ORGAN TRANSPLANTS: Overhauling the System

By Staff Reporters

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The Biden administration just unveiled a plan to revamp the problem-ridden system for organ procurement and transplants.

Health Insurance: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

One nonprofit, United Network for Organ Sharing, has had a monopoly on running the system for nearly four decades, but the government’s proposal includes potentially bringing more organizations in, as well as upping funding and modernizing the computer systems involved.

Health Technology: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

NOTE: There are ~104,000 people currently waiting for an organ transplant, and 17 people die per day while waiting.

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Harvesting: https://medicalexecutivepost.com/2017/09/05/on-organ-harvesting/

Dialysis: https://medicalexecutivepost.com/2021/09/22/podcasts-more-dialysis-center-investigative-reporting/

Body Brokers: https://www.msn.com/en-us/news/us/new-cbs-reports-documentary-body-brokers-explores-realities-of-donating-bodies-to-science/vi-AA18WVZ8?ocid=U521DHP&pc=U521&cvid=11f7cdab99224f1aa9290a2a3dbed05b&ei=33

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BOND HOLDERS: Credit Suisse

AT1 BONDS = OH NO!

By Staff Reporters

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DEFINITION: Junk bonds are bonds that carry a higher risk of default than most bonds issued by corporations and governments. A bond is a debt or promise to pay investors interest payments along with the return of invested principal in exchange for buying the bond. Junk bonds represent bonds issued by companies that are financially struggling and have a high risk of defaulting or not paying their interest payments or repaying the principal to investors. Junk bonds are also called high-yield bonds since the higher yield is needed to help offset any risk of default.

CITE: https://www.r2library.com/Resource/Title/0826102549

AT1 DEFINITION: Additional Tier 1 bonds are also known as “contingent convertibles,” or “CoCos”. They were created in the wake of the 2008 financial crisis as a way for failing banks to absorb losses, making a taxpayer-funded bailout less likely. They are a risky bet — if a lender gets into trouble, this class of bonds can be quickly converted into equity, or written down completely. Because they are higher-risk, AT1s offer a higher yield than most other bonds issued by borrowers with similar credit ratings, making them very risky. If AT1s are converted into equity, this supports a bank’s balance sheet and helps it to stay afloat. They also pave the way for a “bail-in”, or a way for banks to transfer risks to investors and away from taxpayers if they get into trouble.

CITE: https://www.r2library.com/Resource/Title/0826102549

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UBS’s emergency takeover of Credit Suisse may have been necessary to avert a financial crisis, but at least one group is Yosemite Sam-level angry over how the deal shook out. Investors holding $17 billion worth of Credit Suisse’s additional tier-one bonds were shocked to discover that their $17 billion was now worth a grand total of…$0. The value of those bonds had been completely wiped out in the deal.

Additional tier-one bonds, or AT1 bonds for short, were established after the 2008 financial crisis to reduce the likelihood that taxpayers would have to bail out a failed bank. AT1s are considered riskier assets, but with that risk comes higher potential returns.

RISK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

So, if these bondholders knew they were taking on risk, why are they so upset?

According to MorningBrew, mainly because, in this unusual deal, they got wiped out while shareholders didn’t. That’s not how the order of operations usually works:

  • When a write-down happens, shareholders traditionally suffer losses before bondholders get hit.
  • This deal flipped the food chain, and livid AT1 bondholders are now huddling up with lawyers about potential legal action.

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ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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NAPA Update for Inova Loudoun Hospital

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By Anonymous Letter Leaker

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DAVE – This is what happens when private equity takes over anesthesiologists and other medical services. Private equity has squeezed so much out of physician lives and their practices, that practice has become intolerable. They are all so burnt out that the physician anesthesiologist must now strike out against their own private equity group owners (NAPA). The trickle-down effect becomes with the hospital now caught in the middle, contracted with a private equity group which  provides anesthesia, but they have no anesthesiologist employees.

Where does patient care survive?

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February 2023
Colleagues,

As you may be aware, Inova contracts with North American Partners in Anesthesia (NAPA) to provide anesthesia services at Inova Loudoun Hospital. This week, we received notice that our anesthesiologists at Inova Loudoun Hospital have submitted 90-day notice letters of resignation to NAPA. In the spirit of full transparency, we are sharing this news with our physicians.

Here’s what you need to know:

Although we are monitoring this situation, Inova is not a participant in discussions. They are held solely between the anesthesiologists and NAPA. We are actively working to ensure minimal disruptions to current workflows at our care sites.      Our anesthesiologists are among the best in the country, and we fully expect that our team members will continue to provide world-class healthcare to the communities we are privileged to serve.

Per our care mandate, people are at the center of everything we do, and we take any situation that affects the work environment of our team members very seriously. We will continue to communicate with NAPA and keep you apprised of pertinent developments.

If you have questions about this situation, please contact Loren Rufino, Senior Vice President, Perioperative Services.

Thank you,

John J. Moynihan, MD, FACS               
President, Surgery Service Line          

Loren A. Rufino        
SVP, Perioperative Services   
Administrator Surgery Service Line

Paula R. Graling, DNP, RN, CNOR, NEA-C,
FAAN
VP, Nursing, Surgery Service Line

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Three BOTS of Artificial Intelligence

A.I.

By Staff Reporters

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  • Google revealed its answer to ChatGPT: an “experimental conversational AI service” called Bard that’s currently in testing mode.
  • Microsoft (which invested in ChatGPT) announced its own surprise event scheduled for later today in order to “share some progress on a few exciting projects.”
  • Chinese tech giant Baidu confirmed it’s on track to introduce its AI chatbot, known as “Ernie Bot” in English, in March.

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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LAUGH -or- CRY?

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IAN BEAN MD

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books& qid=1275315485&sr=1-4

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PODCAST: Employee Engagement and Health Plans

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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MEDICAL PROVIDERS: Hobson’s Choice in Medicine

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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TUCSON, Ariz., Dec. 06, 2022 (GLOBE NEWSWIRE) — Sheila Page, D.O., a family physician in Aledo, Texas, and president of the Association of American Physicians and Surgeons (AAPS), is featured in the winter issue of the of the Journal of American Physicians and Surgeons. She writes:  “Today physicians often feel constrained to pick from among options that are not in the best interest of patients but are ‘covered’ by insurance or approved by officials.”

“An apparently free choice when there is no real alternative is a Hobson’s Choice, and physicians must understand the political structure in which this type of ‘choice’ is embedded,” Dr. Page explains.

“During the COVID pandemic, people often faced a Hobson’s Choice of taking a shot that they believed put their life, health, or fertility at risk, or be barred from their education or career,” she noted.

“Voters generally believe that they have two choices, Republican or Democrat, and that they represent extremes of political ideology. However, when they are in office, politicians behave as if they belong to the same club,” she writes.

“Physicians have accepted the Hobson’s Choice of either abiding by ridiculous regulatory burdens or refusing to treat the senior population,” she explains. They “accept the Hobson’s Choice of either standing against the oppression or keeping their ‘place at the table.'” 

“The phrase ‘we need to keep our place at the table to avoid being on the menu’ entirely misses the point,” she states. “The profession is on the table already being carved up. How many times have we been told we must choose the lesser of two evils? Either choice is still evil!”

“We must identify the enemy within,” Dr. Page writes. “The medical profession must grasp the extent to which it has been manipulated by pharmaceutical, insurance, and other systems tied to medicine. We have been burdened with regulations and threats to our licenses by the same people who are selling us the solutions.”

“There is tremendous profit in the existing system, but we must nevertheless offer healing and hope, learn how to fight back effectively, and reject the Hobson’s Choice,” she concludes.

CITE: The Journal of American Physicians and Surgeons is published by the Association of American Physicians and Surgeons (AAPS), a national organization representing physicians in all specialties since 1943.

CITE: https://www.r2library.com/Resource/Title/082610254

Contact Information:
Jane Orient
Executive Director
janeorientmd@gmail.com
(520)323-3110

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PODCAST: Industrial Revolution – Healthcare Revolution

SEE THE FUTURE BY LOOKING BACK

By Eric Bricer MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PFOF: New SEC Rules Not Thrown Out Entirely!

By Staff Reporters

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DEFINE: https://wordpress.com/post/medicalexecutivepost.com/274910

DEFINITION: https://www.cfainstitute.org/-/media/documents/issue-brief/payment-for-order-flow.ashx

CITE: https://www.r2library.com/Resource/Title/082610254

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Yesterday the SEC proposed the biggest update to the stock trading rules book since 2005. The four proposed rules may become the magnum opus of Gary Gensler, who took over as SEC chair after the meme stock mayhem of 2021. The rules aim to get retail traders better prices by targeting a method of executing trades called payment for order flow (PFOF). PFOF works like this:

  • Brokers like Robinhood send trades to wholesalers like Citadel, which profit off the difference between the individual trader’s proposed price and the price they actually make the trade for.
  • Wholesalers pay brokers a small fee for the privilege of making the trade, and *juicy detail alert* those “small fees” make up a huge chunk of the brokers’ revenue.

Gensler has long argued that PFOF limits competition and encourages brokers to gamify risky trading behavior—like vetting your life savings on GameStop stock. The practice is banned in the UK and Canada.

But the SEC has definitely put it in the “no longer sparks joy” pile

Under the most significant rule proposed yesterday, the “order competition” rule, wholesalers would have to send most retail investors’ trades to an auction where dealers compete to fulfill them for the best price.

The wholesaler only gets to fulfill any leftover trades that no one has bid on. Some on Wall Street argue this will be the most common scenario so the rule won’t have its intended effect, but Gensler thinks auctions could save individual traders up to $1.5 billion per year.

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ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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MEDICAL BILLING: Down and Up Coding?

