Speakers and Reactors:

Dr. Charles Denham – Moderator
Chief Bill Adcox
Dr. Marty MaKary
Jennifer Dingman

Dr. Charles Denham:

Good day. It’s my pleasure to have you join us today for a live webinar and also our podcast entitled “Fraud in the Covid Ecosystem: A Survival Live Guide.” Today is July 7th, 2022, and this is our 189th webinar. I can’t believe it. I’m Dr. Charles Denham, Chairman of TMIT Global and founder of the MedTech Bystander Rescue Care Program. I’ll be moderating today and showing a number of videotapes that are part of a program featuring several of our experts. We’re delighted to have a wonderful responder with us today, as well as the voice of the patient. Today, we’re going to address fraud, a delicate and emotionally charged topic that exists within the suppliers, providers, and purchasers’ community.

This will be one of a series of programs that we’ll be able to show you. During the Covid crisis, there have been multiple alerts about fraudulent tests, grants, prescription cards, fraudulent testing, and fraudulent Medicare billing. When we look at fraud, the legal definition is the intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate both civil and criminal law, and we’ll be revisiting this definition throughout the program. A fraud perpetrator may be prosecuted and imprisoned under criminal law, but may also be sued for civil issues. We have a video generated by the federal government that addresses this issue, which we’ll be posting on our website.

As we consider the issue, scammers are preying on Covid-19 fears. They can cause harm, fraudulently bill the federal government, or commit identity theft. Covid-19 fraud is rapidly evolving. The federal government has produced a video addressing these topics, which we’ve summarized in these slides. We must be cautious of unsolicited requests for personal information. Discussing fraudulent issues regarding medical identity, it’s critical to talk to your physicians and get your Covid testing or treatments through someone you trust. While you can reduce the probability of fraud, you can’t completely remove it. If you suspect fraud, it’s critical to take action.

One of the areas we’ve covered in patient safety and quality is the Swiss cheese model. I had the honor of working with Professor James Reason from the United Kingdom and understood that he popularized this concept of Swiss cheese having holes and that we need multiple layers of safeguards to stop threats or potential harm to individuals or organizations. No one slice of cheese is entirely safe. We created a video to address how we would apply these principles to Covid, addressing distancing, masks, disinfection of high-contact surfaces, ventilation, and testing. Even with all these layers, people can become infected. Now, with the BA.4 and BA.5 Omicron lineage of the virus, it’s a critical issue.

Because this has been politicized, many people are Covid-tired. In many communities, these layers of safeguards have been dropped at the worst possible time, when we have a virus that’s evolved to be highly transmissible and lethal and is beginning to evade the vaccines and natural protection of prior infections. Today, we’re going to cover the Four Ps. As a systems engineer and a doctor, systems engineers apply models to complex scientific situations and use those models to rationalize and reconcile what’s going on. The Four P model covers prevention, preparedness, protection, and performance in addressing fraud.

How can we prepare for fraud protection? How can we minimize harm if we are deceived? If a fraudster does manage to deceive us, or if this is one of the issues we’ll discuss today, how can we mitigate the damage, given that some things will slip through our defenses? And what can we learn from others? How can we gain insights from others today? We’re delighted to have a wonderful group of speakers, some of whom are featured in multiple videotapes, and we also have Jennifer Dingman live to provide her insights. We’ll be addressing several of these topics today. For those of you who are new to us, our goal is to measure our success by how well we protect and enhance the lives of families, patients, and caregivers. Our mission is to save lives, save money, and create value in the communities we serve.

We strive to live by our I CARE values of compassion, integrity, accountability, reliability, and entrepreneurship. All of our speakers, both on video and live, have nothing to disclose. For those of you who are listening to the podcast, we regularly provide these disclosures. If you visit our website in the future, and for those of you listening to the podcast, you’ll find that we will continuously update the content we cover. On our website, we also have a progress report. As of Q3 2022, we have been producing this program for the Coronavirus Care community of practice since March 2020, when the pandemic began. You can visit our website at medtechglobal.org/coronavirus-response.

The first issue is the coronavirus itself, which is far from over. For those of you who are listening to the podcast, we have a graphic representation that depicts the various strains of the virus, from Alpha to Beta to Delta to Omicron. It’s crucial to understand that the situation is continuously evolving and that we will likely see more surges in the future. Today, we will discuss the current state of fraud, the basics of coronavirus, and where we stand with the BA.4 and BA.5 Omicron lineages. We’ll also examine the Swiss cheese model and address prevention, preparedness, performance improvement, and a concept called “left of boom,” which Chief Adcox will discuss.

We will use a framework that considers the value chain elements of suppliers, providers, and purchasers, as well as the entire U.S. healthcare system, which is valued at over $3.5 trillion. We’ll cover the idea of competing narratives, the stories told about the science, and how misinformation, disinformation, and malformation have plagued us throughout the pandemic. We’ll also discuss our collaborative approach to emerging threats, including fraud, and the five rights of medical records as they apply to medical records theft and cybersecurity. Dr. Boats will address the five Rs of readiness, response, rescue, recovery, and resilience.

