market for Medical Care Work Like Cosmetic Surgery?” National Center for Policy Analysis, June 17, 2013, http://healthblog.ncpa.org/why-cant-the-market-for-medical-care-work-like-cosmetic-surgery/.
16Devon M. Herrick, “The Market for Medical Care Should Work Like Cosmetic Surgery,” National Center for Policy Analysis, Policy Report no. 349, May 2013, http://www.ncpa.org/pdfs/st349.pdf.
17Iva Roze Skoch, “Why Is IVF So Expensive in the United States?,” Newsweek, July 21, 2010, http://www.newsweek.com/why-ivf-so-expensive-united-states-74385.
18“Missouri, Women Under 35; Best IVF Clinics in Missouri for Women Under 35 Using Fresh Embryos,” FertilitySuccessRates.com, https://fertilitysuccessrates.com/report/Missouri/women-under-35/data.html.
19“Treatment Costs: MCRM Dispels the Myths of IVF Costs,” MCRM Fertility, http://www.mcrmfertility.com/new-patients/treatment-costs.aspx (visited December 7, 2016).
20“Cost Comparison: National Cycle Costs vs. WINFertility’s Treatment Bundle,” WINFertility, http://www.winfertility.com/how-we-are-different/ivfcost-comparison/.
21Marshall Allen, “A Hospital Charged $1,877 to Pierce a 5-Year-Old’s Ears. This Is Why Health Care Costs So Much,” ProPublica, November 28, 2017, https://www.propublica.org/article/a-hospital-charged-to-pierce-ears-why-health-carecosts-so-much?utm_campaign=KHN%3A%20First%20Edition&%E2%80%A6.
22Sarah Kliff, “A Woman Had a Baby. Then Her Hospital Charged Her $39.95 to Hold It,” Vox, October 4, 2016, https://www.vox.com/2016/10/4/13160624/medical-bills-birth-delivery.
23Dylan Stableford, “Snakebite Victim Charged $89,000 for 18-Hour Hospital Stay,” Yahoo News, January 28, 2014, http://news.yahoo.com/snakebite-89000-162515519.html.
24Elisabeth Rosenthal, “As Hospital Prices Soar, a Stitch Tops $500,” New York Times, December 2, 2013, sec. Health, http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html.
25Steven Brill and Brady McCombs, “Bitter Pill: Why Medical Bills Are Killing Us,” Time, April 4, 2013, http://time.com/198/bitter-pill-why-medicalbills-are-killing-us/.
26Nina Bernstein, “How to Charge $546 for Six Liters of Saltwater,” New York Times, August 25, 2013, http://www.nytimes.com/2013/08/27/health/exploringsalines-secret-costs.html.
27Jim Landers, “DMN Reporter Got His Knees Replaced—but Was the Stiff Price a Good Deal?,” Dallas Morning News, July 16, 2015, https://www.dallasnews.com/business/health-care/2015/07/16/dmn-reporter-got-his-knees-replaced—but-was-the-stiff-price-a-good-deal.
28Ge Bai and Gerard F. Anderson, “Extreme Markup: The Fifty US Hospitals with the Highest Charge-to-Cost Ratios,” Health Affairs 34, no. 6 (2015): 922–28, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2014.1414.
29Brill and McCombs, “Bitter Pill.”
30ScriptSave WellRx, “Compare Pharmacy Prescription Drug Prices,” https://www.wellrx.com/prescriptions.
31Tricia Romano, “The Hunt for an Affordable Hearing Aid,” New York Times, October 22, 2013, http://well.blogs.nytimes.com/2012/10/22/the-hunt-for-anaffordable-hearing-aid/.
32Andis Robeznieks, “Retailers Making Big Push into Healthcare,” Modern Healthcare, May 4, 2014, http://www.modernhealthcare.com/article/20130504/MAGAZINE/305049991.
33Susan Thurston, “More Adults Getting Flu Shots at Their Local Pharmacy or Retail Outlet,” Tampa Bay Times, October 13, 2012, http://www.tampabay.com/news/business/retail/more-adults-getting-flu-shots-at-their-local-pharmacy-or-retail-outlet/1256143.
34Ibid.
35Christopher Cheney, “Behind the CVS Health Rebranding Strategy,” HealthLeaders Media, September 8,2014, http://healthleadersmedia.com/page-1/led-308131/Behind-the-CVS-Health-Rebranding-Strategy##; Christopher Cheney, “CVS Ramps Up Retail Clinics with Provider Affiliations,” HealthLeaders Media, July 22, 2014, http://healthleadersmedia.com/content.cfm?content_id=306633&page=1&topic=QUA; Ayla Ellison, “CVS vs. Walgreens, Who Wins the Healthcare Collaboration Battle?,” Becker Hospital Review, August 28,2014, http://www.beckershospitalreview.com/hospital-transactions-and-valuation/cvs-vs-walgreens-who-wins-the-healthcare-collaborationbattle.html; Hiroko Tabuchi, “How CVS Quit Smoking and Grew into a Health Care Giant,” New York Times, July 11, 2015, http://www.nytimes.com/2015/07/12/business/how-cvs-quit-smoking-and-grew-into-a-health-care-giant.html?_r=0.
36John Commins, “CVS Health Posts Strong Retail, Omnicare Outlook,” HealthLeaders Media, February 10, 2016, http://www.healthleadersmedia.com/health-plans/cvs-health-posts-strong-retail-omnicare-outlook.
37“IBM Watson, CVS Deal: IBM and CVS Partner to Predict Patient Health,” HNGN.com, July 31, 2015, http://www.hngn.com/articles/114717/20150731/ibm-watson-cvs-deal-partners-predict-patient-health.htm.
38CVSHealth, “CVS Health and IBM Tap Watson to Develop Care Management Solutions for Chronic Disease,” July 30, 2015, https://cvshealth.com/newsroom/press-releases/cvs-health-and-ibm-tap-watson-develop-care-management-solutions-chronic-disease.
39Charles Duhigg, “How Companies Learn Your Secrets,” New York Times, February 15, 2012, http://www.nytimes.com/2012/02/19/magazine/shoppinghabits.html?pagewanted=1&_r=1&hp.
40Ibid.
41Sheryl Kraft, “How Health Care Will Look with a Physician Shortage,” Chicago Tribune, November 4, 2015, http://www.chicagotribune.com/lifestyles/health/scdoctorshortagehealth111120151105story.html.
42John Commins, “Doctors in Demand: New Physicians Flooded with Job Offers,” HealthLeaders Media, September 19,2017, http://www.healthleadersmedia.com/physician-leaders/doctors-demand-new-physicians-flooded-job-offers?spMailingID=11954869&spUserID=MTY3ODg4NjI3Mjk1S0&spJobID=1241608301&spReportId=MTI0MTYwODMwMQS2#.
43Jenny Gold, “In Cities, the Average Doctor Wait-Time Is 18.5 Days,” Washington Post, January 29, 2014, http://www.washingtonpost.com/news/wonkblog/wp/2014/01/29/in-cities-the-average-doctor-wait-time-is-18-5-days/.
44Ibid.
45“Retail Health Clinics: State Legislation and Laws,” National Conference of State Legislatures, November 2014, http://www.ncsl.org/research/health/retailhealth-clinics-state-legislation-and-laws.aspx.
46“AMA Calls for Investigation of Retail Health Clinics,” Medical News Today, June 26, 2007, http://www.medicalnewstoday.com/articles/75308.php.
