The County of San Bernardino (California) Department of Aging and Adult Services has issued a warning that scammers are posing as government officials and contacting senior citizens in the area by phone, e-mail, and even in person. They ask if the person has health insurance. If the answer is no, they threaten to send them to jail for allegedly not adhering to federal health policies. Then they offer to sell the victim “Obamacare insurance” which will supposedly keep them out of jail.

It shouldn’t need stating, but: There is no Obamacare insurance, these seniors aren’t going to be hauled off to jail and the scam is a blatant misreading of the provisions of the recent health care reforms. For the record, in 2014, citizens will be required to have health care coverage — but there will be access to public programs for those who don’t have private insurance. And those who still don’t procure coverage only face graduated fines, not jail time.

While this scam appears to be limited to San Bernardino, so far, it’s worth keeping an eye out for similar frauds in other parts of the country. It’s also a reminder to all health professionals that there are still a lot of people who don’t understand how health care reform actually effects them — and there are plenty of people spreading misinformation.

If you suspect someone has been a victim of these particular con artists, authorities encourage you to call law enforcement or San Bernardino Adult Protective Services at 877-565-2020.

A new study from the American Medical Association looked into which doctors — by gender, age, specialty, etc. — are most likely to get sued or have other liability claims against them.

The report (downloadable) makes interesting — if sometimes maddening — gawking material. For example, a review of the records found that 65% of claims are dropped or dismissed, and another 30% are settled or decided via an alternate dispute method. Only 5% of claims actually go to court — of those, 90% are decided for the physician.

Even a win can be costly, however: Average costs to defend against a claim were just under $40,700. For claims that were dropped or withdrawn, it cost an average of just over $22k to defend; cases that go to trial average more than $100k to defend.

More frustrating: The rate of claims seems to have little correlation to actual malpractice. The AMA researchers found that among closed claims, 3% of patients hadn’t suffered any injury and in another 37%, there had been no error.

Worse: Many injured patients and wrongly accused doctors don’t get true justice. The researchers found that 27% of claims are paid despite the doctor not making an error. At the same time, 27% of patients who suffered from an error receive no compensation.

By the numbers

A doctor’s specialty, type of practice and even gender play a role in how likely he or she is to face liability claims.

Not surprisingly, the study found that the specialties with the highest rate of claims were general surgery and obstetrics/gynecology, with nearly 70% of physicians in those specialties facing suits during their careers.

Least likely to face claims: pediatricians and psychiatrists. Less than 30 percent of doctors in these specialties were sued during their careers.

The study also found that the type of practice can increase a doctor’s risk of being sued. Among physicians in solo practices or single specialty group practices, 45% faced lawsuits in their careers. The rate was only 40% for physicians working in hospitals, and 37% for doctors in multi-specialty group practices. Owners of practices are also more likely to be sued than employees.

Male doctors are twice as likely to be sued. In part, because they are concentrated in specialties with high rates of claims and are more likely to own their practices. The researchers noted that other studies indicate differences in interpersonal skills may contribute to some of the gender gap in lawsuits, but the data is difficult, at best, to quantify.

That’s the lesson recently learned by Kawai Ary-Berry, a licensed massage therapist in Lubbock, Texas. She was found guilty of a range of health care fraud offenses, including billing the federal worker’s compensation fund for services never performed, billing for massage services she improperly coded as physical therapy and fraudulently billing the government for “equipment rental” when she had patients sit in a sauna.

Berry now faces 78 months in federal prison, to be followed by three years of supervised release, and must pay $1.6 million in restitution.

The breach was discovered by a photographer for The Boston Globe, who noticed a 20-foot by 20-foot pile of paper when he was dropping off his own trash. He checked out the cache of paper, curious why it wasn’t being recycled. Closer examination showed the paper was a mass of patient records from at least four Massachusetts medical centers and their associated pathology groups. The hospitals affected are Carney, Holyoke, Milford and Milton.

The investigation is ongoing, but so far it appears that the a billing vendor used by several of the pathology groups dumped the records. The billing company was sold at the beginning of this year — most of the records were from 2009.

A small sample of the records collected by The Globe contained sensitive data including patient names, addresses, insurance information, Social Security numbers, pathology reports and post-miscarriage lab work.

A few things are still unclear, including how many patients — at how many hospitals — may have been affected. The hospitals are trying to determine whose records may have been compromised so they can begin notification procedures.

Data breaches of this sort aren’t uncommon, but it appears in this case that the hospitals had no reason to believe the records weren’t being disposed of properly.

Unfortunately, even hospitals with strict adherence to privacy controls can fall victim to a data breach if one of it’s countless physicians, other associated health care providers, billing companies, insurance partners or other contractors who have access to patient data aren’t as careful.

Over a five-year period, Harlem Hospital Center in New York had some 7,000 echocardiograms that were only read by technicians — the ordering physicians never saw them, for reasons that aren’t clear.

Pretty scary sounding. But follow-up examination of the records found that of the 7,000 ECHOs, only 14 of them had been misdiagnosed. Twelve of those 14 patients were contacted — and none of them had suffered any adverse effects.

