I recently read “The Chickenshit Club” Jesse Eisinger’s account of how political, cultural, and institutional changes have led to a shift from a justice system that held individuals accountable for corporate malfeasance to one that prefers deferred prosecution agreements and large dollar settlements. He cites many examples, following Enron and Arthur Andersen in 2002, in which prosecutors shy away from bringing individuals to trial and instead look to punish corporations, and extract large fines.
In healthcare, recent cases involving medical device and drug companies as well as large for-profit health systems seem to support Eisinger’s point. These cases involve settlements of hundreds of millions or even billions of dollars but don’t hold any individuals personally accountable.
While this trend may hold true in the case of large drug companies, for most healthcare providers, individual accountability continues to be a significant part of the justice system. In recent years, there are hundreds of examples of healthcare providers and executives that have been personally prosecuted, sentenced to jail, fined, and excluded from future participation in Medicare and Medicaid. A small sample of these cases is listed below;
| Date | Description | |
|---|---|---|
| Jun 2017 | AMI Monitoring owner – $1M settlement | Alleged steering to higher level of unnecessary services |
| May 2017 | eClinical Works founders – $155M settlement | Alleged false claims regarding software |
| Feb 2017 | 21st Century Oncology MD – $3.8M settlement | Alleged false claims for laboratory tests |
| Feb 2017 | Owner of National Pain Care Inc. – $20M settlement | Alleged false claims for medically unnecessary diagnostic tests |
| Feb 2017 | Owner of skin cancer centers – $18M settlement | Alleged false claims for biopsies and radiation therapy |
| Jan 2017 | Owners of Medstar Ambulance – $12.7M settlement | Alleged false claims for services not medically necessary |
| Oct 2016 | Owner of Life Care Centers of America -$145M settlement | Alleged false claims for rehab therapy |
| Jun 2016 | Owner of HIV/AIDS clinics – Sentenced to 63 months in prison | Alleged fraudulent billing and kickbacks to patients |
| Jun 2016 | Hospice owner – 8 yrs prison and ordered to pay $7.4M | Alleged defrauding of Medicaid and Medicare |
| Apr 2016 | Podiatrist – 3 yrs in prison and ordered to pay $1.3M | Alleged billing of services not delivered |
| Apr 2016 | Pain clinic owner – 9 yrs in prison and ordered to pay $3.1M | Alleged false billing |
| Mar 2016 | Behavioral health clinic owner – 20 yrs in prison and $5.9M | Alleged fraud and money laundering |
| Dec 2015 | FL businessman – Sentenced to over 14 yrs in prison | Alleged false claims for biopsies and radiation therapy |
| Dec 2015 | Cardiologist – Sentenced to 20 yrs in prison | Alleged unecessary nuclear stress tests and cardiac stents |
| Nov 2015 | Medical transport owner – 2 yrs in prison and $494,378 | Alleged billing of unecessary services |
Jesse Eisinger might be right about trends towards limited accountability of the C-suite at large, publically traded, organizations, however, most healthcare providers and executives of many healthcare organizations are finding that they are not part of this trend and remain exposed to prosecution as individuals