47“AMA Lays Down Guidelines for Retail Clinics,” Managed Care Magazine Online, July 1,2006, accessed August 24, 2015, http://www.managedcaremag.com/archives/0607/0607.news_retailclinics.html. For a list of regulations enacted by state, see “Retail Clinics: State Legislation and Laws,” National Conference of State Legislatures, January 1, 2016.
48For an example, see Hilary Daniel and Shari Erickson for the Medical Practice and Quality Committee of the American College of Physicians, “Retail Health Clinics: Executive Summary of a Policy Position Paper from the American College of Physicians,” Annals of Internal Medicine 163, no. 11 (2015): 869–70. doi:10.7326/M15-0571.
49Lydia DePillis, “In a Fight between Nurses and Doctors, the Nurses Are Slowly Winning,” Washington Post, March 18, 2016, https://www.washingtonpost.com/news/wonk/wp/2016/03/18/in-a-fight-between-nurses-and-doctors-the-nurses-are-slowly-winning/?utm_term=.cec3fa8815fb.
50Ryan Basen, “AMA Does Not Want PA Autonomy,” MedPage Today, June 15, 2017, https://www.medpagetoday.com/meetingcoverage/ama/66039.
51Lara C. Pullen, “AMA Does Not Want Pharmacists to Prescribe Medication,” Medscape, June 22, 2012, http://www.medscape.com/viewarticle/766252.
52“Health Care on Aisle 7: The Growing Phenomenon of Retail Clinics,” RAND Health, no. RB-9491-1, 2010.
53Benjamin J. McMichael, “Occupational Licensing and Legal Liability: The Effect of Regulation and Litigation on Nurse Practitioners, Physician Assistants, and the Healthcare System,” PhD Disseration, Graduate School of Vanderbilt University, May 2015, https://law.vanderbilt.edu/phd/students/files/McMichael.pdf.
54Andis Robeznieks, “Retailers Making Big Push into Healthcare,” Modern Healthcare, May 4, 2014, http://www.modernhealthcare.com/article/20130504/MAGAZINE/305049991.
55Sarah Wickline Wallan, “ACP: Retail Clinics Need Scope of Practice Limits,” MedPage Today, October 15, 2015, https://www.medpagetoday.com/primarycare/generalprimarycare/54114; Catharine Paddock, “AMA Calls for Investigation of Retail Health Clinics,” Medical News Today, June 26, 2007, http://www.medicalnewstoday.com/articles/75308.php.
56James D. Woodburn, Kevin L. Smith, and Glen D. Nelson, “Quality of Care in the Retail Health Care Setting Using National Clinical Guidelines for Acute Pharyngitis,” American Journal of Medical Quality 22, no. 6 (2007): 457–62, doi:10.1177/1062860607309626.
57Richard Jacoby, Albert G. Crawford, Paresh Chaudhari, and Neil I. Goldfarb, “Quality of Care for 2 Common Pediatric Conditions Treated by Convenient Care Providers,” American Journal of Medical Quality 26, no. 1 (February 2011): 53–58, doi:10.1177/1062860610375106.
58Andrew Sussman, Lisette Dunham, Kristen Snower, et al., “Retail Clinic Utilization Associated with Lower Total Cost of Care,” American Journal of Managed Care 19, no. 4 (April 2013): e148–157, http://www.ajmc.com/journals/issue/2013/2013-1-vol19-n4/retail-clinic-utilization-associated-with-lowertotal-cost-of-care.
59Gardiner Harris, “When the Nurse Wants to Be Called ‘Doctor,’” New York Times, October 1, 2011, http://www.nytimes.com/2011/10/02/health/policy/02docs.html.
60Ateev Mehrotra, Hangsheng Liu, John L. Adams, et al., “Comparing Costs and Quality of Care at Retail Clinics with That of Other Medical Settings for 3 Common Illnesses,” Annals of Internal Medicine 151, no. 5 (September 1, 2009): 321–28, http://annals.org/aim/article-abstract/744702/comparing-costs-qualitycare-retail-clinics-other-medical-settings-3.
61Lisa Girion, “Doctors’ List Puts a Price on Care,” Los Angeles Times, May 28, 2007, http://articles.latimes.com/2007/may/28/business/fi-prices28.
62Jim Epstein, “Oklahoma Doctors vs. Obamacare,” Reason.com, November 15, 2012, http://reason.com/reasontv/2012/11/15/the-obamacare-revolt-oklahoma-doctors-fi.
63Ibid.
64Ibid.
65Chad Terhune, “Many Hospitals, Doctors Offer Cash Discount for Medical Bills,” Los Angeles Times, May 27, 2012, accessed August 25, 2015, http://articles.latimes.com/2012/may/27/business/la-fi-medical-prices-20120527.
66Melinda Beck, “How to Cut Your Health-Care Bill: Pay Cash,” Wall Street Journal, February 15, 2016, http://www.wsj.com/articles/how-to-cut-yourhealth-care-bill-pay-cash-1455592277.
67David Belk, “Are You Paying Way Too Much for Your Medications?” Huffington Post, December 14,2013, https://www.huffingtonpost.com/david-belk/health-care-costs_b_4066552.html.
68David Belk, “Medications: What Your Pharmacist Won’t Tell You,” True Cost of Healthcare (blog), 2016, http://truecostofhealthcare.org/medications/.
69Charles Ornstein and Katie Thomas, “Prescription Drugs May Cost More with Insurance than without It,” New York Times, December 9, 2017, https://www.nytimes.com/2017/12/09/health/drug-prices-generics-insurance.html?emc=edit_th_20171210&nl=todaysheadlines&nlid=15782921&_r=1.
70Shannon Brownlee, “CVS Clinics Hurt America’s Health Care,” Providence Journal, September 17, 2014, http://www.providencejournal.com/article/20140917/OPINION/309179890.
71Kimberly Lankford, “Pay Cash for Your Health Care,” Kiplinger’s Personal Finance, February 2015, http://www.kiplinger.com/article/insurance/T027C000-S002-pay-cash-for-your-health-care.html#JZUq2QCPKmq3V9e0.99.
72Ibid.
73Steve Hargreaves, “Cash-Only Doctors Abandon the Insurance System,” CNN.com, June 11, 2013, http://money.cnn.com/2013/06/11/news/economy/cash-only-doctors/.
74Ibid.
75Ibid.
76Alex Nixon, “Doctors Flock to Concierge Practices: ‘The Downside Is It Costs Extra Money, So It’s Not for Everyone...,’” Concierge Medicine Today, February 3, 2014, http://conciergemedicinetoday.org/2014/02/03/doctors-flock-to-concierge-practices-the-downside-is-it-costs-extra-money-so-its-not-for-everyone/.
77Steve Hargreaves, “Cash-Only Doctors Abandon the Insurance System,” CNNMoney, June 11, 2013, http://money.cnn.com/2013/06/11/news/economy/cash-only-doctors/index.html.
78Nancy Baum, “Physician Ownership in Hospitals and Outpatient Facilities,” Center for Healthcare Research and Transformation, 2013, http://www.chrt.org/document/physician-ownership-in-hospitals-and-outpatient-facilities/.
79Centers for Medicare and Medicaid Services, “Physician-Owned Hospitals,” CMS.gov, https://www.cms.gov/medicare/fraud-and-abuse/physicianselfreferral/physician_owned_hospitals.html.