That silver lining is disguising a nasty gray cloud. Delving further into that data indicates something doesn’t add up.

To be so accurate in diagnosing via the tests (99.8% accurate, to be exact), the hospital would have to have the world’s best team of technicians — and one wonders why the physician oversight would be needed.

It would also seem safe to assume the doctors ordered those tests for a reason — yet they clearly didn’t use the results when deciding on a course of treatment for their patients. Why not? And why didn’t anyone notice that vital test results were missing?

For that matter, with so many patients seemingly unaffected by their ECHOs never being read, it’s fair to ask how many of those patients actually needed the test performed in the first place.

Without more information, it’s hard to come up with acceptable answers: Perhaps most of the patients were retested later. Possibly more patients were negatively affected than has been disclosed. It’s also possible that this group of ECHOs was not representative of the majority of tests. (Physicians and techs may have given lowest priority to results which showed no indication of disease — and these are the tests that fell through the cracks in the system.)

Regardless, this case has served to shine a light on some of the less visible signs that something has gone wrong with the health care system. Do you blame it on overworked/distracted employees, defensive medicine run amok or something else? Let’s hear your thoughts in the comments.

A new study from Health Affairs demonstrates the problem. Out of more than 1,500 interviews with patients, the researchers said the dominant themes were:

• More is better.
• Newer is better.
• You get what you pay for, and
• Guidelines limit doctors’ ability to give patients the care they deserve.

No wonder health care costs keep spiraling out of control.

Pamela Arrey, a Baltimore pharmacist, was recently sentenced to four years in jail after she pleaded guilty to health care fraud, identity theft and conspiracy to misbrand drugs. She’ll spend another three years on “supervised release” after serving her time. In addition, Arrey has to forfeit her home and pay over $500k in restitution. The home’s mortgage was paid largely through the ill-gotten funds.

Arrey owned and operated two pharmacies in Baltimore. For nearly five and a half years, Arrey claimed reimbursement from health care benefits programs for refills of prescriptions for which no drugs were ever dispensed. She targeted refills that had been authorized by doctors, but never picked up by patients, and used patient’s personal information to make the claims.

Areey also illegally relabeled and sold prescription drugs she had purchased from an unlicensed supplier. The mislabeled medications included vital prescriptions for treating diabetes and anti-seizure medications for epileptic patients.

Using the patient story line from the episode “Ignorance is Bliss,” the final tally came in at just about $300k.

Originally, the patient presented with anemia, a mild cough and ataxia or lack of muscle coordination. The preliminary diagnosis was a rare blood disease. Upon learning of the patient’s heavy drinking, the diagnosis was changed to a potential liver problem which required a liver biopsy at roughly $10k.

Then the patient collapsed — requiring an MRI for about $1k. The MRI indicated the patient had previously suffered a broken rib that healed incorrectly, damaging the spleen — and spurring the growth of 16 “baby spleens.” The estimated cost of a (highly unconventional) “multiple-splenectomy” was $200k.

Following this treatment, the patient suffered a stroke, requiring another $60k in various treatments. In the meantime, he also received various drug treatments which cost in the area of $90k.

That estimate doesn’t take into account the fact that one patient received essentially 24/7 care from a team of specialists — who handled no other patients while he was in their care. (They did however, spend a fair amount of time looking gorgeous and discussing their complicated love lives.)

While it’s easy to mock the show’s portrayal of life in a hospital, $300k to treat one patient is a sadly realistic number given today’s out-of-control health care costs.

During the past four years, Sapse is accused of telling his patients, suffering with a variety of illnesses including multiple sclerosis and cerebral palsy, that he could cure them with a new stem cell therapy.

The “treatment” involved putting placental tissue in the patients’ abdomens. It is, needless to say, not approved by the FDA. Sapse isn’t licensed in any state. He had other physicians actually perform the procedures.

Sapse netted approximately $1 million from his patients for the treatments. According to the investigation, Sapse spent most of the money gambling.

While a factory-style approach to efficiency may seem like the worst thing that could happen to the quality of patient care, the opposite is true.

Hospitals that have adopted continuous improvement programs like those used by manufacturers have found they’ve improved both their bottom lines and the level of care patients receive.

Seattle Children’s Hospital has adapted kaizan, a Japanese theory of business management, to continually make small adjustments that reduce waste and create a better experience for patients. It’s working.

For example, the hospital reorganized the stock room so that there are two constantly rotating bins of supplies. When one is empty, it’s sent to the central supply, where a scan of the bins bar code automatically orders replacements and nurses use the “back-up” bin. The increased efficiency allowed the hospital to cut its stockroom size in half. It also reduced waste, since there are fewer expired or outdated supplies that need to be tossed.

Between that and a number of other, equally small changes, the hospital has seen significant gains. In the past year, Seattle Children’s reduced its costs per patient by 3.7%, saving $23 million. The increased efficiency also allowed the hospital to serve more patients without incurring capital expenses to expand.

In another example, Akron Children’s Hospital spent $20,000 to streamline the sterilization process for surgical instruments and handle more operations each year. While the upfront cost might seem steep, it saved the hospital from spending another $3.5 million to expand the department.