It’s essential to recognize that we’re not done with the virus yet. For those of you on the podcast, we will play a video that shows the significant spikes in cases, especially in the teenage population. Unfortunately, I cannot narrate the video, but you can watch it on our website. The video shows a heat map of the disease’s spread and how it has expanded rapidly in recent weeks. We don’t know if this trend will continue, but we must be vigilant. Looking at the variant evolution, from Alpha to Beta to Delta, which had a significant impact, and then to Omicron with its high transmissibility, we now have the BA.4 and BA.5 lineages of Omicron. Omicron has shown some evasion of neutralizing antibodies in those who have already had the disease, affecting both vaccinated and unvaccinated individuals. Those who have not been vaccinated are at even higher risk, even if they have already had the virus, due to the potential for reinfection and severe disease.

We have hundreds of people dying every day. Now, a quick background on TMIT Global and the coronavirus Community of Practice. Our first speaker today is Jennifer Dingman.

For the past 37 years, TMIT Global has been working in the patient safety and quality area. We have been fortunate to develop relationships with over 3,100 hospitals and have an expert pool of 500 professionals who work with us. When we began our Coronavirus program, we started with about 40 experts from multiple fields including clinical, operational, and financial, of various ages. That number has since grown to more than 130, plus additional contributors.

For those of you watching, you may recognize names like Sully Sullenberger, Dr. Don Berwick, Dr. Howard Coe, Dr. Jim Beijian, Bill George, the former CEO of Medtronic, and other leaders who have appeared in our previous discovery films. We now have three documentary series scheduled for release shortly. In addition, we have conducted more than 50, 90-minute programs combined with our patient safety initiatives, 26 Survive and Thrive programs, and a range of activities with students and major medical centers in both research and content development.

I won’t go on for too long, but I encourage you to watch these programs, which we will update regularly. They have been converted to podcasts for those who prefer to listen, and have also been produced as mini-documentaries that are available on our website and YouTube.

Lastly, we have a youth and young adult team ranging from middle school to age 30, with a significant number of high school and college students, as well as those in the early stages of their careers. We have strong representation in our R&D model from organizations and leading universities such as Harvard, Stanford, UCLA, Chapman University, Princeton, NYU, Tufts, CL, University of Florida, and more.

Our initial focus was on essential critical workers to develop opportunities for them to cope with the virus back in 2020 when we noticed no one was really focusing on them. Our argument was, if we save the families, we save the worker. If we save the worker, we save the nation. We conducted a study of 1,000 workers centered on the head, heart, hands, and voice, asking what we need to know, feel, do, and share.

It’s my pleasure to introduce Jennifer Dingman. Jenny is the founder of Pulse, Persons United Limiting Substandard Healthcare, and the co-founder of Pulse America Division. She has been a TMIT advocate for many years, served on federal quality programs, co-authored in the Journal of Patient Safety, and notably, won the Pete Conrad Global Patient Safety Award for her work on hospital-acquired conditions, a major pay-for-performance program for US hospitals. She has been a dedicated supporter of both caregivers and consumers.

This program was originally designed for essential critical worker families. Due to its great reception, we’ve expanded it to the general public. So Jennifer, we’re thrilled to have you help set our course today by focusing on our families, consumers, and caregivers.

Jennifer Dingman:
Thank you, Dr. Denham, for having me. I’m very interested in today’s webinar and the information being presented. I’d like to thank everyone for attending and encourage you to share the recording of this and other webinars with friends, relatives, colleagues, and neighbors. I’m excited about the speakers today and the information we will learn. As consumers, patients, and families, we can help prevent future fraud. Many people believe COVID is over or have become complacent. I have a local physician friend who caught COVID but has recovered. She is concerned about the growing complacency. We need to stay vigilant, as this is still a killer disease. The more we know and learn, the safer we’ll be. Dr. Denham, I’ll hand it back to you. Thank you for this excellent series.

Dr. Charles Denham:

Thank you, Jennifer. We greatly appreciate it. There are a number of structures that we need to understand to contextualize how those of us who are consumers, as well as caregivers and others, have to deal with this fraud issue. One structure we use repeatedly is the healthcare value chain. I know that the majority of our audience, both live and those who will be listening to the podcast and watching the videos, are consumers. Many are familiar with healthcare, while others are from law enforcement.

So, let me provide a quick overview of our healthcare system. There are three main components: suppliers, providers, and purchasers. Suppliers provide products, technologies, and services to our providers. These might include devices, pharmaceuticals, testing, and many other things. Our providers, which encompass professional caregivers and healthcare institutions like hospitals, outpatient surgery centers, urgent care centers, and doctor’s offices, use these supplies to deliver care to purchasers. The largest purchasers are the federal government through Medicare and Medicaid programs, insurance payers or intermediaries working with employers or directly with consumers, and consumers themselves.

We’ll discuss the fraud that occurs and overlaps among suppliers, providers, and purchasers. Suppliers may deal with counterfeit masks, tests, and medications, as well as misinformation and disinformation about these products and services. Fraudsters may use and popularize these products to sell ineffective items for COVID-19. Providers may encounter price gouging, conflicts of interest, wrongful termination of caregivers, and other fraudulent behaviors in this more than $3.5 trillion market. There’s also surprise billing, lawsuits against patients, and counterfeit testing processes. In the case of purchasers, there may be denial of coverage, denial of disability benefits, and a “co-pay time bomb,” where insurers who initially waived co-pays for COVID-19 testing have now quietly rescinded that policy, leading to surprise expenses for consumers. Medical identity theft and cybercrime are also concerns.