80Tanya Albert Henry, “Physician-Owned Hospitals Seize Their Moment,” Amednews.com, April 29, 2013, http://www.amednews.com/article/20130429/government/130429948/4/.
81Ryan Marling, “How Amazon Can Position Itself as the Pharmacy of the Future,” The Health Care Blog, June 7, 2017, http://thehealthcareblog.com/blog/2017/06/07/howamazoncanpositionitselfasthepharmacyofthefuture/.
82Art Carden, “What Would Louis XIV Have Paid for a Sonicare?,” Forbes.com, May 26, 2011, reprinted at http://www.independent.org/newsroom/article.asp?id=3086.
83Phil Gramm, 142nd Cong. Rec. S9923 (September 5, 1996).
1Patients Beyond Borders, “Medical Tourism Statistics & Facts,” http://www.patientsbeyondborders.com/medical-tourism-statistics-facts. Reliable figures on the size of the medical tourism market are hard to come by. Estimates of the number of travelers and the dollar value of the market vary greatly because data are incomplete or differing definitions of medical services are employed. See David Reisman, Trade in Health: Economics, Ethics and Public Policy (Cheltenham: Edward Elgar, 2014).
2Beth Howard, “Should You Have Surgery Abroad?,” AARP The Magazine, November 2014, http://www.aarp.org/health/conditions-treatments/info-2014/medical-tourism-surgery-abroad.html.
3David Reisman,Trade in Health: Economics, Ethics and Public Policy (Cheltenham: Edward Elgar, 2014).
4Patients Beyond Borders, “Medical Tourism Statistics & Facts,” http://www.patientsbeyondborders.com/medical-tourism-statistics-facts.
5Joanna Gaines and Duc B. Nguyen, “Medical Tourism,” chap. 2(21) in Centers for Disease Control and Prevention, Health Information for International Travel 2016 (New York: Oxford University Press, 2015), http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/medical-tourism.
6Joint Commission International, “Who Is JCI,” http://www.jointcommissioninternational.org/about-jci/who-is-jci/, visited December 3, 2016.
7Ketaki Gokhale, “Heart Surgery in India for $1,583 Costs $106,385 in U.S.,” Bloomberg.com, July 28, 2013, http://www.bloomberg.com/news/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-.html.
8Ibid.
9J. Geeta Anand, “The Henry Ford of Heart Surgery,” Wall Street Journal, November 25, 2009, http://www.wsj.com/articles/SB125875892887958111.
10Chris Morris, “‘Production Line’ Heart Surgery,” BBC News, August 2, 2010, http://www.bbc.com/news/health-10837726.
11Tarun Khanna, V. Kasturi Rangan, and Merlina Manocaran, “Narayana Hrudayalaya Heart Hospital: Cardiac Care for the Poor (A),” Harvard Business School Case 505-078, June 2005 (revised August 2011), http://www.hbs.edu/faculty/Pages/item.aspx?num=32452.
12Devon M. Herrick, “Medical Tourism: Global Competition in Health Care, National Center for Policy Analysis,” NCPA Policy Report no. 304, August 2007, www.ncpa.org/pub/st/st304.
13Ketaki Gokhale, “Heart Surgery in India for $1,583 Costs $106,385 in U.S.,” Bloomberg.com, July 28, 2013, http://www.bloomberg.com/news/2013-07-28/heart-surgery-in-india-for-1-583-costs-106-385-in-u-s-.html.
14“Top 10 Procedures,” Narayana Health, http://www.narayanahealth.org/top-10-procedures.
15Khanna, Rangan, and Manocaran, “Narayana Hrudayalaya Heart Hospital.” 16Helen Nyambura-Mwaura and Samuel Gebre, “India Health-Care Providers Look to Tap Africa ‘Growth Wave,’” Bloomberg.com, November 24, 2016, https://www.bloomberg.com/news/articles/2016-11-25/africans-seekinghealth-care-in-india-draw-hospitals-to-kenya.
17Saritha Rai, “Indian Surgeon Known for Walmart-izing Heart Surgery Brings Affordable Healthcare Closer to Americans,” Forbes, February 25, 2014, https://www.forbes.com/sites/saritharai/2014/02/25/indian-surgeon-knownfor-walmart-izing-heart-surgery-brings-affordable-healthcare-closer-to-americans/#4164c40d4081.
18Nyambura-Mwaura and Gebre, “India Health-Care Providers.”
19Khanna, Rangan, and Manocaran, “Narayana Hrudayalaya Heart Hospital.”
20Nyambura-Mwaura and Gebre, “India Health-Care Providers.”
21Khanna, Rangan, and Manocaran, “Narayana Hrudayalaya Heart Hospital.”
22Adam Plowright, “Inside India’s ‘No-Frills’ Hospitals, Where Heart Surgery Costs Just $800,” Business Insider, April 21, 2013, http://www.businessinsider.com/ inside-indias-no-frills-hospitals-where-heart-surgery-costs-just-800-2013-4; Joe Carter, “What India’s $800 Heart Surgery Can Teach Us about Healthcare in the U.S.,” Acton Institute PowerBlog, June 25, 2013, http://blog.acton.org/archives/56543-what-800-heart-surgery-can-teach-us-about-healthcare.html.
23Plowright, “Inside India’s ‘No-Frills’ Hospitals.”
24G. Ananthakrishnan, “Boom Time for Medicare,” Hindu, April 30, 2006, http://www.hindu.com/thehindu/mag/2006/04/30/stories/2006043000010100.htm.
25Barak Richman, Krishna Udayakumar, Will Mitchell, and Kevin A. Schulman, “Lessons from India in Organizational Innovation: A Tale of Two Heart Hospitals,” Health Affairs 27, no. 5 (2008): 1260–70, https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.27.5.1260.
26Ibid.
27Ibid.
28Ibid.
29Deloitte Center for Health Solutions, “Medical Tourism Consumers in Search of Value Produced,” 2008, http://www.academia.edu/9144718/Medical_Tourism_Consumers_in_Search_of_Value_Produced_by_the_Deloitte_Center_for_Health_Solutions.
30Reenita Das, “Medical Tourism Gets a Facelift ... and Perhaps a Pacemaker,” Forbes, August 19, 2014, 2015, http://www.forbes.com/sites/reenitadas/2014/08/19/medical-tourism-gets-a-facelift-and-perhaps-a-pacemaker/; P. Keckley and H. Underwood, “Medical Tourism: Update and Implications,” Deloitte Center for Health Solutions, 2009, http://www.coa.org/docs/deloittestudymedicaltourism_111209_web.pdf.
31Astrid Galavan, “Facing Rising Dental Costs, Seniors Head to Mexico,” Associated Press, August 9, 2015, http://www.businessinsider.com/ap-facing-rising-dental-costs-seniors-head-to-mexico-2015-8; Scott Carney, “Inside India’s Rent-a-Womb Business,” Mother Jones, April 2010, http://www.motherjones.com/politics/2010/02/surrogacy-tourism-india-nayna-patel; David M. Frankford, Linda K. Bennington, and Jane Greene Ryan, “Womb Outsourcing: Commercial Surrogacy in India,” MCN, The American Journal of Maternal/Child Nursing 40, no. 5 (2015): 284–90; Johanna Hanefeld, Richard Smith, Daniel Horsfall, and Neil Lunt, “What Do We Know about Medical Tourism? A Review of the Literature with Discussion of Its Implications for the UK National Health Service as an Example of a Public Health Care System,” Journal of Travel Medicine 21, no.6(December2014):410–17, https://academic.oup.com/jtm/article/21/6/410/1843042.