By Staff Reporters

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DEFINITION

Upcoding is a type of fraud where healthcare providers submit inaccurate billing codes to insurance companies in order to receive inflated reimbursements. These false “current procedural technology” (CPT) submissions indicate that doctors provided patients with treatments that were more complex, costly, and time-consuming than what they actually received. This unlawful scheme is a violation of the False Claims Act (FCA) because it defrauds federal programs including Medicare, Medicaid, and Tricare.

CITE: https://www.r2library.com/Resource/Title/082610254

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There are nearly 7,800 CPT codes used by healthcare providers. Collectively, these codes represent all of the procedures, conditions, and drugs that are currently reimbursable by the health insurance industry. Each one of them has an associated cost for individuals and insurance companies, based upon the urgency of the issue and the complexity of the decision-making required of the healthcare provider. Medicaid and Medicare reimburse providers based on this system.
For example, a five-minute consultation with a nurse for a minor medical question would receive a different, less expensive CPT than the one for a full examination by a doctor lasting 45-minutes. However, if the physician charges the federal programs for the more expensive 45-minute examination when the five-minute consultation is what actually occurred, this would constitute upcoding.

Unbundling

Unbundling is another common form of upcoding. This fraudulent scheme involves billing for individual procedures that are usually performed and billed together under a single CPT code. In some cases, the billing codes for complicated medical operations have associated components built into their CPTs. For example, a hip replacement surgery may factor in the costs of the surgeon’s as well as the use of the operating room. Unbundling occurs when a healthcare provider submits each component within a CPT to Medicare or Medicaid separately. This creates a cost redundancy where wrongdoers can unlawfully seek reimbursement for the same procedure several times over.

CMS: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf

What Is Downcoding?

Downcoding is the opposite of upcoding. If you perform a service but record the CPT for a lower-level service, that is downcoding. Downcoding also leaves you vulnerable to an audit, which is never good. But, it can also cost a practice thousands of dollars a year in lost revenue because you’re not getting the higher rate of pay that you would if you had recorded the service properly.

According to the National Correct Coding Initiative (NCCI): “Physicians must avoid downcoding. If an HCPCS/CPT code exists that describes the services performed, the physician must report this code rather than report a less comprehensive code with other codes describing the services not included in the less comprehensive code.”

MORE: https://zeemedicalbilling.com/what-is-upcoding-and-downcoding-in-medical-billing/

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HERE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

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MEDICARE: “Dis” Advantage Plan Marketing

CMS Cracks Down on Medicare Advantage TV Marketing

Dr. David Edward Marcinko MBA

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CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. The new policy is effective Jan. 1st and was discussed in an Oct. 19th memo from CMS to MA and Part D providers. The agency said it issued the new policy after reviewing thousands of beneficiary complaints regarding confusing, misleading or inaccurate information from plans — plan sponsors are also responsible for all marketing activities from brokers and third-party agencies.

“CMS has conducted so-called ‘secret shopping’ by calling numbers associated with television advertisements, mailings, newspaper advertisements and internet searches to monitor the experience beneficiaries have engaging these entities,” the agency wrote.

“Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision.”

Source: Jakob Emerson, Becker’s Payer Issues [10/27/22]

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OIG: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp

RELATED: https://medicalexecutivepost.com/2021/05/21/podcast-medicare-advantage-plans-insurance-company-goldmine

MORE: https://medicalexecutivepost.com/2022/04/29/probe-medicare-advantage-part-c-plans-deny-needed-care-to-tens-of-thousands-of-patients/

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: The Threat of Synthetic Fentanyl

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An Interview with Retired DEA Agent Derek Maltz

By Richard Helppie

[The COMMON BRIDGE]

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LISTEN PODCAST: https://thecommonbridge.substack.com/p/the-threat-of-synthetic-fentanyl

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BALTIMORE “NOD”: https://medicalexecutivepost.com/2019/07/16/what-is-the-baltimore-nod/

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UPDATE: Recession, Goldman Sachs, and Tesla

By Staff Reporters

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The director of the nonpartisan Congressional Budget Office [CBO] added his voice Thursday to those economists who say it’s unclear if the economy has hit a downturn, despite posting two straight quarterly drops in growth. “The U.S. economy shows signs of slowing, but whether the economy is currently in a recession is difficult to say,” wrote CBO Director Phillip Swagel in a letter to Sen. Lindsey Graham (R-S.C.). “It is possible that, in retrospect, it will become apparent that the economy moved into recession sometime this year. However, that is not clear from data that were available at the beginning of August,” Swagel added.

Goldman Sachs said its credit card unit is under investigation by the Consumer Financial Protection Bureau, a federal agency tasked with protecting Americans from financial abuse. In a securities filing, Goldman said the CFPB is examining a number of the company’s credit card account management practices, including refunds, resolving billing errors, advertisements and reporting to credit bureaus. And, in a statement to CBS MoneyWatch, Goldman said the bank “is cooperating with the CFPB on this matter.”

Finally, shares of electric vehicle maker Tesla rallied in after-hours trading as the company won shareholder approval for a 3:1 stock split, the second such move in two years, as the world’s most valuable automaker looks to make its stock more affordable.

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FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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My Conversation with an Anonymous Cigna Representative

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Cigna, do you even have a clue that dentists don’t like you?

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By Darrell K. Pruitt DDS

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Hi Dr. Pruitt,

I’m truly sorry for any negative experience you’ve encountered with us. Is there a claim, benefit, or authorization concern I can help with? Please email me at LetUsHelpU@cigna.com. I’d like an opportunity to assist.

At a time when interest rates are surging, and just when I request an increase, CIGNA REDUCED MY REIMBURSEMENTS! Never again will I do business with you, and will discourage other dentists from falling into your trap …. And that is why dentists don’t like #TeamCigna. 

What is your name, anyway. You know mine. Perhaps Linkedin’s transparency makes it a poor choice for marketing Cigna.

As if things could get no worse between Cigna and dentists, you censored my response!

NOTE: Cigna representatives prefer to remain anonymous for reasons of accountability.

***

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

Health Insurance: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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FRUSTRATED Physicians!

By Staff Reporters

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65% of Physicians Report Feeling Frustrated in Past 3 Months

A recent study by Survey Healthcare Global on the mental health of healthcare professionals found:

 •  65% of physicians report feeling frustrated.
 •  54% of physicians report feeling burned out.
 •  52% of physicians report feeling unappreciated.
 •  Respondents rank constant stress (34%) and staff shortages (30%) as the leading factors for stress.
 •  18% report that they are more likely to drink, smoke, or use/abuse substances as a result.
 •  75% say their organizations do not offer any wellness resources and programs to HCP employees.

Source: Survey Healthcare Global Via Business Wire, March 21, 2022

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BITCOIN: A Subjective Theory for Physicians

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By Michel Accad, MD

Michel Accad MD Practices internal medicine and cardiology in San Francisco

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Bitcoin Cash - Wikipedia

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In a recent article on the Mises Institute’s Power and Market blog, Kyle Ward appealed to the subjective theory of value to castigate Peter Schiff for his notorious skepticism of Bitcoin:

READ: http://alertandoriented.com/the-subjective-theory-of-bitcoin/

CITE: https://www.r2library.com/Resource/Title/082610254

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Assembly Line Medicine Survival Skills

WHAT I LEARNED IN MEDICAL SCHOOL TODAY

By Pamela Wible MD

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PODCAST: Health Insurance Carrier STOCK EARNINGS CALLS

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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What Exactly is a PONZI SCHEME; etc?

AND OTHER INVESTING SCAMS!

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.

More: https://medicalexecutivepost.com/2010/06/04/the-madoff-circle/

The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.

Link: https://en.wikipedia.org/wiki/Ponzi_scheme

A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.

CITE: https://www.r2library.com/Resource/Title/0826102549

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How to Spot and Protect Yourself From Investment Fraud

Pyramid schemes have existed for at least a century in different guises. Some multi-level marketing plans have been classified as pyramid schemes.

And, there are MANY other schemes in the financial services sector.

MORE: https://www.msn.com/en-us/money/other/are-you-about-to-be-the-victim-of-a-ponzi-scheme/ar-BB1cqabu?li=BBnb7Kz

Front Running: https://medicalexecutivepost.com/2018/02/06/what-is-front-running/

Churning: https://medicalexecutivepost.com/2021/07/23/churning-front-running-and-pumping-dumping/

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Why the Stock Markets CRASHED TODAY [9/20/21]?

Feel Free to Add to the Our Growing List of Reasons!

BUT REMEMBER THAT CORRELATION IS NOT CAUSATION

CMP logo

BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Chart: The Worst Stock Market Crashes of the 21st Century | Statista

THE LIST GOES ON

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China’s Evergrande Project Giant Contagion Jitters

Global and International Market Meltdowns

Crypto-Currency and Gas Price Tumbles

Depressed Automobile Rentals and Used Car Prices

Lowering US Treasury Bond Yields

US Debt Ceiling Risks and Looming Federal Shutdown

Travel Bans with Mask & Vaccine Debates During the Corono-Virus Pandemic

The $3.5 Trillion Dollar Senate Bill

Politics and Potential Federal Tax Law Changes

The National Park, Pacific North-West and California Wild Fires

The Weather, Flooding, Tornadoes, Hurricanes and Tropical Storms

Southern Border Immigration Crisis

A Dearth of Micro-Chips

Quadruple Witching Friday

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CORRECTION? https://www.msn.com/en-us/money/markets/the-odds-of-a-20-correction-in-stocks-are-rising-as-the-market-transitions-to-the-next-stage-of-its-cycle-morgan-stanley-warns/ar-AAODytg

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Feel free to add to our list.

Is this the start of a cyclical bear market?