Chief Bill Adcock, Chief Security Officer and Vice President of MD Anderson Cancer Center, and Chief of Police of the University of Texas at Houston, has been a long-standing champion of performance improvement in emerging threats, much broader than COVID-19. He’s been instrumental in threat safety science, applying concepts such as “left of boom,” derived from the military, and the four P model. Now, let’s listen to a recording from Chief Adcock, who will not be here live, but will share with us these concepts.

It’s my pleasure to introduce Chief Bill Adcock, Chief Security Officer and Vice President at MD Anderson Cancer Center, and Chief of Police at the University of Texas at Houston Police Department. He has been a long-standing champion of performance improvement in emerging threats, much broader than COVID-19. We’re excited about getting back to some of these emerging threats and addressing the gaps in our safety net, as discussed last month. Chief, would you explain the concept of “left of boom” that you derived from the military?

William Adcox:
Sure. Dr. Denham, thank you everyone for being here today. “Left of boom” is a term that was coined by the United States military while we were battling terrorism on the front lines in Iraq. The terrorists had become very skilled at developing IEDs, which are improvised explosive devices, and planting them. Our vehicles would drive over them, and a large explosion would damage vehicles, killing or permanently injuring many of our soldiers. The military was able to obtain a tremendous amount of funding, billions of dollars, to harden the vehicles so they could survive an IED attack. However, the attacks were still occurring. They quickly realized that they needed to do something to prevent IEDs from being planted in the first place.

So they went back to Congress for more money, and the understanding was that they felt they’d already given the money to deal with the problem. They explained they needed to get “left of boom,” or left of the explosion, meaning they needed to go upstream to identify how they could work with the Iraqi community and various organizations to identify the technically skilled individuals who were building these IEDs in order to disrupt them and prevent them from happening. “Left of boom” refers to actions taken before an event occurs, while “right of boom” refers to actions taken after an event.

Dr. Charles Denham:

That was so helpful for us to really understand the four P model that we use in all of our projects: prevention, preparedness, protection, and performance improvement. Could you help us understand more deeply the two different factors of prevention that you’re focusing on?

William Adcox:
Certainly. This model is critical, and we recommend that everyone use it. In prevention, there are two types: primary and secondary. Primary prevention occurs when an incident or event does not happen, meaning you’ve actually prevented it. Secondary prevention focuses on reducing the overall harm when a harmful event does occur. We’re able to reduce the residual outcome or damages through partnerships, working with communities and various parties.

Preparedness is our state of readiness, ensuring that we can effectively respond to harmful or damaging events. This includes having early warning systems, training personnel, conducting exercises, and having solid operational plans in place.

Protection is an agile and adaptive model that leverages people, processes, and technology to best protect institutions, patients, ourselves, and others.

Lastly, we have performance improvement, a constant loop of quality assurance and improvement across all service lines and events. Using a data-driven process, we can review and take the necessary action to make improvements. The model is not independent; all of these aspects are interrelated and interdependent, feeding upon one another. You really need to have a full model in place and a solid understanding of how it works. That’s the best way to protect yourself and prevent events for your organization. There’s no doubt about it.

Dr. Charles Denham:

“So, we will be applying this concept as we go through these various areas of fraud. In 2019, before the Covid crisis struck, we launched a community of practice comprised of leaders like, and including, Chief Adcox and Dr. Boats at MD Anderson, leaders at the Mayo Clinic, and leaders at a number of our top-ranked US News and World Report hospitals, encompassing approximately 30 areas, both visible and invisible, that were of great concern to us in hospitals. A number of these organizations, for those of you listening to the podcast, include Mayo, Harvard Affiliated Hospitals, University of Florida, University of Southern California, UCSF, Stanford, and, as I said, MD Anderson. One of the areas was a focus on readiness for epidemics, so we were not surprised when that became a critical issue. But one of the other major concerns is the cybersecurity of patient records, including breach, theft, and contamination of medical records. Fraudsters may steal your records or contaminate them through what they are undertaking, meaning that if someone steals your medical records and then uses them to get drugs or to get a medical procedure, all of a sudden, your medical record has been contaminated. Even though you still have it, it could be damaged or deleted. Other areas of fraud include theft of intellectual property, employee fraud including misrepresentation of identity, qualification, safety-related issues such as vaccination testing and attestations of truth, patient fraud including misrepresentation of identity and safety issues. This is not only a cybersecurity threat, but also the fraud that can occur once they get those records. There’s the conflict of interest of staff, including physicians, researchers, and administrators, and their behaviors in conflict with preserving the rights of an employee. Wrongful termination is an example of where conflicts of interest occur within an organization. There’s also conflict of interest of governance, which has occurred at a number of our top medical centers, where those who are part of the governing body have dipped into the coffers or gained some unfair business advantage because of their representation of the hospital. And then there’s academic fraud, including fabrication, falsification, and plagiarism, which can actually affect medical care. When a fraudulent paper comes out, the fraud is perpetrated, and patients who are improperly given a treatment suffer. These all seem esoteric, but we will get into some practical examples. We use another framework of inside and outside threats. When you look at your family and yourself individually, your goal is to build resilience, both from external threats that can harm your family, and internal threats. So, what are those? Well, in hospitals, it’s staffing shortages, COVID, but it can also be the risk of an immunocompromised person living with you, an elderly person who may be at greater risk, or someone who denies vaccines and decides not to get vaccinated or wear a mask, putting everyone else at potential risk. We are dealing with competing narratives. And one of the really good examples of a narrative is what you’re seeing in the press now. We have polarizing press taking positions and telling stories. The narrative, as described beautifully in a video clip from the TV show Bull, is a story that makes sense of a version of the facts that supports an argument made by an organization or an individual. Attorneys will take advantage of the existence or absence of documentation to support their clients. Good attorneys believe they should do everything in their power, regardless of whether their client is guilty or innocent, to win the case, believing that, overall, more justice and fairness are delivered that way. Many of us have anxiety and are upset by this. However, that’s the way the system works. Our attorneys, especially trial attorneys, and those negotiating against or for you for insurance coverage, will seize facts and address a version of the facts that supports their argument. It’s not necessarily about truth or falsehood; it’s about available facts. It’s critical that patients manage their medical documentation and supplement it to protect themselves because a significant proportion of the fraud we see involves unsuspecting, naive caregivers and care receivers. Patients receiving care are taken advantage of by the way the system works. I have many friends who are attorneys, and they will agree that this is what they do. They develop a narrative. It’s the way the system works, as described by Michael Weatherly in this video clip.”