32David Reisman, Trade in Health: Economics, Ethics and Public Policy (Cheltenham: Edward Elgar, 2014).
33David A. Hyman and Charles Silver, “It Was on Fire When I Lay Down on It: Defensive Medicine, Tort Reform, and Healthcare Spending,” in The Oxford Handbook of U.S. Health Law, ed. I. Glenn Cohen, Allison K. Hoffman, and William M. Sage (Oxford: Oxford University Press, 2017).
34Reisman, Trade in Health, p. 73.
35Ibid., p. 74.
36Elisabeth Rosenthal, “The Growing Popularity of Having Surgery Overseas,” New York Times, August 6, 2013, http://www.nytimes.com/2013/08/07/us/the-growing-popularity-of-having-surgery-overseas.html.
37Bill Brody, “Nighthawks: Global Outsourcing Comes to Radiology,” Johns Hopkins Medicine, Crossroads, September 9, 2004, http://www.hopkinsmedicine.org/about/Crossroads/09_09_04.html.
38Devon M. Herrick, “Medical Tourism: Global Competition in Health Care, National Center for Policy Analysis,” NCPA Policy Report no. 304, August 2007, www.ncpa.org/pub/st/st304
39See John C. Goodman, “What Medical Tourism Tells Us about Our Healthcare System,” Beacon, http://blog.independent.org/2013/05/08/what-medical-tourism-tells-us-about-our-healthcare-system/; Devon Herrick, “Medical Tourism: Have Insurance Card, Will Travel,” National Center for Policy Analysis, September 22, 2010, http://www.ncpa.org/pub/ba724.
40C. Walters, “Get on a Plane, Go to Your Surgery,” Consumerist, September 11, 2009, http://consumerist.com/2009/09/11/get-on-a-planego-to-your-surgery/; Joanne Wojcik, “Employers Consider Short-Haul Medical Tourism,” Business Insurance, August 23, 2009, http://www.businessinsurance.com/article/20090823/ISSUE01/308239988.
41“Medical Tourism Takes a Domestic Twist,” Employee Benefit News, August 30, 2015, http://ebn.benefitnews.com/news/medical-tourism-domestictwist-2712341-1.html.
42Goodman, “What Medical Tourism Tells Us about Our Health Care System.”
43“Domestic Medical Tourism Offers More Bang for Buck,” Healthcare Reform Magazine, January 23, 2014, http://www.healthcarereformmagazine.com/usdomestic-medical-travel/domestic-medical-tourism-more-bang/.
44Bruce Einhorn, “Hannaford’s Medical-Tourism Experiment,” Bloomberg Business, November 9, 2008, http://www.bloomberg.com/bw/stories/2008-11-09/hannafords-medical-tourism-experimentbusinessweek-businessnews-stock-market-and-financial-advice.
45M. P. McQueen, “Paying Workers to Go Abroad for Health Care,” Wall Street Journal, September 30, 2008, sec. Business, http://www.wsj.com/news/articles/SB122273570173688551.
46Scott Hensley, “Medical Tourism Starts at Home,” WSJ Health Blog, September 10,2008, http://blogs.wsj.com/health/2008/09/10/medical-tourism-starts-at-home/; “Medical Tourism—Inside and Outside the US Creating Pricing Competition among Hospitals,” The Medical Quack, November 24, 2009, http://ducknetweb.blogspot.com/2009/11/medical-tourism-inside-and-outside-us.html.
47John Goodman, “Employers Opt for Medical Tourism,” NCPA.org Health Policy Blog, October 17, 2012, http://healthblog.ncpa.org/employersopt-for-medical-tourism/.
48“Wal-Mart Offers No-Cost Heart, Spine, and Transplant Surgeries to Employees,” Massdevice, October 12,2012, http://www.massdevice.com/wal-mart-offers-no-cost-heart-spine-transplant-surgeries-employees/.
49David Reisman, Trade in Health: Economics, Ethics and Public Policy (Cheltenham: Edward Elgar, 2014).
50James C. Robinson and Timothy T. Brown, “Increases in Consumer Cost Sharing Redirect Patient Volumes and Reduce Hospital Prices for Orthopedic Surgery,” Health Affairs 32, no. 8 (August 1, 2013): 1392–97, doi:10.1377/hlthaff.2013.0188.; “Stunning Results from California,” NCPA.org Health Policy Blog, August 7, 2013, http://healthblog.ncpa.org/stunning-results-fromcalifornia/; James C. Robinson and Timothy T. Brown, “Changes in Patient Volumes, Allowed Charges, Consumer Cost Sharing, and CalPERS Payments for Orthopedic Surgery Associated with Reference Pricing,” Berkeley Center for Health Technology, https://www.calpers.ca.gov/docs/board-agendas/201306/pension/item-7-attach-1.pdf.
51Associated Press, “Employers Offer Cash to Push Shopping around for Health Care,” New York Times, October 14, 2015.
1Zach Carter, “The Spoilsmen: How Congress Corrupted Patent Reform,” Huffington Post, August 4, 2011, http://www.huffingtonpost.com/2011/08/04/patent-reform-congress_n_906278.html; Dean Baker, “Issues in Trade and Protectionism,” Center for Economic and Policy Research, November 2009, http://cepr.net/documents/publications/trade-and-protectionism-2009-11.pdf.
2Global Intellectual Property Center, “Prizes and Patent Pools: Viable Alternatives to the Patent System?” (undated), http://www.theglobalipcenter.com/sites/default/files/reports/documents/Prizes__Patent_Pools.pdf. The Global Intellectual Property Center is an arm of the U.S. Chamber of Commerce.
3Dean Baker, “Issues in Trade and Protectionism,” Center for Economic and Policy Research, November 2009, http://cepr.net/documents/publications/trade-and-protectionism-2009-11.pdf.
4Daniel F. Spulber, “Public Prizes versus Market Prices: Should Contests Replace Patents?,” Journal of the Patent and Trademark Office Society 97, no. 4 (2015): 690–735. For a fully developed alternative that retains the use of patents while also breaking the link between incentives to innovate and sales, see Stan Finkelstein and Peter Temin, Reasonable RX: Solving the Drug Price Crisis (Upper Saddle River, NJ: FT Press, 2008).
5To avoid incentivizing inventors to run up their costs, the prize formula could cap compensable costs at an identified level or step down the multiplier as costs increase.
6Pharmaceutical Research and Manufacturers of America, “2015 Biopharmaceutical Research Industry Profile,” April 2015, http://phrmacdn.connectionsmedia.com/sites/default/files/pdf/2015_phrma_profile.pdf.
7Matthew Herper, “The Cost of Creating a New Drug Now $5 Billion, Pushing Big Pharma to Change,” Forbes.com, August 11, 2013, http://www.forbes.com/sites/matthewherper/2013/08/11/how-the-staggering-cost-of-inventing-new-drugs-is-shaping-the-future-of-medicine/#5d7766486bfc.
8David Belk, “The Pharmaceutical Industry,” True Cost of Healthcare, http://truecostofhealthcare.net/the_pharmaceutical_industry/.