MORE: https://medicalexecutivepost.com/2018/12/22/stocks-and-sectors-in-bear-territory/

RELATED: https://medicalexecutivepost.com/2016/03/18/doctors-and-bull-and-bear-markets/

MORE: https://medicalexecutivepost.com/2007/11/25/of-bull-and-bear-markets/

EVERGRANDE: https://www.msn.com/en-us/money/markets/evergrande-s-debt-crisis-has-jolted-the-stock-market-here-s-why-everyone-s-suddenly-worrying-about-china-s-2nd-largest-property-developer/ar-AAODW0q

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PODCAST: Lessons for [physician] Investors: The Trial of Theranos Founder ELIZABETH HOLMES

By Bertalan Meskó, MD PhD

Wofür R&D Jahre benötigt, braucht künstliche Intelligenz wenige Minuten“

Elizabeth Holmes has no idea how much damage she has done with Theranos. As I often wrote, for digital technologies to gain ground and become part of our everyday lives, we need not only technological solutions but a cultural paradigm shift. Holmes rolled a massive rock in front of it.

Similarly, Facebook’s data privacy practices do not increase people’s confidence in the company’s products. All the scandals that have surrounded the social network could backfire when Facebook wants to step into healthcare – and this is exactly what we wrote about in our latest article, Is There A Place For Facebook In Healthcare? In it, we looked at what Facebook currently does in medicine and evaluated whether those are viable ways to follow in the future.

Take care,
Berci
Bertalan Meskó, MD PhD
The Medical Futurist

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MORE: https://www.cnbc.com/2021/09/10/the-lessons-for-investors-from-the-trial-of-theranos-founder-elizabeth-holmes.html?utm_source=The+Medical+Futurist+Newsletter&utm_campaign=f5b0ff1b6b-EMAIL_CAMPAIGN_2021_9_14&utm_medium=email&utm_term=0_efd6a3cd08-f5b0ff1b6b-399696053&mc_cid=f5b0ff1b6b&mc_eid=40fee31c25

YOUR COMMENTS ARE APPRECIATED.

Thank You

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https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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https://healthcarefinancials.files.wordpress.com/2007/10/foreword-mata.pdf

PODCAST: Novartis Drug Company Settlement with the USA

Why SOME Doctors Take Money from Pharmaceutical Companies

Q&A: Eric Bricker, chief medical officer of Compass patient advocacy service - Dallas Business ...

BY ERIC BRICKER MD

MAssive Global Drug Company Novartis Paid $678M to Settle Charges from the US Federal Government.

The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.

Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?

Learn the Psychology of Doctors and Money.

Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health

YOUR THOUGHTS ARE APPRECIATED

Thank You

***

Financial Advisors are Website Posting Their Fees?

Nevertheless – Physicians and All Investors Must be AWARE & INFORMED!


By Dr. David E. Marcinko MBA CMP®
CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

Many financial planning websites mention fees, as required, but still remain opaque to potential clients because the advisor wants to control the discussion and understandably wishes to avoid the website shopper phenomenon.

But, physicians and all investors can still control the discussion, and still provide transparency, because posting up front pricing information doesn’t mean presenting information in a vacuum!

For example, a 1%/year fee doesn’t have to just be 1%; it can be 1%, compared to an industry average cost of X%, where the average cost of an actively managed mutual fund is Y%.

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See the source image

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Similarly, it doesn’t have to be a retainer fee of $1,000/year; it can be a retainer fee for less than the cost of a monthly cable bill! And, a financial plan doesn’t cost $1,500; it costs 8-12 hours of staff time to craft extensive, customized solutions; but saves the doctor-client so much more!

And, if services have a range of potential prices, they might be provided with some insight into the factors that impact the price. Modern young and internet savvy doctors expect this sort of information.

ASSESSMENT: Your thoughts are appreciated.

LINK: https://medicalexecutivepost.com/2015/04/06/understanding-the-failure-to-recognize-mutual-fund-fees/

MORE: https://medicalexecutivepost.com/2015/02/12/a-review-of-investing-expenses/

LINK: https://medicalexecutivepost.com/2018/04/26/the-six-types-of-investment-fees/

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

THANK YOU

***

PODCAST: Medicare Advantage Plans [Insurance Company Goldmine]

Medicare Advantage PART C

Insurance Carriers Want Medicare-For-All to Happen?

https://roundstoneinsurance.com/wp-content/uploads/2020/01/Eric-Bricker-Headshot_500x500-480x480.png

By Eric Bricker MD

A Commonwealth Fund Study Found Insurance Carrier Revenue from Medicare Advantage Plans Increase 5X More Than Revenue from Employer Sponsored Health Plans.

In Fact, Government Sources (Medicare Advantage, Medicaid Managed Care, ACA/Obamacare Plans) Make Up More Revenue ($213B) for the 5 Largest Insurance Carriers Than Revenue from Employers ($148B).

Government Payers Are the New Cash Cow for Health Insurance Companies.  
And so, Medicare-Advantage-for-All May Happen … Because Insurance Carriers WANT It to Happen.

PODCAST: A Commonwealth Fund Study Found Insurance Carrier Revenue from Medicare Advantage Plans Increased 5X More Than Revenue from Employer Sponsored Health Plans.

Your thoughts are appreciated.

THANK YOU
***

Why we cannot assume CFP® equals “Fiduciary”

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Rick Kahler MS CFP

By Rick Kahler MS CFP®

One of the most important ways to find competent and trustworthy investment advisers is to be sure they owe you a fiduciary duty.

This means the advisers’ legal and ethical responsibility is to act in your best interests, not their own or their employer’s.

An ongoing legal case featured in an October 31 article by Ann Marsh in the online Financial Planning magazine highlights both the importance and the difficulty of finding a fiduciary adviser. (Disclosure: I am one of several advisers quoted in the article.)

The whistleblower case against J. P. Morgan involves an adviser and former J. P. Morgan employee, Johnny Burris, who says he was fired after refusing to give in to pressure to sell some of his employer’s high-priced products that he did not believe to be in his clients’ best interest.

Importance?

Here is why this case is important to anyone looking for financial advice: many advisers at investment firms like J. P. Morgan hold the Certified Financial Planner (CFP) designation. According to the website of the CFP Board of Standards, the organization that awards the certification, CFP’s are required “to put your interests ahead of their own at all times and to provide their financial planning services as a ‘fiduciary’—acting in the best interest of their financial planning clients.”

This sounds straightforward enough. Since 2008, the CFP Board has positioned the CFP designation as an indicator that an adviser will put clients’ interest first.

Unfortunately, that isn’t quite accurate.

Here is the tricky part: Advisers who sell financial products are allowed to “wear two hats” in their interaction with consumers. Any time they are giving financial advice and acting as financial planners (as defined by the CFP Board), they are expected to act in the best interest of the client/customer.

Yet if they don’t give any financial advice other than what is ancillary to the sale (a very confusing concept) of financial products to the same client/customer, that fiduciary requirement does not apply. The consumer is apparently expected to have the exceptional discernment and knowledge to know which hat is being worn at any given time.

As a consumer, you can assume that advisers holding the CFP® designation have completed many hours of education and passed tests to assess their professional competence.

However, because of the CFP Board’s hairsplitting, you cannot assume “CFP” equals “fiduciary.”

You still have to ask two essential questions:

The first is “In this engagement with me, who are you primarily responsible to, me or your company?” An adviser employed by a brokerage house or investment bank is very likely to be held most responsible to their company and expected to sell that firm’s financial products. This sets up a conflict of interest, in that the products with the highest fees will make the most money for the firm and the adviser, while those with lower fees may well be in the best interest of the clients.

A CFP® adviser who works for an independent financial planning firm may be less likely to be pressured to sell a given line of products. They also may do enough financial planning to be required to be a fiduciary.

However, you still need to ask the second question: “How do you get paid?” Any adviser who receives income from selling financial products cannot fully represent clients as a fiduciary without first overcoming an inherent conflict of interest.

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stock market

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Assessment

An adviser who doesn’t sell any products, who gives investment advice, and whose income comes solely from client fees is answerable and responsible to those clients as a fiduciary. You can trust that such a fee-only adviser will genuinely put your interests first. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™     Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Welfare Benefit Trust Plans for Physicians?

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A SPECIAL REPORT FOR THE ME-P

“Hall of Fame” for Egregious Investment Advice

By David K. Luke MIM, Certified Medical Planner™ – candidate

[Physician Financial Advisor – Fee Only]

www.NetWorthAdvice.com

www.CertifiedMedicalPlanner.org

Physicians unfortunately often become unwitting targets of some very egregious investment advice. Usually it involves an investment product with an imbedded fat commission just waiting to be deposited in a “financial advisor’s” bank account.

In the “Hall of Fame” of egregious investment advice is the Welfare Benefit Trust. About 10 years ago, while I was working for a top five national brokerage firm (this was before my fee-only days when I was still on the “dark side”) our internal Insurance Products Department at the brokerage firm’s head office presented an amazing investment product. This “Welfare Benefit Trust” we were told should be shown to our profitable small business owners as a cure for their every ill caused by paying too much taxes. A Welfare Benefit Trust essentially works like this:

  • The business provides a fringe benefit for their employees, such as health insurance and life insurance.
  • The benefit is established in the name of a trust and funded with a cash value life insurance policy
  • Here is the gravy: the entire amount deposited into the trust (insurance policy) is tax deductible to the company, and
  • The owners of the company can withdraw the cash value from the policy in later years tax-free.

Yes, the holy grail of tax avoidance has been achieved: tax deductible up front and tax-free when you withdraw. By the way, if you are not familiar with such investments there is a reason. They are not legal by the tax code. Physician practices, as well as other small and mid-sized businesses, became buyers into these welfare benefit trusts as they were sold as a way for the practice to “protect” a large profit in a certain year from being taxed. We were told it was not uncommon for a single transaction into a welfare benefit trust to be $200,000 to $300,000 dollars or more in a single premium payment, yielding typically a six-figure commission check.