Video Clip Transcript:
“And then we’ll work with the DA to pick the perfect jury. By monitoring the reactions of our mirror jury, we will know at the end of each day how our case is being presented and what changes we need to make to achieve the best outcome for our client. Very impressive, Dr. Bolt. But it starts with the narrative, the story we tell that makes sense of what happened but also supports our version of the facts and leads everyone, the judge and the jury, to the same conclusion: the narrative.”

Dr. Charles Denham:

“So, one must understand that as you deal with fraud, as you deal with prevention, preparedness, protection, and then performance improvement, you’re dealing with the narrative. Now, the leaders in information are helping us understand that there’s misinformation, disinformation, and malformation. This is the best framework that exists. The terms misinformation and disinformation are used interchangeably by many pundits. But those who really need to understand what’s true—facts, patterns, and what’s not a fact—have to sort the wheat from the chaff. So let’s go through what this is. They’re on the dimensions of falseness and intent to harm. What’s misinformation? It’s unintentional mistakes such as inaccurate photo captions, dates, statistics, translations, or when satire is taken seriously, spreading false information that you think is true.

You may think something is true because you’ve received information about treatment for COVID, for instance, that is actually misinformation. You’re honestly sharing and applying it, believing it is true. Your intent when you pass it on is not to harm someone else. But disinformation is fabricated or deliberately manipulated audiovisual content, intentionally created conspiracy theories, or rumors. There’s a huge proportion of this among science deniers, and enormous politicization has generated a lot of fraud and people buying supplements and products or not getting vaccinated or not using masks because their sources of information have a political intention.

Malformation, not often talked about, is fabricated or deliberately manipulated audiovisual content, intentionally created conspiracy theories, or rumors. It’s the deliberate abuse of private information with the intent to harm or intimidate. You may have accurate information about someone, but it’s personal and private, and then it’s used, as in the case of nurse Kimberly Hyatt in Washington State. Her HR record was released, creating a negative tone and questions about her after she made a typical system error on a patient, unintentional. She committed suicide because the harm was so great.

So let’s talk about some real detail regarding some elements of fraud. We’re going to be undertaking a much broader-scale program because it’s such an enormous problem. But when we look at suppliers and counterfeit masks, we have produced videos that you can review on our website. We’ve come up with a framework that’s easy to remember: filter, fit, and finish. When deciding whether to wear masks or which one to pick and how to use it, it’s important to remember the filter—how good is it at filtering out particles? The fit, because a bad fit on a good filter may not protect as well as a not-the-best filter with a really good fit. And finish means not touching the outside of the masks. Medical masks and N95 masks have an electrostatic charge that attracts the virus to keep it from entering your airway. Cloth masks have been discarded as ineffective against the current virus.

When thinking about masks, I personally know Dr. Fauci and the recently retired head of the NIH. Unfortunately, information they shared was taken out of context. You can find a video clip from two years ago of Dr. Fauci and another from a month ago and claim he’s a liar or contradicting himself. We found out aerosol is how it spreads and it spreads from asymptomatic people. So, a quick snapshot of masks: what’s important is can I catch it, can I spread it, can I get sick, can I get long-haul, and do I benefit from a mask? If you’re unvaccinated, absolutely both for protecting you and others. If you’re vaccinated, yes, still, especially with the highly transmissible omicron sub-variant. Youth and children, yes, the benefits are there, and you can make decisions based on what’s happening in your community.”