9V. Prasad and S. Mailankody, “Research and Development Spending to Bring a Single Cancer Drug to Market and Revenues after Approval,” JAMA Internal Medicine, (September 11, 2017): doi:10.1001/jamainternmed.2017.3601.
10Herper, “The Cost of Creating a New Drug.”
11Belk, “The Pharmaceutical Industry.”
12Michael Kremer and Heidi Williams, “Incentivizing Innovation: Adding to the Tool Kit,” Innovation Policy and the Economy 10, no. 1 (2010), http://www.jstor.org/stable/10.1086/605851.
13Priority Review Vouchers website, http://priorityreviewvoucher.org/.
14Amy Nordrum, “Drug Prices: World’s Most Expensive Medicine Costs $440,000 a Year, but Is It Worth the Expense?,” International Business Times, February 13, 2016, http://www.ibtimes.com/drug-prices-worlds-most-expensivemedicine-costs-440000-year-it-worth-expense-2302609.
15Ibid.
16Kelly Crowe, “How Pharmaceutical Company Alexion Set the Price of the World’s Most Expensive Drug,” CBC News, June 25, 2015, http://www.cbc.ca/news/health/how-pharmaceutical-company-alexion-set-the-price-of-the-world-s-most-expensive-drug-1.3125251.
17Ibid.
18David A. Hyman and William E. Kovacic, “Risky Business: Should the FDA Pay Attention to Drug Prices?,” Regulation 40, no. 4 (2017): 22–26.
19Rachel Bluth, “Looking for Bargains, Many Americans Buy Medicines Abroad,” NPR, December 17, 2016, http://www.npr.org/sections/health-shots/2016/12/17/505690791/looking-for-bargains-many-americansbuy-medicines-abroad.
20Neil Osterweil, “The Letter (and Spirit) of Drug Import Laws,” WebMD, (undated), https://www.webmd.com/healthy-aging/features/letter-and-spiritof-drug-import-laws#1.
21eDrugSearch.com, “State-Sponsored Web Sites for Ordering Imported Drugs,” https://edrugsearch.com/state-sponsored-web-sites-for-ordering-imported-drugs/. See also Phil Galewitz, “Cities, Counties and Schools Sidestep FDA Canadian Drug Crackdown, Saving Millions,” Kaiser Health News, December 8, 2017, https://khn.org/news/cities-counties-and-schools-sidestep-fda-canadian-drug-crackdown-saving-millions/.
22Phil Galewitz, “FDA Raids Florida Stores That Consumers Use to Buy Drugs from Canada,” Kaiser Health News, November 20, 2017, https://khn.org/news/fda-raids-florida-stores-that-consumers-use-to-buy-drugs-from-canada/?utm_campaign=KHN%3A%20First%20Edition&utm_sour%E2%80%A6.
1U.S. Department of Justice, Office of Public Affairs, “Former Wellcare Chief Executive Sentenced for Health Care Fraud,” news release, http://www.justice.gov/opa/pr/former-wellcare-chief-executive-sentenced-health-care-fraud.
2Amy Sherman, “Rick Scott ‘Oversaw the Largest Medicare Fraud in the Nation’s History,’ Florida Democratic Party Says,” PolitiFact Florida, March 3, 2014, http://www.politifact.com/florida/statements/2014/mar/03/florida-democraticparty/rick-scott-rick-scott-oversaw-largest-medicare-fra/.
3Jeff Overley, “Ex-WellCare CEO Gets 3Years for Medicaid Fraud,” Law360, May 19, 2014, http://www.law360.com/articles/539387/ex-wellcare-ceo-gets3-years-for-medicaid-fraud.
4Charles Babcock, “Fraud Trial for WellCare Ex-CEO Shows Medicaid Abuse,” Bloomberg.com, November 19, 2012, http://www.bloomberg.com/news/articles/2012-11-20/fraud-trial-for-wellcare-ex-ceo-shows-medicaid-program-abuse.
5Ibid.
6Ibid.
7Kris Hundley, “WellCare Whistle-Blower Talks about His Corporate Double Life,” Tampa Bay Times, July 3, 2010, http://www.tampabay.com/news/business/wellcare-whistle-blower-talks-about-his-corporate-double-life/1106867.
8Babcock, “Fraud Trial for WellCare Ex-CEO.”
9Kris Hundley, “WellCare Whistle-Blower Talks about His Corporate Double Life,” Tampa Bay Times, July 3, 2010, http://www.tampabay.com/news/business/wellcare-whistle-blower-talks-about-his-corporate-double-life/1106867.
10Ibid.
11Ibid.
12Ibid.
13Ibid.
14Jeff Harrington, “WellCare Health Plans Whistle-Blower to Receive about $21 Million,” Tampa Bay Times, April 3, 2012, http://www.tampabay.com/news/business/wellcare-health-plans-whistle-blower-to-receive-about-21-million/1223263.
15Carol Gentry, “New Whistleblower Charges at WellCare,” Health News Florida, November 4, 2014, http://health.wusf.usf.edu/post/new-whistleblowercharges-wellcare#stream/0.
16Anthony Brino, “Fraud Files: Trio of Managed Care Execs Head to the Slammer,” HeathcareITNews, May 20, 2014, http://www.healthcareitnews.com/news/fraud-files-trio-managed-care-execs-head-slammer.
17Taxpayers Against Fraud Education Fund, “Whistleblower Stories,” http://www.taf.org/whistleblower-stories#Thakur (visited November 23, 2016).
18U.S. Department of Justice, “Generic Drug Manufacturer Ranbaxy Pleads Guilty and Agrees to Pay $500 Million to Resolve False Claims Allegations, cGMP Violations and False Statements to the FDA,” news release, May 13, 2013, https://www.justice.gov/opa/pr/generic-drug-manufacturer-ranbaxy-pleadsguilty-and-agrees-pay-500-million-resolve-false.
19Taxpayers Against Fraud Education Fund, “Whistleblower Stories.”
20David Voreacos, “Florida Pharmacists Win $597 Million Blowing Whistle on Scheme,” Bloomberg Markets, August 13, 2013, https://www.bloomberg.com/news/articles/2013-08-13/florida-pharmacists-win-597-million-blowingwhistle-on-scheme.
21Paul Heldman, “Firm to Pay $486m Fraud Settlement,” Sun Sentinel, January 20, 2000, http://articles.sun-sentinel.com/2000-01-20/business/0001192012_1_fresenius-medical-care-health-care-fraud-nmc-medical-products.
22Ibid.
23Voreacos, “Florida Pharmacists Win $597 Million.”
24Jessica Mason, “U.S. Chamber Works behind the Scenes to Gut Whistleblower Protections,” PRWatch, April 29, 2016, http://www.prwatch.org/news/2016/04/13098/us-chamber-works-behind-scenes-gut-whistleblowerprotections.
25Gregory Wallace, “$168 Million Payout to Johnson & Johnson Whistleblowers,” CNN Money, November 4, 2013, http://money.cnn.com/2013/11/04/news/johnson-and-johnson-whistleblower-payout/index.html.
26Ed Cara, “How Did Dr. Farid Fata, America’s Greater Cancer Fraudster, Get Away with It for So Long?,” Medical Daily, July 7, 2015, http://www.medicaldaily.com/how-did-dr-farid-fata-americas-greatest-cancer-fraudster-get-away-it-solong-341478.