A few years later the gig was up as it became obvious these could not be tax legal. My understanding is that most medical practices that bought these “unrolled” them when the major brokerage firms realized that avarice got the best of them and stopped selling them. In 2007, the IRS and the Treasury Department issued a formal warning cautioning “about certain Trust Arrangements Sold as Welfare Benefit Funds”. The IRS called these “abusive schemes” and made such a transaction what the IRS lovingly calls a “listed transaction”. Essentially, a listed transaction is a transaction that the IRS has determined to be a tax avoidance transaction. The IRS even keeps these Listed Transactions on their website, listed in chronological order from 1 to 34. Welfare Benefit Trusts is #33.

Good Welfare Benefit Trusts

First of all, it is important to mention that “there are many legitimate welfare benefit funds that provide benefits” according to the IRS. Internal Revenue Code Sections 419 and 419A spell out the rules allowing employers to make tax-deductible contributions to Welfare Benefit Plans. There is nothing wrong with these plans and no mystery to them. After all, a medical practice or any business for that matter is allowed to deduct the costs of doing business as an expense. This includes employee salary and benefits.

VEBAs (Voluntary Employee Benefits Association) have been around since 1928 and are used by employers to provide health, life, disability, education and other benefits for their employees and are the original Welfare Benefit Trusts. When properly established and executed, a VEBA can be a legitimate employee benefit structure. In 2007 the United Auto Workers, in order to relieve the Big 3 Automakers from carrying the liability for their health plans on their accounting books, formed the world’s largest VEBA with over $45 billion in assets.

Bad Welfare Benefit Trusts

However, the IRS does have a problem with Welfare Benefit Plans that are promoted to small business owners as a scheme to avoid taxes and provide medical and life insurance benefits to key employees that in substance primarily serve the owner(s) of the business. These 419 Welfare Benefit Plan schemes claim that the employer’s contributions are deductible under IRC section 419 as ordinary and necessary business expenses, allowing the business owner to provide a life insurance policy for his favorite employee, himself, and accumulate cash value in a life insurance policy.

Lest there be any confusion or debate, IRC 264(a)(1) states:

(a) General rule

No deduction shall be allowed for –

(1) Premiums on any life insurance policy, or endowment or

annuity contract, if the taxpayer is directly or indirectly a

beneficiary under the policy or contract.

While VEBAs have been used properly, as in the UAW example above, unfortunately they are often a front for an abusive tax shelter. In the 1970’s VEBAs were being used by the wealthy as a popular tool for tax reduction and asset protection. In 1984 Congress passed the Deficit Reduction Act, which limited the use of VEBAs. In the 1990’s however VEBAs were structured to give business owners tax benefits not allowed and got back on the IRS radar. Two state medical societies along with a neonatology group practice became test cases by the IRS that helped close those VEBAs with abusive tax structures and purporting to be employee welfare benefit plans: Southern California Medical Professionals Association VEBA, New Jersey Medical Profession Association VEBA and Neonatology Associates, PA. Although the VEBAs claimed to have favorable determination letters, the actual execution of the plan did not comply with the law, mainly by allowing the employees to hold term policies in the plan that could be converted into universal life policies at the same insurer and use the conversion credit account to spring cash value in the policy. This then allowed policyholders to borrow against the UL policy as a supposedly nontaxable source of retirement income, with the repayment of the loan paid out of the policy’s death benefits. (“Making Welfare Plans Work”, Advisor Today, September 2000 P 110). This of course is not allowed under the tax code.

Those that think that they may be in the clear with their abusive tax shelter because:

  1. A large passage of time has occurred since they have owned it
  2. They have a favorable determination letter
  3. Other honorable businesses/ Medical Societies also have the same tax shelter
  4. My insurance agent said it was legal

may want to read the 98-page ruling by the United States Tax Court filed on July 31, 2000 in the case of the above-mentioned Neonatology and related cases. The long arm of the IRS reached back 9 years to 1991, 1992, 1993 disallowing hundreds of thousands of dollars and assessing deficiencies and huge “accuracy-related” tax penalties. Even the doctors that had died since then were not given a break either; their estates and surviving widows were assessed the deficiencies and penalties.

In 2002 the IRS talked Congress into passing new laws basically killing the use of multiple employer 419 plans. Some TPAs (third party administrators) that had set up the multiple employer plans discovered that they could use single employer 419 welfare benefit trusts and VEBAs because Congress forgot to include them when they passed the negative laws shutting done the multiple employer plans. This forced the IRS to issue notices 2007-83 and 2007-84, Rev. Ruling 2007-65 and make welfare benefit trusts listed tax transactions now on the listed tax transactions list. (“Negative IRS Notices On 419 and VEBA Plans” Roccy M. Defrancesco Nov 1, 2007)

Ugly Welfare Benefit Trusts

I call these “Ugly” because these Welfare Benefit Trusts were sold to small business owners after the 2007 IRS listed transaction warning, and after the multiple IRS notices and revenue rulings. The major brokerage firms by 2004 had stopped selling Welfare Benefit Trusts to protect their own financial interests, realizing these were compliance and lawsuit time bombs. The 2007 IRS listed transaction notice along with multiple other notices however did not seem to stop some smaller broker dealer firms and life insurance agents from promoting these.

I have become aware of the fact that Welfare Benefit Trusts that are in violation of the basics of the tax code (unlimited full deduction of premium,  100% tax free distribution to owner of cash value) are still being sold even today and even affecting existing clients. These Welfare Benefit Trusts go by many different names and the insurance agents selling them are using a number of different insurance companies to fund the plan. These plans involve the sale of an insurance policy usually with a six-digit premium that often pays the insurance agent a six-digit commission, so perhaps I should not be surprised that individuals (physicians?) are still being victimized

Conversation with IRS Attorney on Welfare Benefit Trusts

On January 20, 2012 I discussed with Betty Clary, an IRS attorney that helped draft the listed transaction #33 on the IRS website, on what exactly the IRS considers an abusive Welfare Benefit Plan. She stated that, once you take out the fact that the trust cannot be offering a collective bargaining element which is covered by another IRS code, there were three elements they look for:

  1. There has to be a Trust that claims to be providing welfare benefits
  2. There is either a cash value policy involved that offers accumulation or a policy in which money is set aside for a future policy in which accumulation occurs, such as a term policy that can then offer a higher accumulated value.
  3. The plan cannot deduct in any year more than the benefit provided. For example if the plan just provides a death benefit, the most that can be deducted in a year is only the term cost of that benefit, not the entire premium. If the plan offers medical benefits, then only the cost (what was paid out to the employee) for that benefit can be deducted in that year.

I found it interesting that the IRS is pursuing this broader definition as an abusive plan. Betty explained that in the case of a discovered abusive Welfare Benefit Plan, the IRS would disallow the deductions, assert income back to the owner as a distribution of profits, and assess penalties. The courts are clear that you cannot get out of penalties by claiming you are relying on the person that sold you the Welfare Benefit Plan.

What if you currently have a Welfare Benefit Trust for your Practice?

Realizing that someone you trusted has financially devastated you, carelessly misguided you and sold you a bogus tax program in order to pay cash for his new 7 series BMW can be a difficult and rude awakening. After accepting the fact that your Welfare Benefit Plan you have for your practice meets the basic criteria as mentioned in this article as an abusive transaction, I would recommend that you consult an attorney that specializes in pursuing promoters of abusive Welfare Benefit Plans and discuss your options. I have had discussions with Lance Wallach, an accountant and expert witness used in a number of Welfare Benefit Trust cases, which has confirmed to me that you must be proactive. You may be advised to file an IRS form 8886, which is a disclosure form related to prohibited tax shelter transactions. The penalties for failure to file a form 8886 can be stiff. Of course, filing this form will open the Pandora’s Box on your Welfare Benefit Trust to the IRS. Lance has told me that many of these 8886 filings are done incorrectly. An incorrectly filed IRS form is an unfiled IRS form, so please consult a CPA who is experienced in this area. Your attorney that has expertise with Welfare Benefit Trusts will be able to guide you with this. Regarding recourse, according to Lance, most all cases are settled out of court, as the insurance company, the agent, and the agency prefer to avoid the publicity.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Video on Why The Federal Government Is Suing The Banks

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The Case against Banks – Trying to Understand the Financial Crisis?

Did you know that Federal regulators recently filed a lawsuit against banks for their role in the financial crisis. This motion graphic done, with What’s Trending, breaks down the story so you can understand the facts behind the case.

Video Link: http://columnfivemedia.com/work-items/whats-trending-motion-graphic-why-the-federal-government-is-suing-the-banks/

Source: www.ColumnFiveMedia.com

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Is the Mutual Fund Company “Invesco” Dissing Podiatrists?

Attacking One of Us = Attacking all of Us

By Ann Miller RN MHA

[Executive-Director]

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Dear ME-P Readers, Subscribers and Visitors,

As you know, here at the Medical Executive-Post, we champion all hard working, honest and ethical medical professionals, regardless of specialty or degree designation. From the ME-P corporate executive suite, to the mailroom, we appreciate their laborious ministrations under increasingly difficult cultural, political and financial conditions on behalf of the US citizenry.

And so, it was with much dismay when this new advertisement from the behemoth mutual fund company Invesco, headquartered right here in Atlanta GA, was brought to our attention. Rest assured. We are not amused and request your input!

You Input Requested

Do you agree with the Ad? Is it an attack on one medical specialty – or on all of us? Would your opinion differ if the ad mentioned a proctologist – or a dentist? How about a brain surgeon or a nurse? Is the dated impression of doctors being on the golf-course still accurate?