Now, let’s consider the important work in aerosols and mask science. Those who understand the science of masks know there’s no real controversy, provided you delve into the issue and the content. Let’s move away from misinformation and disinformation and talk about those who are selling counterfeit masks, misleading people into thinking they are protected. You can find information about counterfeit masks on the CDC website. Signs of a counterfeit mask may include the absence of markings on the filtering facepiece, no approval number, and no NIOSH markings. NIOSH is the trusted source for safety issues related to masks. Sometimes, NIOSH may be spelled incorrectly by people outside the country. Counterfeit masks may have decorative fabric or other add-ons, claims of approval for children (which NIOSH doesn’t do), and the respirator may have ear loops instead of headbands. Though some good surgical masks have ear loops. For those on the audio, I’m showing an example of the correct exterior markings of a legitimate mask. Visit the CDC website for information and examples of counterfeit masks.

As we head into the summer, the highly transmissible Omicron variant will likely continue to circulate. As an expert who has studied this for the past 24 months, I don’t enter poorly ventilated indoor spaces without wearing a mask. My family and I wear masks in stores, when giving rides, or when using ride-share services. We also practice good hand hygiene.

Let’s now address the issue of price gouging, conflicts of interest, and surprise billing by healthcare providers. I’ve personally experienced this with my son’s heart surgery. We confirmed the surgeon and hospital were in-network, only to receive a bill from the out-of-network anesthesiologist that was higher than the surgeon’s charge. The worst part is hospitals suing patients who can’t afford to pay, sometimes resulting in the loss of their homes.

I’ll share a video from Dr. Marty Makary, a respected physician and author of two books, “Unaccountable” and “The Price We Pay,” both of which I highly recommend. I’ve had the pleasure of getting to know Dr. Makary and working with him in the cancer field. I have no financial relationship with him or any of the other speakers. Now, let’s watch his TEDx presentation.

Dr. Marty Mackary:
When American hospitals were built, they were constructed by their communities to serve those communities. It’s an incredible heritage. Many of them were established by wealthy business leaders as donations or charities. Others were built by churches or by everyday members of the community to serve that community. Their charters were incredible. Mr. Hopkins dedicated Johns Hopkins to serve, quote, “the indigent of the city,” regardless of one’s race, creed, or ability to pay. This is our great public trust. Hospitals were founded on a great public trust. When polio affected 20,000 people in the United States, disabling them and putting them in iron lung machines, it was one of the worst things imaginable.

Jonas Salk invented the vaccine. He was advised by many of his colleagues and business friends to patent it. They said it would be the greatest moneymaking patent in history. But he declined, saying it would be a gift to the American people and the property of humanity. We talk about drug pricing today, but let’s remember our great heritage of public trust. Doctors, nurses, physical therapists – all of us who see patients at every level – have inherited this great public trust. It allows us to have intimate relationships with patients, one of the most beautiful aspects of our profession. We have this trust because, for centuries, health professionals have earned it. As one philosopher put it, who else advocates for equality better than the witnesses of birth and death? That is our great medical heritage.

When I see a patient, I need them to trust me. We sometimes have to make tough decisions, and we need to make them together. I rely on that public trust. In no other profession can you put a knife to someone’s skin within seconds of meeting them, and they let you do it because of the public trust. They will tell you secrets they’ve never told anyone because of that trust. But today, that great public trust is threatened by a new business model in some areas of healthcare that involves price gouging and even predatory billing.

I have friends in my department of surgery who ask why I no longer attend our cancer research ideas meetings. I tell them that I’m working on other stuff, like researching pricing in healthcare, markups that patients encounter, and payment reform. I also defend patients pro bono in court cases when they’re sued by hospitals to have their wages garnished. I do this because 64% of Americans say they’ve avoided or delayed medical care for fear of the bill. We have a public trust crisis in healthcare, and we need to rebuild that trust. Our cures for cancer are no good for half the public if they won’t come in to see us.

We’re trying to create public accountability. We understand the codes and the games. We know that we have good people working in a bad system. Hospital leaders and people in insurance companies are not diabolical. They’re good people who’ve inherited a terrible game that has spun out of control. We’ve inherited the game of inflating prices for the purpose of offering secret discounts to different groups. It’s a crazy game.

This threatens the great public trust. If airlines said they couldn’t show you the price for a flight until after the flight, we would say that’s crazy. But that’s exactly what we have in healthcare. We can get our house in order and provide prices for common, predictable services. We should be able to tell patients the price of a procedure. We need to take care of patients’ financial health as well as their medical health.

I recently spoke with an executive from Google who asked how they could help. I told him we need more public accountability. We should have benchmarking and improvement in healthcare like in other industries. My team at Johns Hopkins firmly believes that financial toxicity is a medical complication. Billing quality is medical quality. Taking care of a patient means taking care of the entire person. We didn’t take an oath to treat patients, cure their diseases, and ruin their lives financially. It’s not part of our great medical heritage.

We’ve created billing quality measures that were published this month in the Journal of the American Medical Association. They’re simple. First, does the hospital provide an itemized bill in plain English? Second, does the hospital offer a real price when patients ask for common shoppable services? Over 60% of medical care is shoppable and predictable. We can give real prices, not inflated ones designed for secret insurance discounts.