27U.S. Department of Justice, “Fraud Statistics—Overview: October 1, 1987–September 30, 2015, 2015,” https://www.justice.gov/opa/file/796866/download.
28David Freeman Engstrom, “Public Regulation of Private Enforcement: Empirical Analysis of DOJ Oversight of Qui Tam Litigation under the False Claims Act,” Northwestern University Law Review 107, no. 4 (2013): 1689, 1718–20.
29Voreacos, “Florida Pharmacists Win $597 Million.”
30Ibid.
31Yuki Noguchi, “D.C. Law Firm’s Big BlackBerry Payday: Case Fees of More Than $200 Million Are Said to Exceed Its 2004 Revenue,” Washington Post, March 18, 2006, p. D03.
32Whistleblowers, Qui Tam & False Claims Act Legal Blog, “Immunity and Protection for Qui Tam Whistleblowers,” Berger & Montague, P.C., http://www.bergermontague.com/practice-areas/whistleblowers,-qui-tam-false-claims-act/whistleblowers,-qui-tam-false-claims-act-legal-blog/immunity-and-protectionfor-qui-tam-whistleblowers.
33Ibid.
3431 U.S.C. 3730(d)(3).
35Cong. Globe, 37th Cong., 3rd Sess. 955–56 (1863).
36Richard Kronick, “Projected Coding Intensity in Medicare Advantage,” Health Affairs, 2017, http://content.healthaffairs.org/content/36/2/320.abstract; Fred Schulte, “Medicare Failed to Recover up to $125 Million in Overpayments from Private Insurers,” NPR.org, http://www.npr.org/sections/health-shots/2017/01/06/508260306/medicare-failed-to-recover-up-to-125million-in-overpayments-from-private-insure.
37Complaint, U.S. v. UnitedHealth Group, No. CV 16-08697 WMF (SSx) (C.D. Cal. May 16,2017), https://www.documentcloud.org/documents/3727655-Justice-Department-Complaint-Against.html. In October, 2017, the case was dismissed for failing to plead details of the alleged fraud with sufficient particularity. Erica Teichert, “UnitedHealth defeats Federal Medicare Advantage Suit,” Modern Healthcare, October 6, 2017, http://www.modernhealthcare.com/article/20171006/NEWS/171009939. The DOJ dropped the lawsuit entirely in 2018.
38Better does not mean perfectly. Criminals sometimes fool private insurers too. For an example in which criminals are alleged to have billed private carriers for more than $100 million, see Jacob Batchelor, “Doctor Accused of Illegally Letting Assistants Do Surgeries,” Law360, September 16, 2015, http://0-www.law360.com.tallons.law.utexas.edu/articles/703343/print?section=health. All payment systems experience some level of fraud, as we say in the text.
39Alex Wolf, “Fight for Conoco-Aetna Docs Erupts in $120M Kickbacks Suit,” Law360.com, September 29, 2015, http://0-www.law360.com.tallons.law.utexas.edu/health/articles/708425/fight-for-conoco-aetna-docs-erupts-in120m-kickbacks-suit.
1ValuePenguin, “Average Cost of Homeowners Insurance (2017),” https://www.valuepenguin.com/average-cost-of-homeowners-insurance.
2Chris Conover, “Young People under Obamacare: Cash Cows for Older Workers,” Forbes, November 27, 2012, https://www.forbes.com/sites/chrisconover/2012/11/27/young-people-under-obamacare-cash-cow-for-older-workers/#63f0498247fc.
3Ibid.
4Ibid.
5“Obamacare Architect: ‘Lack of Transparency Is a Huge Political Advantage,’” Real Clear Politics, November 10, 2014, http://www.realclearpolitics.com/video/2014/11/10/obamacare_architect_lack_of_transparency_is_a_huge_political_advantage.html.
6David Grabowski, Jonathan Gruber, and Vincent Mor, “You’re Probably Going to Need Medicaid,” New York Times, June 13, 2017, https://nyti.ms/2tfTdFy.
7See, for example, Jay Bhattacharya and M. Kate Bundorf, “The Incidence of the Healthcare Costs of Obesity,” NBER Working Paper no. 11303, National Bureau of Economic Research, May 2005, http://www.nber.org/papers/w11303.
8Tami Luhby, “Before Obamacare, Some Liked Their Health Care Plans Better,” CNN.com, March 31, 2017, http://webcache.googleusercontent.com/search?q=cache:YteV7Tj1pMgJ:money.cnn.com/2017/03/31/news/economy/obamacare-health-care-plans/index.html=&cd=1&hl=en&ct=clnk&gl=us.
9Andrew McGill, “The Platinum Patients,” Atlantic, June 2017, https://www.theatlantic.com/theplatinumpatients/.
10Carolyn Y. Johnson, “Half of Americans Are Responsible for Only 3 Percent of Health Care Costs,” Washington Post, April 3, 2017, https://www.washingtonpost.com/news/wonk/wp/2017/04/03/most-americans-spend-little-on-healthcare-and-that-hasnt-budged-in-37-years/?utm_term=.bf0b54e27098.
11Anita Soni, “Statistical Brief #470: Trends in the Five Most Costly Conditions among the U.S. Civilian Noninstitutionalized Population, 2002 and 2012,” Agency for Healthcare Research and Quality, April 2015, https://meps.ahrq.gov/data_files/publications/st470/stat470.shtml.
12McGill, “The Platinum Patients.”
13BlueCross BlueShield, “A Study of Cost Variations for Knee and Hip Replacement Surgeries in the U.S.,” January 21, 2015, https://www.bcbs.com/about-us/capabilities-initiatives/health-america/health-of-america-report/study-cost-variations.
14James R. Healey, “Average New Car Price Zips 2.6% to $33,560,” USA Today, May 4, 2015, https://www.usatoday.com/story/money/cars/2015/05/04/new-car-transaction-price-3-kbb-kelley-blue-book/26690191/.
15BlueCross BlueShield, “A Study of Cost Variations for Knee and Hip Replacement.”
16Phil LeBeau, “New Car, New Reality: Auto Loan Borrowing Hits Fresh Highs,” CNBC.com, June 2, 2016, http://www.cnbc.com/2016/06/02/usborrowers-are-paying-more-and-for-longer-on-their-auto-loans.html.
17Linda Rath, “Knee Replacement and Revision Surgeries on the Rise,” Arthritis Foundation, (undated), http://www.arthritis.org/living-with-arthritis/treatments/joint-surgery/types/knee/knee-replacement-younger-patients.php.
18Samuel Greengard, “Clinical Outcomes and Statistics of Knee Replacement,” Healthline.com, February 18, 2015, http://www.healthline.com/health/total-knee-replacement-surgery/outcomes-statistics-success-rate.
19Christopher Kurz, Geng Li, and Daniel Vine, “The Young and the Carless? The Demographics of New Vehicle Purchases,” FEDS Notes, Board of Governors of the Federal Reserve System, Washington, June 24, 2016, http://dx.doi.org/10.17016/2380-7172.1798.
20Examples include Carmen H. Rodriguez, “Without ACA Guarantees, 52 Million Adults Could Have Trouble Buying Individual Plans,” Kaiser Health News, December 13, 2016, http://khn.org/news/without-aca-guarantees-52million-adults-could-have-trouble-buying-individual-plans/; U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, “At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: 129 Million People Could Be Denied Affordable Coverage without Health Reform,” (undated), https://aspe.hhs.gov/system/files/pdf/76376/index.pdf.