More importantly, does the ad affect your impression of Invesco as a contemporaneous company aware of the modern Health 2.0 culture, or a backward thinking dinosaur resting on its [glorious or in-glorious] past?

Is it Time to Close the Door on Invesco?

Are they Aware?

Do you think that the huge and costly marketing department at Invesco is is even aware that our iMBA Inc sponsored, and ME-P promoted textbooks and handbooks, dictionaries, white papers and CD-ROMs on investing, financial planning, insurance, and risk and wealth management for physicians, was largely written by medical professionals of all stripes? Many holding dual degrees and designations like MBA, CFP®, CMP™, JD, MHA, CFA, etc.

Link: http://www.CertifiedMedicalPlanner.org

Or, that they have been used in [non-clinical] continuing education programs for medical professionals, for more than a decade?

Of course, this includes allopaths, osteopaths, podiatrists, nurses, physical therapists and other related members of the healthcare ecosystem? After all, it often takes a team to treat a poly-systemically ill patient.

Link: www.BusinessofMedicalPractice.com

Assessment

Feel free to contact Invesco directly and tell em’ what you think about their new ad campaign [positive or negative]:

Inveso Client Services:

  • Calls within the United States 800.959.4246
  • Calls outside of the United States 713.626.1919 (Call Collect)

Hours of Service – Monday-Friday, 7:00am-6:00pm CST; subject to change due to NYSE holidays or early market closings.

Contact Link: https://www.invesco.com/portal/site/us/menuitem.33e9ce03dea2c250a83af864f14bfba0/

Industry Indignation Index: 65/100 [probably smelly]

Conclusion

Over the next few weeks we will aggregate your thoughts and may report back to you, and Invesco, about the results. Till then, be sure to also tell us what you think. right here? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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A Look at Suicide Statistics

The Eleventh Leading Cause of Domestic Death

Courtesy Medical Billing and Coding [Infographics]

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One million people commit suicide every year. Suicide is the 11th leading cause of death in the US.

Japan

Japan also has one of the highest suicide rates in the industrialized world and these suicides are mostly attributed to unemployment and depression. It is the leading cause of death for Japanese people under 30; many choose to jump in front of trains as a suicide method. When suicide hotlines were set up in Japan, 1300 calls a week were received.

Assessment

This is a staggering number in Japan, and it signifies the importance of obtaining a job for people, since unemployment and depression are popular reasons for suicide.

Link: http://www.medicalbillingandcoding.org/a-look-at-suicide-statistics/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Vows of Change at Moody’s

But, the Flaws Remain the Same

By Jesse Eisinger ProPublica | @eisingerj 

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In the aftermath of the financial crisis, nobody has gone to prison and there haven’t been any serious structural changes in the financial system. But at least everyone involved feels bad about it and has vowed to change, right? For Moody’s Investors Service, those pledges are empty, Bill Harrington says.

In this column, co-published with New York Times’ DealBook, I monitor the financial markets to hold companies, executives and government officials accountable for their actions.

A Window to the Debacle

Mr. Harrington was an analyst in the structured finance group at Moody’s for more than a decade, much of it spent rating collateralized debt obligations. He worked at Moody’s until the middle of last year, although he left the C.D.O. group in 2006. In his job, he had a window on the biggest debacle in the history of credit ratings. Companies like his allowed banks to pass off hundreds of billions worth of paper onto investors by waving their magic wands and deeming the securities investment-worthy.

Since then, the government has tried to change the ratings agencies. The Dodd-Frank financial reform law has some bold measures, like making the ratings firms liable for their judgments. Unfortunately, the rules are in danger of not being enforced because of budget constraints and resistance from the agencies.

But the biggest problems at Moody’s may have been cultural. The dominant ethos during the boom, instilled by Brian M. Clarkson, the former president and chief operating officer [1], was that customer service was Job 1. And the customers were the bankers.

Banker Customers

The ability for bankers to run the show has long been an obvious flaw in the ratings system for structured products. Investment banks create the securities and benefit when they receive generous ratings. Banks pay the agencies that supply the ratings. Yet the agencies are somehow supposed to hold the line with the people who are responsible for their paychecks.

To Moody’s credit, Mr. Clarkson is now gone. To Moody’s discredit, however, his philosophy is largely still in place, at least according to Mr. Harrington.

To the last day Mr. Harrington was there, he says, bankers remained hard-charging and aggressive advocates for their deals, sometimes to the point of abusing the analysts.

Wall Street ain’t beanbag, so that’s not surprising. The troubling aspect is that the Moody’s bosses acted like disinterested brokers between two sides in disputes with analysts, instead of standing up for the analysts and defending their independence. “That was the standard operating procedure that got worse and worse. We didn’t get the benefit of the doubt,” Mr. Harrington said.

When I asked Moody’s about Mr. Harrington’s experiences, a spokesman wrote in an e-mail: “We take strong exception to your characterization of Moody’s culture. We have always had an unwavering culture of integrity, analytical independence and objectivity and that culture has only grown stronger since the financial crisis.” He pointed to numerous efforts at Moody’s to improve the ratings process and to bolster Moody’s procedures.

In the spring of 2009, Mr. Harrington was working on a deal and a banker was persistently calling him. He returned the first call, but had other work that day and didn’t return the next two calls right away. “I thought caller ID served a purpose,” he said wryly.

Soon after, his boss alerted him to a call he’d received from Michael Kanef, the head of compliance. Mr. Kanef wanted to know why Mr. Harrington hadn’t returned the banker’s call. Mr. Harrington was shocked. Why was the head of compliance getting involved? But he got the apparent message: Analysts are to lean over backward for the bankers. That had been Mr. Clarkson’s philosophy, and now it was his successors’.

“The culture persists — and it’s being enforced by compliance department,” Mr. Harrington said.

So who is Mr. Kanef? Before he was the head of regulatory affairs and compliance, he was in charge of ratings on residential mortgage-backed securities [2]. Did such an executive deserve a promotion?

And then there is Raymond W. McDaniel, the chief executive throughout the housing boom, the bust and the entire financial crisis. He remains at the helm. And he had to swallow the bitter pill of more than $9 million in compensation last year. Indeed, most of Moody’s top management has been in place through the crisis.

Moody’s didn’t make Mr. Kanef or Mr. McDaniel available for comment.

The Blame Game

So if Moody’s doesn’t think the executives who ran the company were responsible for its collapse in reputation and contribution to the multitrillion-dollar financial crisis, who do they think is to blame? The analysts, Mr. Harrington says. The hard-working, low-level minions with little decision-making power.

Mr. McDaniel has conceded that sometimes “we drink the Kool-Aid.”

But that hardly makes the analysts to blame.

“If some analysts drank the Kool-Aid, it was only because management mixed and stirred it up and threatened that analysts wouldn’t get to heaven on the spaceship unless he or she drank it,” Mr. Harrington said.

Moody’s has recognized it has a disaster on its hands — a public relations disaster. Clients — the investors who use ratings — have been losing faith in the agencies. Mr. Harrington said that Moody’s executives marched analysts into meetings to explain how they were going to tell their clients about how much Moody’s had grown and learned from its mistakes. It was as if they were in “Communist re-education camp,” he said.

At one of these meetings, an analyst asked if they could be given training in how to deal with banker abuse, Mr. Harrington recalls. The suggestion was immediately shot down by the executive running the meeting.

Moody’s says that its retraining efforts are part of its continuing efforts to reach out to investors to improve its ratings.

Assessment

When Moody’s executives make public presentations, as when Mr. McDaniel testified [3] in front of the Financial Crisis Inquiry Commission, the overarching theme is that the agency’s problem was limited to the housing-related structured finance. Few people saw how fast and deep the housing market would crash. How could the ratings agencies?

A few weeks ago, Alan Greenspan penned an instantly notorious line: “With notably rare exceptions,” [4] he wrote, unfettered financial markets have worked well. Moody’s persists in believing that with notably rare exceptions, so too have credit ratings.

Full Article: http://www.propublica.org/thetrade/item/vows-of-change-at-moodys-but-the-flaws-remain-the-same/

Conclusion

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Where Are the Financial Crisis Prosecutions?

The White Collar Slump?

By Jesse Eisinger
ProPublica: jesse@propublica.org

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You may have noticed that prosecutors in this country are in something of a white-collar slump lately.

The stock options backdating prosecutions have largely been a bust [1], not because it wasn’t a true scandal. The Securities and Exchange Commission and the Justice Department investigated more than 100 companies. Over a hundred took accounting restatements. Yet only a handful of executives went to prison, with some high-profile cases fizzling out. Prosecutors also stumbled in other high priority corporate fraud prosecutions, like the KPMG [2] tax shelter and the stock-exchange specialists [3] cases.

Bear Sterns

The most spectacular prosecutorial flameout [4] was the case against the Bear Stearns hedge fund managers. The consequences of that disaster are still reverberating. The United States attorney’s office in Brooklyn rushed to haul low-level executives in front of a jury based on a few seemingly incriminating emails. The defense was easily able to convince jurors that these represented only out-of-context glimpses of fear as markets swooned, not a conspiracy to mislead. But, now we have a supposedly new push: the insider trading scandal.

Insider Trading

The United States attorney in Manhattan, Preet Bharara, and the United States Attorney, General Eric H. Holder Jr., are hyping their efforts. “Illegal insider trading is rampant and may even be on the rise,” Mr. Bharara dubiously pronounced in a speech [5] in October. The Feds are raiding [6] hedge funds and publicly celebrating their criminal investigations related to insider trading.

The storyline is that Wall Street now lives in fear. Hedge fund managers’ phones might be tapped, any stray remark is suspect, and old trades are being exhumed so that the entrails can be examined.

In fact, plenty of folks on Wall Street are happy about the investigation. A scant few — the ones with clean consciences — like the idea that the world of special access to favorable tips is being cleaned up.