Dr. Marty Mackary:
When American hospitals were built, they were constructed by their communities to serve those communities. It’s an incredible heritage. Many of them were established by wealthy business leaders as donations or charities. Others were built by churches or by everyday members of the community to serve that community. Their charters were incredible. Mr. Hopkins dedicated Johns Hopkins to serve, quote, “the indigent of the city,” regardless of one’s race, creed, or ability to pay. This is our great public trust. Hospitals were founded on a great public trust. When polio affected 20,000 people in the United States, disabling them and putting them in iron lung machines, it was one of the worst things imaginable.

Jonas Salk invented the vaccine. He was advised by many of his colleagues and business friends to patent it. They said it would be the greatest moneymaking patent in history. But he declined, saying it would be a gift to the American people and the property of humanity. We talk about drug pricing today, but let’s remember our great heritage of public trust. Doctors, nurses, physical therapists – all of us who see patients at every level – have inherited this great public trust. It allows us to have intimate relationships with patients, one of the most beautiful aspects of our profession. We have this trust because, for centuries, health professionals have earned it. As one philosopher put it, who else advocates for equality better than the witnesses of birth and death? That is our great medical heritage.

When I see a patient, I need them to trust me. We sometimes have to make tough decisions, and we need to make them together. I rely on that public trust. In no other profession can you put a knife to someone’s skin within seconds of meeting them, and they let you do it because of the public trust. They will tell you secrets they’ve never told anyone because of that trust. But today, that great public trust is threatened by a new business model in some areas of healthcare that involves price gouging and even predatory billing.

I have friends in my department of surgery who ask why I no longer attend our cancer research ideas meetings. I tell them that I’m working on other stuff, like researching pricing in healthcare, markups that patients encounter, and payment reform. I also defend patients pro bono in court cases when they’re sued by hospitals to have their wages garnished. I do this because 64% of Americans say they’ve avoided or delayed medical care for fear of the bill. We have a public trust crisis in healthcare, and we need to rebuild that trust. Our cures for cancer are no good for half the public if they won’t come in to see us.

We’re trying to create public accountability. We understand the codes and the games. We know that we have good people working in a bad system. Hospital leaders and people in insurance companies are not diabolical. They’re good people who’ve inherited a terrible game that has spun out of control. We’ve inherited the game of inflating prices for the purpose of offering secret discounts to different groups. It’s a crazy game.

This threatens the great public trust. If airlines said they couldn’t show you the price for a flight until after the flight, we would say that’s crazy. But that’s exactly what we have in healthcare. We can get our house in order and provide prices for common, predictable services. We should be able to tell patients the price of a procedure. We need to take care of patients’ financial health as well as their medical health.

I recently spoke with an executive from Google who asked how they could help. I told him we need more public accountability. We should have benchmarking and improvement in healthcare like in other industries. My team at Johns Hopkins firmly believes that financial toxicity is a medical complication. Billing quality is medical quality. Taking care of a patient means taking care of the entire person. We didn’t take an oath to treat patients, cure their diseases, and ruin their lives financially. It’s not part of our great medical heritage.

We’ve created billing quality measures that were published this month in the Journal of the American Medical Association. They’re simple. First, does the hospital provide an itemized bill in plain English? Second, does the hospital offer a real price when patients ask for common shoppable services? Over 60% of medical care is shoppable and predictable. We can give real prices, not inflated ones designed for secret insurance discounts.

And I apologize to those of you representing hospitals, but you know it’s true. And if you look at your own hospital, you’ll be surprised. If not, then I congratulate you and I think you should make people aware of it. Let’s shift gears to conflicts of interest among staff, including physicians and researchers, conflicts of interest in governance, and academic fraud. The first two tie directly to wrongful termination, which is a critical issue. It’s one of the major areas of fraud in both healthcare and among essential critical workers. Just to remind you of the last topic we covered, Walmart employees were the largest group being sued for their medical bills. So these are not wealthy people. Now, academic fraud, including fabrication, falsification, plagiarism, or dishonest grant documentation, we have an epidemic of this.

What’s critical in COVID is that people are publishing articles in less-than-top scientific journals, and there’s no check and balance for some of these predatory journals addressing this challenge. Now I’m watching our time. We’re at 11:04. For those of you watching live, we’ll cover these topics in more detail. Let’s talk about counterfeit testing. Testing is critical. It’s going to be even more critical probably later this summer and this fall if we don’t see the Omicron B.4, B.5, and especially B.5 lineages surge. If they surge, we will have to go back to understanding the right test at the right time. And we’re going to be updating a major mini-documentary we did on this. Today, we’re just going to cover the counterfeit issues. So what are the counterfeit issues? There are counterfeit tests out there that you can buy over the web that are not real tests at all.

They’ll come out negative every time because they don’t even have the reagents necessary to identify whether you have COVID or not. This is extremely dangerous if you’re going to meet with an elderly person, an immunocompromised person, or meet in a group. Also, there’s so much misinformation and disinformation on testing. Testing is a godsend for those of us. My son will be going to Costa Rica on a surfing trip next week. He’s taking the tests with him, he’s using N95 masks, and we’re doing everything to provide the layers we can. Would I buy a cheap test on the web from some unknown vendor? Absolutely not. I couldn’t count on it at all. Even with the best tests, we know we have false negatives. The other category is counterfeit testing by providers.