21Mark V. Pauly and Bradley Herring, Pooling Health Insurance Risks, (Washington: AEI Press), p. 18, https://www.aei.org/wp-content/uploads/2014/07/-pooling-health-insurance-risks_114406587191.pdf.
22Ibid.
23Greg Scandlen, Myth Busters: Why Health Reform Always Goes Awry (North Charleston, SC: CreateSpace Publishing, 2017).
24Letter from Douglas W. Elmendorf, Director of Congressional Budget Office, to Michael B. Enzi, Ranking Member, Committee on Health, Education, Labor, and Pensions, U.S. Senate, June 21, 2010, https://www.cbo.gov/sites/default/files/111th-congress-2009-2010/reports/06-21-high-risk_insurance_pools.pdf.
25U.S. Department of Health and Human Services, Office of Consumer Information and Insurance Oversight, “Pre-Existing Condition Insurance Plan Program; Interim Final Rule,” 45 CFR Part 152, Federal Register 75 no. 146 (July 30, 2010): 45026, https://www.federalregister.gov/documents/2010/07/30/2010-18691/pre-existing-condition-insurance-plan-program.
26Karen Pollitz, “High Risk Pools for Uninsurable Individuals,” The Henry J. Kaiser Family Foundation, February 2017, http://files.kff.org/attachment/IssueBrief-High-Risk-Pools-For-Uninsurable-Individuals.
27Wikipedia, “Michigan Stadium,” https://en.wikipedia.org/wiki/Michigan_Stadium.
28Farzon A. Nahvi, “Don’t Leave Health Care to a Free Market,” New York Times, July 10, 2017, https://www.nytimes.com/2017/07/10/opinion/healthinsurance-free-market.html.
29John Cochrane, “After the ACA: Freeing the Market for Health Care” in The Future of Healthcare Reform in the United States, ed. Anup Malani and Michael H. Schill (Chicago: University of Chicago Press, 2015), pp. 161-201, https://faculty.chicagobooth.edu/john.cochrane/research/papers/after_aca_published.pdf.
30Jonathan Gruber, “Health Care Reform Is a ‘Three-Legged Stool’: The Costs of Partially Repealing the Affordable Care Act,” Center for American Progress, August 5, 2010, https://www.americanprogress.org/issues/healthcare/reports/2010/08/05/8226/health-care-reform-is-a-three-legged-stool/.
1Gallup Editors, “Most Americans Practice Charitable Giving, Volunteerism,” Gallup, December 13, 2013, http://www.gallup.com/poll/166250/americanspractice-charitable-giving-volunteerism.aspx.
2This point has been made many times. Obamacare was subject to a similar moral critique. As John Goodman wrote, the insurance premium regulations “[f]orce[d] young people to pay two or three times the real cost of their insurance in order to subsidize older people who have more income and more assets.” John Goodman, “Is There a Moral Case for Obamacare?” National Center for Policy Analysis, Health Policy Blog, July 6, 2011, http://healthblog.ncpa.org/is-there-amoral-case-for-obamacare/#sthash.7xxpksYB.dpuf.
3“Changes in U.S. Family Finances from 2010 to 2013: Evidence from the Survey of Consumer Finances,” Federal Reserve Bulletin, September 2014, https://www.federalreserve.gov/pubs/bulletin/2014/pdf/scf14.pdf.
4Kaiser Family Foundation, “Poverty Rate by Age 2015,” http://kff.org/other/state-indicator/poverty-rate-by-age/?currentTimeframe=0.
5Elizabeth Arias, M. Heron, and J. Xu, “United States Life Tables,” National Vital Statistics Reports 66 no. 3 (April 11, 2017): Table 20, https://www.cdc.gov/nchs/data/nvsr/nvsr66/nvsr66_03.pdf.
6Alyene Senger, “The Number of Workers per Medicare Beneficiary Is Falling,” infographic in “Medicare at Risk: Visualizing the Need for Reform,” Heritage Foundation, May 22, 2012, http://dailysignal.com/2012/05/22/medicare-at-risk-visualizing-the-need-for-reform/.
7Centers for Medicare and Medicaid Services, “National Health Expenditures 2015 Highlights,” https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf.
8Phillip Longman, “Justice between Generations,” Atlantic Monthly, 1985, https://www.theatlantic.com/past/docs/issues/96may/aging/longm.htm.
9Norman Daniels, Am I My Parents’ Keeper (Oxford: Oxford University Press, 1988) p. 43.
10Ibid., 44–45.
11Singapore’s mandatory savings program is described in William A. Haseltine, Affordable Excellence: The Singapore Healthcare Story (Washington: Brookings Institute, 2013). See also David Reisman, Social Policy in an Ageing Society: Age and Health in Singapore (Cheltenham: Edward Elgar, 2009). The program contains many elements that are not described here, some of which involve the state heavily in the regulation of the delivery of health care. See Ezra Klein, “Is Singapore’s ‘Miracle’ Health Care System the Answer for America?,” Vox, April 25, 2017, http://www.vox.com/policyandpolitics/2017/4/25/15356118/singaporehealthcaresystemexplained.
12Haseltine, Affordable Excellence.
13Reisman, Social Policy, pp. 37–38.
14Ibid.
15Drew Desilver, “5 Facts about Social Security,” Pew Research Center, August 18, 2015, http://www.pewresearch.org/fact-tank/2015/08/18/5-factsabout-social-security/.
16Bob Sullivan, “The Future of U.S. Health Care? FSAs & HSAs,” Credit.com, December 19, 2016, http://blog.credit.com/2016/12/the-future-of-u-s-healthcare-account-based-health-plans-163671/.
17KFF.org, “Medicaid Spending per Full Benefit Enrollee: FY2011,” http://kff.org/medicaid/state-indicator/medicaid-spending-per-full-benefitenrollee/?currentTimeframe=0&selectedDistributions=total.
18Harold Pollack, Bill Gardner, and Timothy Jost, “Valuing Medicaid: Why We Need It, How We Should Improve It,” American Prospect, July 26, 2015, http://prospect.org/article/valuing-medicaid.
19Matt Zwolinski, “The Pragmatic Libertarian Case for a Basic Income Guarantee,” Cato Unbound, August 4, 2014, https://www.cato-unbound.org/2014/08/04/matt-zwolinski/pragmatic-libertarian-case-basic-incomeguarantee.
20Pollack, Gardner, and Jost, “Valuing Medicaid,” citing Benjamin D. Sommers, Katherine Baicker, and Arnold M. Epstein, “Mortality and Access to Care among Adults after State Medicaid Expansions,” New England Journal of Medicine 367 (2012): 1025–34, doi:10.1056/NEJMsa1202099.
21Thomas L. Hungerford and Rebecca Thiess, “Issue Brief #370: The Earned Income Tax Credit and the Child Tax Credit,” Economic Policy Institute, September 25, 2013, http://www.epi.org/publication/ib370-earned-income-tax-creditand-the-child-tax-credit-history-purpose-goals-and-effectiveness/.