But others are pleased for a different reason: They realize the investigation is a sideshow.

All the hype carries an air of defensiveness. Everyone is wondering: Where are the investigations related to the financial crisis?

Enron, Lehman, Merrill, Citigroup and Others

John Hueston, a former lead Enron prosecutor, wonders: “Have they committed the resources in the right place? Do these scandals warrant apparent national priority status?”

Nobody from Lehman, Merrill Lynch or Citigroup has been charged criminally with anything. No top executives at Bear Stearns have been indicted. All former American International Group executives are running free. No big mortgage company executive has had to face the law.

How about someone other than the Fabulous Fab [7] at Goldman Sachs? How could the Securities and Exchange Commission merely settle with Countrywide’s Angelo Mozilo [8] — and for a fraction of what he made as CEO?

The world was almost brought low by the American banking system and we are supposed to think that no one did anything wrong?

The most common explanation from lawyers for this bizarre state of affairs is that it’s hard work. It’s complicated to make criminal cases in corporate fraud. Getting a case that shows the wrong-doer acted with intent — and proving it to a jury — is difficult.

But, of course, Enron was complicated too, and prosecutors got the big boys. Ken Lay was found guilty (he died before he served his time). Jeff Skilling is in prison now, though the end result was bittersweet for prosecutors when much of his conviction was overturned by the Supreme Court. WorldCom’s Bernie Ebbers and Tyco’s Dennis Kozlowski are wearing stripes.

Complicated Cases

Sure, it takes time to investigate complicated cases. Many people think that the SEC, at the least, will bring some charges against top executives at Lehman Brothers. The huge, ground-breaking special examiner’s report [9] on Lehman Brothers laid bare problems with Lehman’s accounting. But that report came out back in March — on a bank that blew up more than two years ago. That seems awfully slow.

The most popular reason offered for the dearth of financial crisis prosecutions is the 100-year flood excuse: The banking system was hit by a systemic and unforeseeable disaster, which means that, as unpleasant as it may be to laymen, it’s unlikely that anyone committed any crimes.

Stupidity is No Crime

Or, barring that wildly implausible explanation (since, indeed, many people saw the crash coming and warned about it), the argument is that acting stupidly and recklessly is no crime.

As I ride the subway every morning, I often fantasize about criminalizing stupidity and fecklessness. But alas, it’s not to be.

Nevertheless, it’s hardly reassuring that bankers, out of necessity, have universally adopted the dumb-rather-than-venal justification. That doesn’t mean, however, that the rest of us need to buy it. It’s shocking how pervasive and triumphant this narrative of the financial crisis has been.

Link: http://www.propublica.org/thetrade/item/where-are-the-financial-crisis-prosecutions/

Assessment

Just as it’s clear that not all bankers were guilty of crimes in the lead-up to the crisis, it strains credulity to contend no one was. Corporate crime is usually the act of desperate people who have initially made relatively innocent mistakes and then seek to cover them up. Some banks went down innocently. Surely some housed bad actors who broke laws.

As a society, we have the bankers we deserve. Sadly, it’s looking like we have the regulators and prosecutors we deserve, too.

Conclusion

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Mortgage Investors Join Outcry Against Banks

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Coordinated Strategies Emerging

[By Karen Weise ProPublica: Oct. 18, 2010, 1:18 p.m.]

Homeowners, and at times the government, have long complained that banks and other companies that service mortgages aren’t good at their job of collecting monthly payments, modifying loans and processing foreclosures. Now, a new cast of characters are piling on the criticism: the servicer’s own clients, the investors that actually own the mortgages.

The Servicers

Servicers handle the day-to-day of working with homeowners on behalf of the investors, who bought bundled mortgages from Wall Street. But investors are now threatening servicers with legal action. Just like homeowners, investors are frustrated by the poor job in modifying loans that servicers have been doing. They also say servicers are looking out for themselves, not investors’ interests as their contracts typically require.

For example, Investor Bill Frey, who runs the securities firm Greenwich Financial Services, says servicers view investors as “a Thanksgiving turkey to be carved up and shared among them-selves.” Investors can range from foreign governments and hedge funds to college endowments and pension funds. During the housing bubble, they gobbled up AAA-rated bonds created by pools of mortgages. Now that defaults and foreclosure are mounting, investors argue that flaws in how loans are serviced are costing them billions of dollars.

They say servicers have often dragged out foreclosures to rack up fees and refused to reduce second mortgages to make modifications sustainable. Investors often prefer modifications to foreclosures. But for modifications that won’t ultimately prevent a homeowner from defaulting, investors still prefer quick foreclosures so they can recoup their money and move on.

Of Terminal In-Decision

“Terminal indecision is not good,” says Frey. “If it can be fixed, fix it. If it can’t, nix it.”

Servicers have been slow [1] to modify mortgages—something we’ve written [1] about many times [2] — and when they do modify loans, homeowners are still saddled with other debt from second mortgages and home equity lines. Even after modifications under the government’s program, homeowners typically still must spend almost two-thirds of their income to pay off their mortgage and other loans, like credit cards or second mortgages.

Emerging Paperwork Scandal

The current mortgage paperwork scandal [3] adds more fuel [4] to the fire as major servicers have halted foreclosures because of potential paperwork irregularities around the country. Concerns are also growing that banks may not have properly transferred loans into the mortgage pools in the first place. “This deficient approach undermines the integrity and the operational framework of the housing finance and mortgage system as it exists today,” the Association of Mortgage Investors wrote [5] in a press release.

(For more on the growing scandal, check out our recent explanation of the main players involved.)

The Mortgage Bankers Association, which represents most major servicers, did not respond to ProPublica’s request for comment.

Legal Strategies

Investors from across the country have been coordinating legal strategies for over a year ago, with the effort ramping up in early spring, according to Frey. Since then, more and more investors have formed a loose consortium, gaining momentum “like a snowball going downhill,” he says. In the last month alone, the group added other investors that own an additional $100 billion in mortgage bonds.

They have not filed any suits yet, Frey says, because the group is first trying to grow even more. Also, since each investor group has different, nonmortgage business with the banks, some investors have conflicting interests in how to proceed, he says. The consortium now represents investors that own more than $600 billion in mortgage securities, which is around a third of the entire mortgage securitization market. The group includes 65 major mortgage investors; Bloomberg reported that large investment companies including Black Rock, PIMCO and Fortress are part of the effort, as are the quasi-governmental Fannie Mae and the Federal Home Loan Banks, which both own private securitized loans.

Coordinating investors is no easy task, since the mortgage bonds were sliced and diced to be sold off to investors around the world. To assert legal rights, investors must coordinate to prove that they collectively represent a certain percentage of each mortgage pool, or in some cases, a certain percentage of each slice of each mortgage pool. (The Wall Street Journal [6] and Bloomberg [7] both describe how Texas-based attorney Talcott Franklin is coordinating a clearinghouse to keep track of the various investments.)

Once investors have standing in each pool, they have the legal right to pressure servicers and trustees to improve or face litigation. The group says they have the legal authority to act in over 2,300 deals.

Investors say servicers must reduce or cancel second mortgages entirely before adjusting the primary loan, since that follows the legal pecking order of how loans should be paid off. But investors say servicers have are dragging their feet in reducing second mortgages to protect their own books, since the largest servicers — Bank of America, Citigroup, JPMorgan Chase and Wells Fargo — also own almost 60 percent of the $1 trillion second lien market.

Bank

Congressional Oversight Panel

A Congressional Oversight Panel concluded in April that there is “tension” between Treasury’s goal of supporting reductions to second mortgages and Treasury’s interest in ensuring that writing down second liens doesn’t severely weaken banks’ balance sheets. The panel wrote than when a servicer owns the second lien, the “inexorable conflict of interest” will more likely lead to modifications on the first loan, “as it benefits the bank at the expense of the mortgage-backed security investors.”

We’ve previously reported [8] that mortgages servicers frequently tell homeowners that investors are the roadblock to loan modifications, even though few mortgage deals actually restrict modifications.

Servicers are also supposed to act like watchdogs and report back to investors when they identify loans they suspect didn’t meet the lending standards promised when the bonds were initially sold to investors. If the banks did misrepresent the quality of the loans initially, the banks would have to buy back the invalid mortgages from the investors. But in many cases, the servicers are subsidiaries of the banks that sold the bonds, which investors say helps explain why servicers have been dragging their feet. Bloomberg noted [7] an analyst’s report that said mortgage repurchases could total over $179 billion.

Original Link: http://www.propublica.org/article/investors-join-outcry-against-mortgage-servicers

Assessment

According to an investor letter cited [6] in the Wall Street Journal, in some mortgage pools that have high default rates, the banks have not repurchased any loans when the servicers are subsidiaries of the banks that sold the bonds. Investors say this is all no small matter. Since the country’s mortgage market is heavily dependent on government support right now, they insist servicers make good on their contracts before start buying loans and supporting the mortgage market again.

Related Articles:

  1. http://www.propublica.org/article/mod-program-falling-short-of-govts-vague-goals
  2. http://www.propublica.org/article/loan-mod-profiles-runaround
  3. http://www.propublica.org/blog/item/biggest-banks-ensnared-as-foreclosure-paperwork-problem-broadens
  4. http://www.businessweek.com/news/2010-10-13/document-flaws-may-lead-investors-to-fight-mbs-deals.html
  5. http://www.propublica.org/documents/item/association-of-mortgage-investors-press-release-oct.-1-2010
  6. http://online.wsj.com/article/SB10001424052748704814204575508143329644732.html
  7. http://www.bloomberg.com/news/2010-09-23/mortgage-investors-target-banks-using-texas-lawyer-s-novel-clearing-house.html
  8. http://www.propublica.org/article/when-denying-loan-mods-loan-servicers-often-blame-investors-wrongly

Conclusion

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Dueling New Medicare Reports

Medicare Trustees versus Medicare Actuaries

By Staff Reporters

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According to John Goodman, President, CEO & Kellye Wright Fellow National Center for Policy Analysis, the release of this year’s Medicare Trustees report was unprecedented.