Those that actually have licenses in states who say they’re doing a PCR test. There are many stories of these fly-by-night organizations that do testing, they’ll do it rapidly for you, charge your insurance, or charge you cash, and then they just throw away the sample. It’s vital that you stick with top-notch care providers in your community. Go through your relationship networks to find out where the best places are to get testing. That’s just what I did when I went on a movie set last year during COVID. I identified where the nurses and local children’s hospital were getting tested, went in and got my PCR sample taken in a parking lot, it was expensive, but I knew I could count on it. And those on the movie set could count on it as well.

False vaccination cards are an enormous problem. And you can go on the web to see examples of this. This dropped away when vaccination mandates dropped away. They may come back if we have enormous surges or if you apply for a job that requires vaccination. It’s critical not to falsify any records. People are getting caught, and more importantly, you’re harming others. If you don’t want to get vaccinated, you’ve chosen a path like choosing to go in the smoking section of a restaurant. You’ve made your choice, but please don’t harm other people using these. There are many vendors out there, and they may come back this fall. As we look at fraudulent testing, there are suppliers producing devices that don’t work with false negative results, as well as dishonest providers.

Testing relates to viral load. If you have a huge viral load, you’re more likely to have a true positive. If you have minimal viral load, you might be borderline. Knowing the right test at the right time with the right organization is critical. We’ve undertaken a webinar, go to our website at medtechglobal.org. We spent weeks preparing it, consulted all the best experts on testing. The nature of the testing hasn’t changed. We’ll be updating the differences between the linear flow home test and the PCR test. And remember, PCR tests may detect fragments of the virus long after you’re contagious. The home tests are excellent for identifying whether you’re contagious, especially if you have serial tests. Some universities only require one, I do two or three just to make sure. PCR tests could be positive long after. Please watch our program and listen to the podcast comparing PCR and rapid antigen testing.

What’s really critical for travel is assessing the threats, vulnerabilities, and risks before departure. Maintain safe practices in all vehicles and practice the safest practices at the airport. The jetway without air conditioning in the airplane is one of the most dangerous areas. The restroom is also one of the most dangerous areas, as both are poorly ventilated. Once the airplane’s air conditioning systems are operating, the HEPA filters are active. Please watch our webinar to address these issues. We will have a videotape on our website about the scams that are going on. If we have time before the end of our half past the hour, we’ll go through it. But the test site scams were very high when the surges occurred. False results, false negative results were very common. Lastly, identity theft is critical to know. We presume that because we go to a doctor’s office, we fill in all this information, including our social security number when we go to the hospital and all of our data. And it’s vital to know that these things are crucial when we look at purchasers. We’ve talked about supplier fraud, counterfeit mask tests, counterfeit medications, misinformation. We’ve looked at provider fraud, price gouging, conflicts of interest, surprise billing lawsuits against patients, and counterfeit testing. Now, what about the purchasers of care? Healthcare consumers, insurance companies, and employers, denial of coverage is happening.

That’s why it’s critical to have good medical records. You should have a set of medical records at home. Sign all the releases to get them. Your medical records are vital for your protection against denial of disability benefits. I shared an experience of helping an older man in his sixties who got COVID and long COVID. He could no longer work and was getting lost finding his way to a bank that he’d driven to for 20 years. He had vestibular difficulties and was falling down in the shower. I helped him using his medical records. He was denied four times by a legitimate insurance company. We wore them down and finally, by resubmitting data and documentation and getting him to a long COVID clinic, he received a substantial amount.

The COVID time bomb is that insurance companies have stopped waiving your portion of the bills for COVID care. This happened quietly. So we were lulled into believing that it was okay. Major insurance companies have pulled out those props, and suddenly people are having enormous bills when they go in for a workup of symptoms that are hard to pin down. This is why it’s critical to get into a long-term COVID clinic, get your records, and make sure it’s clear when symptoms started so you can protect yourself. Identity theft and cybercrime are enormous problems. Medical identity theft and contamination are major issues. Hospitals, doctors, pharmacists, ambulance services, nursing homes, home healthcare, and laboratories are notorious for gouging. Cybercrime and identity theft are concerns for all these organizations. Your personal information, social security number, health insurance account, medical record number, doctors, drugs, and devices are critically important. A healthy person with good healthcare insurance and a good credit rating has a medical record that might be worth 20 to 50, or even a hundred times the value on the black market than their credit card information and home address. The reason is that your medical record can be sold to a fraudster who can then get illicit drugs or even transplants and penile implants on someone else’s insurance policy. This is an enormous problem. A recent article stated that the cost of remediation may be $13,500. We’ve seen it as high as $21,000 to remediate.

Many people face challenges in obtaining their medical records. For instance, my wife’s medical records were breached by a major medical center. We’ve been alerted multiple times about breaches to our medical information. This brings us to the five rights of medical records. If you’ve followed us for a while, you’re familiar with our series on the five rights of various medical topics. We play on the dual meaning of “right”: something you’re entitled to and ensuring correctness. Let’s delve into the five rights of medical records.