22Ibid. On the health benefits of these cash transfers, see Hilary Hoynes, Doug Miller, and David Simon, “Income, the Earned Income Tax Credit, and Infant Health,” American Economic Journal: Economic Policy 7, no. 1 (2015): 172–211, http://dx.doi.org/10.1257/pol.20120179; William N. Evans and Craig L. Garthwaite, “Giving Mom a Break: The Impact of Higher EITC Payments on Maternal Health,” American Economic Journal: Economic Policy 6, no. 2 (2014): 258–90, http://dx.doi.org/10.1257/pol.6.2.258; Hilary Hoynes, Marianne Page, and Ann Stevens, “Can Targeted Transfers Improve Birth Outcomes? Evidence from the Introduction of the WIC Program,” Journal of Public Economics 95, no. 7–8 (2011): 813–27; Hilary Hoynes, Diane Whitmore Schanzenbach, and Douglas Almond, “Long Run Impacts of Childhood Access to the Safety Net,” NBER Working Paper no. 18535, National Bureau of Economic Research, 2013, https://gspp.berkeley.edu/assets/uploads/research/pdf/Hoynes-Schanzenbach-Almond-14.pdf. Even health care providers recognize the health-related benefits of nonmedical services. See Theresa Fraze, Valerie A. Lewis, Hector P. Rodriguez, and Elliott S. Fisher, “Housing, Transportation, and Food: How ACOs Seek to Improve Population Health by Addressing Nonmedical Needs of Patients,” Health Affairs 35, no. 11 (2016): 2109–15.
23“Do EITC Recipients Use Their Tax Refunds to Get Ahead? Evidence from the Refund to Savings Initiative,” Washington University in St. Louis, Center for Social Development, CSD Research Brief no. 15-38, July 2015. See also Andrew Goodman-Bacon and Leslie McGranahan, “How Do EITC Recipients Spend Their Refunds?” Federal Reserve Bank of Chicago, Economic Perspectives 38 (2008), https://www.chicagofed.org/publications/economic-perspectives/2008/2qtr2008-part2-goodman-etal.
24Amy Finkelstein, Nathaniel Hendren, and Erzo F. P. Luttmer, “The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment,” NBER Working Paper no. 21308, National Bureau of Economic Research, June 2015, http://www.nber.org/papers/w21308.
25The Obamacare Medicaid expansion reduced the amount of uncompensated care provided by hospitals from $34.9 billion to $28.9 billion. Peter Cunningham, Robin Rudowitz, Katherine Young, et al., “Understanding Medicaid Hospital Payments and the Impact of Recent Policy Changes,” Kaiser Family Foundation, June 9, 2016, http://kff.org/medicaid/issue-brief/understandingmedicaid-hospital-payments-and-the-impact-of-recent-policy-changes/. These numbers must be taken with a grain of salt, because hospitals’ reports of the cost of charity care are unreliable, but it is clear that the Medicaid expansion helped them financially.
26Ibid., citing Craig Garthwaite, Tal Gross, and Matthew J. Notowidigdo, “Hospitals as Insurers of Last Resort,” NBER Working Paper No. 21290, National Bureau of Economic Research, June 2015, http://www.nber.org/papers/w21290.
27Pollack, Gardner, and Jost, “Valuing Medicaid.”
28Kaiser Family Foundations, “Pulling It Together: A Public Opinion Surprise,” April 4, 2011, http://kff.org/health-reform/perspective/pulling-it-togethera-public-opinion-surprise/.
29Mira Norton, Bianca DiJulio, and Mollyann Brodie, “Medicare And Medicaid At 50,” Kaiser Family Foundation, July 17, 2015, http://kff.org/medicaid/poll-finding/medicare-and-medicaid-at-50/.
30U.S.Centers for Medicare and Medicaid Services, “NHE Fact Sheet,” https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html. For a state-by-state breakdown, see MACPAC, “Medicaid Spending by State, Category, and Source of Funds,” https://www.macpac.gov/publication/medicaid-spending-by-state-categoryand-source-of-funds/.
31Usgovernmentspending.com, “Estimated vs. Actual Federal Spending for Fiscal Year 2017 from Federal Budgets,” https://www.usgovernmentspending.com/federal_budget_estimate_vs_actual_2017.
32Erica L. Reaves and Mary Beth Musumeci, “Medicaid and Long-Term Services and Supports: A Primer,” Kaiser Family Foundation, December 15, 2015, http://kff.org/medicaid/report/medicaid-and-long-term-services-and-supports-a-primer/. See also Kaiser Family Foundation, “Medicaid’s Role in Meeting Seniors’ Long-Term Services and Supports Needs,” August 2, 2016, http://kff.org/medicaid/fact-sheet/medicaids-role-in-meeting-seniors-long-term-services-and-supports-needs/.
33Robert H. Brook, Emmett B. Keeler, Kathleen N. Lohr, et al., “Research Brief: The Health Insurance Experiment,” RAND, 2006, https://www.r,and.org/pubs/research_briefs/RB9174.html.
34Allison K. Hoffman, ” Three Models of Health Insurance: The Conceptual Pluralism of the Patient Protection and Affordable Care Act,” University of Pennsylvania Law Review 159 (2011): 103–79; Allison K. Hoffman, “The Unhealthy Return to Individual Responsibility in Health Policy,” Regulatory Review, January 16, 2017, https://www.theregreview.org/2017/01/16/hoffmanunhealthy-return-individual-responsibility-health-policy/.
35Ibid.
36Ibid.
37Brook et al., “Research Brief: The Health Insurance Experiment.”
38Ibid.
39Ibid.
40U.S. Department of Veterans Affairs, “Budget in Brief 2017,” 2016, https://www.va.gov/budget/docs/summary/Fy2017-BudgetInBrief.pdf; U.S. Department of Veterans Affairs, Veterans Health Administration, “Providing Health Care for Veterans,” https://www.va.gov/health/.
41We have discussed quality problems at VHA hospitals in other writings. See, for example, David A. Hyman and Charles Silver, “The Poor State of Health Care Quality in the U.S.: Is Malpractice Liability Part of the Problem or Part of the Solution?,” Cornell Law Review 90, no. 4 (2005): 893–994, http://scholarship.law.cornell.edu/cgi/viewcontent.cgi?article=2996&context=clr.
42Paul Giblin, “VA Patient Load Outpaced Budget, Led to Latest Scandal,” USA Today, June 15, 2014, https://www.usatoday.com/story/news/nation/2014/06/15/va-patient-load-outpaced-budget/10553987/.
43Donovan Slack, “VA Failed to Report 90% of Potential Dangerous Medical Providers, GAO Confirms,” USA Today, November 27, 2017, https://www.usatoday.com/story/news/politics/2017/11/27/va-failed-report-90-potentially-dangerous-medical-providers-gao-confirms/890582001/. See also U.S. Government Accountability Office, VA Health Care: Improved Policies and Oversight Needed for Reviewing and Reporting Providers for Quality and Safety Concerns, November 2017, https://www.gao.gov/assets/690/688378.pdf.
44Donovan Slack and Michael Sallah, “VA Conceals Shoddy Care and Health Workers’ Mistakes,” USA Today, October 11, 2017, https://www.usatoday.com/story/news/2017/10/11/va-conceals-shoddy-care-and-health-workers-mistakes/739852001/.
45Harlan Krumholz, “3 Things to Know Before You Judge VA Health System,” Forbes.com, May 23, 2014, http://www.forbes.com/sites/harlankrumholz/2014/05/23/3-things-to-know-before-you-rush-to-judgment-about-vahealth-system/#347d1f497660.
46 Hyman and Silver, “The Poor State of Health Care Quality.”