No Medicare Signature Sign-Off 

As noted on www.TheHealthCareBlog.com, in previous posts there and at this blog here and here, Medicare’s chief actuary not only refused to sign off on it, he disowned it — encouraging readers to ignore it and focus instead on an alternative report, prepared by the office of the Medicare actuaries.

Assessment

Industry Indignation Index: 50

Conclusion

Are doctors different than the average investor noted in this essay?

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Texas Mortgage Firm Survives and Thrives Despite Repeat Sanctions

The Allied Home Mortgage Capital Caper

By Charles Ornstein and Tracy Weber, ProPublica July 2, 12:24 a.m.

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As his competitors imploded one by one, Jim Hodge, the folksy founder of Allied Home Mortgage Capital [1], touted his sprawling Houston firm as a survivor.

Not only was Allied still standing, Hodge told employees in a company newsletter in December, it was thriving. “The good news,” Hodge wrote, “is that even though we are all having to work harder, most branches are making lots of money.”

But an examination of Hodge’s mortgage company by ProPublica found that its prosperity has come at a price for dozens of customers who claim Allied brokers have put their homes at risk, lied to them or improperly siphoned money from their deals.

The firm has left behind a trail of alleged misconduct and piecemeal government sanctions spanning at least 18 states [2] and seven years. Yet Allied chugs along unimpeded, aided by access to the government-backed Federal Housing Administration [3] loan program.

Over the past year, the FBI and federal prosecutors have made mortgage fraud a priority, filing criminal charges across the country. Regulators, such as the U.S. Department of Housing and Urban Development [4], also say they are getting tough. But Allied’s [5] history shows how even repeat offenders can fall through gaps in the fragmented safety net meant to protect mortgage borrowers.

Now Consider

  • Allied has the highest serious delinquency rate [2] among the top 20 FHA loan originators from June 2008 through May.
  • Nine states have sanctioned the firm in the last 18 months for such violations as using unlicensed brokers and misleading a borrower.
  • Federal agencies have cited or settled with Allied or an affiliate at least six times since 2003 for overcharging clients, underpaying workers or other offenses.
  • At least five lenders have sued, claiming Allied tricked them into funding loans for unqualified buyers by falsifying documents and submitting grossly inflated appraisals, among other allegations.

“Everything is just a nightmare for me,” said Cheryl Stewart, who is suing Allied alleging that its Hammond, La., office misrepresented her income to qualify her for a loan, then deposited money from her closing into the branch manager’s bank account. Stewart said she is on the brink of losing her home as a result. Allied has successfully argued that the case should be moved out of state court and into arbitration.

Despite these repeated complaints, no single agency is investigating the sweep of the company’s actions and whether they represent a pattern or, as Hodge maintains, are to be expected for a company of Allied’s size. It bills itself as the nation’s biggest privately held mortgage broker-banker with some 200 branches.

William Black, an associate professor of economics and law at the University of Missouri-Kansas City, said Allied’s record exemplifies the failings of a regulatory system that has teeth but seldom bites.

“It’s a wonderful example of the overall crisis,” said Black, who has testified before Congress about financial fraud. “What would it take before somebody would take serious action?”

Federal housing officials would not discuss Allied’s performance or their own negative audits of the firm. But after a recent review, the FHA has recommended that the Mortgagee Review Board take action against Allied. The board can fine companies or revoke their access to the FHA market, which has caused firms to close.

Drs. Home

Secret Service Investigations

Separately, the Secret Service, which conducts criminal investigations for the Treasury Department and Federal Deposit Insurance Corp., confirmed that it is looking into allegations of fraud and wrongdoing at Allied’s now-shuttered branch in Hammond.

Although Allied is dwarfed by Wells Fargo, Bank of America, Quicken Loans and JPMorgan Chase, the nation’s largest mortgage firms, it remains a big player in FHA-insured loans.

In the last two years, Allied Home Mortgage Capital originated more FHA mortgages than all but 15 of the more than 10,000 firms that handled such loans. Since 2005, it has processed nearly 40,000 FHA loans worth nearly $5.85 billion, according to the FHA. Those loans now account for at least 70% of Allied’s business, Hodge said.

Allied differs from most other FHA players in that it is both a broker and a lender. It has an affiliated company with a nearly identical name that has been the lender on about 30% of its FHA loans in the last two years.

Since the collapse of the subprime market, the volume of FHA-insured loans has boomed, rising from about 5% of all home loans in 2007 to 20% in 2009. When these loans fail, an insurance fund supported by FHA borrowers picks up the tab.

Both as a broker and a lender, Allied’s rate of seriously delinquent loans is nearly 60% higher than the national average for the past two years. And the FHA paid out more than $500 million from 2005 to 2009 for claims on defaulted loans brokered by Allied, statistics show.

In an interview, Hodge said the delinquency rates reflect more on the lenders that funded the loans than on his brokers.

The $500 million in claims FHA paid out, he said, were covered in part by insurance premiums paid by Allied borrowers — who largely do not default. “They didn’t have a complete loss of a half a billion,” he said.

Hodge said the problems experienced at some of Allied’s branches should not tarnish his firm’s overall record. “If you look at the volume that we did or do,” he said, “it’s not significant.”

Broken Trust

Sal and Ashley DePaula said they had more reason than most people to trust their broker: The manager of Allied’s Hammond branch was a tenant in one of their rental houses.

Over the course of 2006 and 2007, Allied’s staff helped them sell that property to an acquaintance of the manager and refinance several others.

It wasn’t until months later, the DePaulas allege, that they realized they’d become pawns in a scam.

The buyer of the property the couple sold for $93,000, had actually paid $47,000 more than that, according to a lawsuit in state court by the couple and documents they provided. The cash ended up in the account of Shane Smith, the branch manager, a wire-transfer record shows.

Then, after a tornado hit one of the DePaulas’ refinanced rental homes in 2008, they learned they’d never been signed up for the insurance Allied said it had arranged — even though they’d paid for it every month. The couple said they expect to spend more than $36,000 on repairs.

“Had somebody robbed me and stole $50 out of my purse, they would be in jail,” said Ashley DePaula, who said she is “bitter” that no one has been punished.

Last year, the couple learned that Allied had put another borrower’s name on Sal DePaula’s retirement account statement and submitted it in a loan qualification packet.

That other borrower, Louisiana state criminal investigator Terry Apple, said he only realized he was part of an alleged scam when ProPublica showed him a copy of the statement.

“I’m now finding out that I’m just a small part of a very large puzzle,” Apple said.

At least four lawsuits, including one by the DePaulas, have been filed against Allied over the conduct of its Hammond branch. Other borrowers, some of whom are mentioned in legal filings, allege they, too, were defrauded but can’t afford to sue.

“You know how your body can be quivering?” said Franklin Morgan, 62, a disabled Vietnam veteran who faces losing his home. “That’s what my body’s been doing every day.”

In towering stacks of legal documents, attorneys allege that the Hammond office deceived their clients from 2005 through 2007 by misrepresenting loan terms, falsifying records, failing to pay off prior mortgages and diverting hundreds of thousands of dollars. A title lawyer who worked closely with the Allied branch also stands accused — and has been sued by Allied.

The alleged victims include friends and relatives of Allied staff and the birth mother of the assistant manager’s adopted daughter. That assistant manager’s past — including an arrest warrant for allegedly stealing $24,000 from a previous employer — has come to light.

The lawsuits are proceeding, but Ashley DePaula says Allied has offered a small settlement that has not been finalized.

In an interview, Hodge conceded that “serious fraud” had taken place at the branch, which closed in 2008. He also acknowledged personally hiring branch manager Smith even though Smith previously had lost a home to foreclosure and declared personal bankruptcy. Smith and his attorney could not be reached for comment.

Hodge said the Allied corporate office does not appear to be a target of any criminal probe.

“I don’t know all the details,” he said. “It’s a pretty bizarre situation.”

Row Homes

Customers’ Stories

Around the country, other Allied borrowers tell similar tales.

Pete Pauley, pictured with his wife Mary Ellen, sued Allied in W. Va. state court alleging that a broker misled him about a low-interest loan in 2004.

In Charleston, W.Va., businessman Pete Pauley sued Allied in state court alleging that a Weirton, W.Va., broker misled him into signing for a low-interest loan in 2004 whose rate began rapidly rising after one month.

As part of the loan approval process, the branch submitted a letter from a local accountant verifying Pauley’s ownership of his company. That accountant later testified he didn’t know Pauley or write the letter.

Pauley, who runs an oil and gas company, said the experience was humiliating. He and his wife, Mary Ellen, a nurse, learned of other complaints.

Four other couples alleged similar betrayals by another Weirton loan officer, the sister of Pauley’s broker.

Allied settled for $240,000, Pauley said. But Hodge said Allied did so only after the judge strongly encouraged it.

“We ended up buying that guy a house,” he said.

Allied also settled with the other four couples. In addition, it agreed to pay $12,000 in education and restitution costs after the West Virginia attorney general found it had misled borrowers about their loans.

Lenders, too, have felt aggrieved. AmericaHomeKey sold loans brokered by Allied to a secondary investor. After four borrowers failed to make even the first payments on their loans, the investor demanded the lender make good.

AmericaHomeKey then sued Allied in Harris County, Texas, alleging that it had misrepresented the self-employment status of three of the borrowers and failed to check out other basic facts.

“Clearly, these borrowers lacked the financial means and/or the intent to make the payments on these mortgage loans,” the lawsuit said.