1. Right of Ownership: Patients have the right to own a copy of their medical records. While providers may possess the original records, patients are legally entitled to a copy. It’s reasonable for providers to charge a fee for this service. It’s essential to procure these records from all medical facilities, including hospitals and labs.
2. Right to Access: Quality of care is directly tied to patients and providers having timely access to medical records. For the best care, patients should immediately request their medical records after any medical procedure. It’s essential to be patient and courteous when dealing with medical records departments.
3. Right of Communication: Effective communication is crucial. Delays or breakdowns in transmitting medical records can lead to preventable harm and costs. Patients should ensure secure transmission methods. While emailing is not HIPAA compliant, faxing is. Patients can use electronic fax services to safely receive their records.
4. Right to Updates: Keeping records updated is vital. Patients must ensure that their records are current.
5. Right to Security: Ensuring records are securely stored and transmitted is crucial for protecting patient privacy.

In summary, it’s crucial for patients to be proactive about their medical records. By understanding and exercising their rights, they can maintain control over their personal health information and ensure they receive the best possible care.

For years, I’ve been assisting family members. Even though I’m retired as an oncologist, we all have friends with serious diseases. We collaborate with outstanding researchers in over 3,100 hospitals, many of which are top-ranked. Consequently, we frequently send updated records. Let me summarize the key points:

1. Ownership
2. Access
3. Communication
4. Timely and accurate updates: Keeping medical records current, including test results and medication lists, is crucial for safety.
5. Security: Insurance fraud leads to significant errors in medical records. Ransomware disruptions pose threats to both inpatients and outpatients. When fraudsters submit claims in your name, they corrupt your medical records, a problem that might persist for life unless rectified.

Because our time is limited, I want to give Jennifer Dingman the chance to ask questions and touch on some topics we’ve discussed. At the conclusion of the formal presentation, we’ll play a video featuring Dr. Boats, who will discuss the “Five Rs” from our study. For those interested in continuing with our audio program beyond the 90-minute live broadcast, you’re welcome to stay.

The Family Health Safety plans we’ve examined include the Five Rs: readiness, response, rescue, recovery, and resilience. We started this study with families of Essential Critical Workers in March 2020 and have been updating our findings since. We collaborated with institutions like Mayo, Harvard, UCI, UCS, USU, UT Southwestern, University of Florida, UCSF, Stanford, and MD Anderson.

To touch on the topic of readiness: Always have your medical records handy. If someone contracts COVID or another illness, contact the financial department of the concerned facility to determine insurance coverage and potential costs. You should be prepared to negotiate if needed.

When it comes to response: Have a plan for when someone falls ill. Recently, several friends and colleagues contracted COVID, leading them to isolate affected family members. Many discarded their N95 masks, mistakenly believing that the COVID threat had diminished. With the emergence of new variants, we must be prepared. If seeking care, particularly for long COVID symptoms or testing, understand the associated costs. Prices for tests, for instance, can vary significantly.

Regular and deliberate practice of health safety measures is essential. If a loved one shows severe symptoms, be prepared to take them to the emergency department. Always have masks and ensure your phones are charged. In the event of another surge, you might not be allowed to accompany your family member to the emergency department. Before seeking medical attention, make sure your insurance coverage is in place to avoid unexpected charges and ensure all necessary documents and medications are prepared beforehand. If conditions permit, keep windows down and wear masks to protect everyone. After a family member recover from an infection, be cautious and informed about current CDC guidelines. Always ensure safe practices to avoid spreading the virus within the family.

In both law enforcement and healthcare, preparedness is key. Many hoped that the challenges posed by Covid would soon end. But according to the epidemiologists we’ve spoken to, it seems we’re not out of the woods yet. In 2015, my son Charlie and I, along with Mr. David Bsch, began working on combining the best medical and tactical practices. We then introduced the Family Huddle checklist, which guides families on pre, during, and post-event precautions. Our latest advice includes the use of rapid antigen tests before gatherings, improving ventilation, and identifying vulnerable members. We remain committed to providing continuous guidance and updates. Jennifer, with the time we have left, do you have questions on this topic or any issues you’d like to address?

Jennifer Dingman:

I’m here, Dr. Denham. I’ve observed growing complacency about the virus, perhaps due to its persistent presence. But the reality is, hospitalizations, deaths, and long-haul Covid symptoms persist. It’s crucial for groups like ours to continue educating the public. Our speakers today offered invaluable insights, and I’ve learned so much. Thank you.

Dr. Charles Denham:

Thank you, Jennifer. For the past 26 months, you’ve been the voice of the patient. We truly appreciate your unwavering dedication. As we wrap up this session, I want to stress the importance of perseverance against this virus. We must fight the good fight, finish the race, and maintain our faith, ensuring that we take every measure to safeguard our loved ones.

We must remain optimistic that we can overcome this. Even if new lineages emerge, we possess the tools to combat them. Remember, every single one of us can be a patient at some point, and we always emphasize that anyone can become a caregiver. Thank you for joining us today. Special thanks to Jennifer and Chief Ed Cox. We’re fortunate to have Dr. Boats, who is currently in the ICU, with us. We’re also grateful for the expertise of Dr. McKarey. We aim to conclude by 11:30.

Next, in response to numerous requests, we’ll feature the presentation by Dr. Boats on the “five Rs” of our research study. This will highlight how we’ve structured a family plan and updated it for the new normal. Thank you to each one of you. And for those continuing with the audible broadcast, we’re grateful for your participation.