Allied disputes the allegations and will defend itself “with vigor,” Hodge said.

In South Carolina, Charleston title attorney Elizabeth Stuckey Murphy testified in a deposition that she became so concerned about possible fraud at Allied’s Goose Creek branch that she complained to the FHA and law enforcement agencies in 2005.

The branch manager, Murphy claimed in a letter to authorities, had padded closing statements with invoices for contracting work by her husband that was never performed — nearly $30,000 in one case alone.

In a deposition two years later, Murphy was asked about her complaint to the FHA hotline. “To date,” she said, “I haven’t received any response.”

Frequent Troubles

Every year since 2003, Allied has landed in trouble somewhere.

It’s a streak that began with twin wallops from the U.S. Department of Housing and Urban Development totaling $420,000 in settlements — a significant sum for the agency. HUD oversees the FHA program, which insures mortgages for buyers who can’t afford big down payments.

In all, regulators and attorneys general in at least 18 states have acted against the firm or its brokers. Most of the matters have been settled without any admission of wrongdoing by Allied.

Washington state banned a former broker in Allied’s Spokane office after he was convicted of 10 felonies for stealing Allied clients’ money and laundering it. Arizona denied a broker’s license to a firm owned by Allied’s Tucson branch manager because she had previously been convicted of embezzling from a bank.

State regulators say they must limit their actions to what happens within their borders. Federal officials say they don’t generally look into state actions unless a mortgage company’s conduct may also violate federal rules.

Assessment

Although HUD and FHA have recently stepped up oversight of the mortgage industry, they have long had tools to police it. Using data collected on every loan, housing officials can statistically track whether mortgage firms are putting borrowers into FHA loans they can’t or don’t pay on. According to this data, Allied for several years has had a serious delinquency rate well above the national average. And, over the last two years at one Houston branch, some borrowers mustered only a few payments or none at all. The serious delinquency rate within one year of closing was 12%, compared with 4.2% nationwide.

Gary Lacefield, a former HUD investigator, said the numbers are an obvious red flag about Allied that regulators should have acted upon. “I see no reason,” he said, “why they shouldn’t have been hammered.”

Note: ProPublica director of research Lisa Schwartz contributed to this story. USA TODAY editors assisted in preparing it for publication.

http://www.propublica.org/article/texas-allied-home-mortgage-capital-thrives-despite-sanctions

Any ME-P medical professionals, readers, clients or FAs affected by this caper?

Channel Surfing the ME-P

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Conclusion

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Reporting Tips for Covering High Risk Health Insurance Pools

A Call to all ME-P Citizen and Investigative Journalists

By Hope Rachel Hetico RN, MHA

[Managing Editor]

According to our colleagues from the Association of Health Care Journalists [AHCJ], the federal government and states are scrambling now to create temporary high-risk pools for the medically uninsurable by July 1, 2010. As one of the first provisions of the Patient Protection and Affordable Care Act to go into effect, it will serve as a test case for implementation of the new law and it should be closely followed.

[picapp align=”none” wrap=”false” link=”term=medical+professionals&iid=5271528″ src=”e/4/2/f/portrait_of_medical_aedc.jpg?adImageId=12922304&imageId=5271528″ width=”380″ height=”380″ /]

Some states with existing high risk pools are passing laws to ensure their programs comply with the new federal rules and are eligible for some of the $5 billion in federal funding. Other states are refusing to alter their programs and ceding responsibility to the federal government.

But, apart from being a policy story, it’s of great interest to all our ME-P readers, viewers or listeners who have pre-existing conditions and are struggling to find coverage. 

Avoid HI Scammers

Finally, don’t be scammed into buying fake health insurance. With unemployment high and complicated health care changes under way, scammers see big opportunities. Here’s how to avoid getting hurt. 

http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/scams-peddle-fake-health-coverage.aspx

Assessment

And so, we now ask our ME-P citizen journalists or investigative reporters to cover this topic for story tips, suggestions, comments and related posts. We hope to add your insights and resources as the story develops. 

Conclusion

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The Madoff Circle

Who Knew What?

By Jake Bernstein, ProPublica – June 2, 2010 2:40 pm EDT

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When Bernard Madoff pleaded guilty to running the biggest Ponzi scheme in history, he insisted he was the lone perpetrator, asserting that no one – not his family, not his colleagues, not his friends – knew of the fraud.

Alternative Narrative

But an alternate narrative is emerging from the pile of Madoff-related civil suits and court motions that have been filed in the last two years – one in which a small circle of men played knowing, integral roles in the scheme, in some cases benefiting more from it than even Madoff himself.

The evidence for this remains largely circumstantial. These relationships were forged in the days before e-mail, and none of the cases has yet produced anything for public consumption that delivers insights into what these men were thinking. In the one instance in which a judge has ruled on allegations against some of the men, he dismissed the charges for lack of evidence.

But the men’s actions, as described in the court cases, appear to have furthered the scheme. The Securities and Exchange Commission and the trustee charged with recovering money for Madoff’s victims have alleged that some of the men had expectations and influence far beyond what is typical for the usual investor. Most tellingly, the documents say that in at least one instance, and possibly more, these men helped keep the Madoff scam afloat, providing hundreds of millions of dollars of cash when it was on the verge of collapsing.

If this was a conspiracy – and the available information is by no means complete – it does not seem to have been one in which the perpetrators plotted together around a tavern table. Irving Picard, the trustee, has sued several of Madoff’s biggest beneficiaries, alleging they “knew or willfully ignored” that they were participating in a fraud.  The suits are silent on the question of whether those involved coordinated or knew of one another’s activities, but they don’t need to demonstrate that to be successful.

A Commonality

What these men undeniably shared were similar backgrounds and interests. Based largely in New York and South Florida, they moved through parallel milieus of affluent Jewish country clubs and synagogues. They were active in similar philanthropies and served on the boards of foundations, universities and yeshivas.

The cast of characters, spelled out mostly in complaints filed by the trustee and the SEC, includes: Carl Shapiro, [1] 97, a Boston-based philanthropist who made one fortune in ladies dresses and a larger one with Madoff; Robert Jaffe [2], 66, Shapiro’s son-in-law; Maurice “Sonny” Cohn, 79, a one-time Madoff neighbor turned business partner; Robert Jaffe [3], 83, a close friend of Madoff’s for more than 50 years and one of his earliest investors; and Jeffry Picower [4], a lawyer and accountant, who recently died of a heart attack at 67.

None of these men has been charged criminally. Thus far, federal authorities have indicated in court filings that just one of them – Chais – is the subject of a criminal inquiry. A year ago, The Wall Street Journal, citing anonymous sources, reported that the U.S. Attorney’s Office in Manhattan was investigating at least eight investors, including Picower, Chais and Shapiro [5].

All have denied being anything but victims of Madoff’s [6].

Chais, Cohn and Jaffe have drawn considerable ire from investors for running so-called feeder funds that channeled huge sums into Madoff’s investment business. Jaffe alone funneled more than $1 billion of investor money to Madoff, according to the SEC. He worked with Cohn in a business called Cohmad – a contraction of Cohn and Madoff – that operated out of Madoff’s offices. Contrary to what some investors in the funds believed, it appears the men did little to manage the money beyond simply collecting it for delivery to Madoff.

Inner Circle Fared Well

Members of this circle not only did far better than other investors, who averaged 10 percent to 12 percent returns annually, they also had a highly unusual level of input into the nature of their returns.

According to the trustee’s complaint, there were several instances in which Picower or his associates contacted Madoff’s office, asking for specific monthly returns [7]. Over a five-year period in the late ’90s, two of Picower’s accounts [8] had annual returns ranging between 120 percent and 550 percent. A third had yearly returns as high as 950 percent.

Chais and his family consistently received yearly returns higher than 100 percent, far exceeding the gains realized by investors in his funds. Moreover, according to an SEC complaint [9], when Madoff told Chais he was switching to a new strategy that might show occasional short-term trading losses without interfering with net gains, Chais made a special demand to maintain the appearance of loss-free investments.

“Chais told Madoff that he did not want there to be any losses in any of [his] Fund’s trades,” the SEC complaint alleges [9]. “Madoff complied with Chais’ request. Between 1999 and 2008, despite purportedly executing thousands of trades on behalf of the Funds, Madoff did not report a loss on a single equities trade.”

Chais disputes the allegations [9], and his lawyer characterized the SEC’s complaint in a statement as “a distorted and false picture of Stanley Chais.”

“Like so many others, Mr. Chais was blindsided and victimized by Bernard Madoff’s unprecedented and pervasive fraud,” the statement said. “Mr. Chais and his family have lost virtually everything – an impossible result were he involved in the underlying fraud.”

Many of those in the circle took money from the scheme as fees rather than investment gains.

Cohmad officials reaped a total of $98.4 million in payments between 1996 and 2008, most of it labeled income from “account supervision,” according to the SEC [10].

Chais charged fees equal to 25 percent of each Chais fund’s net profit for calendar years in which profits exceeded 10 percent, according to the trustee. As profits exceeded 10 percent every year, Chais took in almost $270 million in fees from 1995 to 2008.

Though Madoff receives the lion’s share of the blame and/or credit for his scheme, it appears that several of his close associates profited more handsomely than he did. Shortly after he confessed, Madoff declared in court documents that his household net worth was about $825 million.

Picower, the biggest beneficiary of the scheme by far, took in $7.2 billion in profit, according to the trustee. Picower’s widow and the trustee are currently haggling over the exact amount of a multibillion-dollar settlement. Carl Shapiro and his family received more than $1 billion, the trustee charged in a court document filed last November in U. S. Bankruptcy Court.

Chais and his family members withdrew approximately $200 million more than they invested with Madoff, according to the SEC. This came on top of the hundreds of millions in fees Chais charged investors.

Chais’ lawyer denied that his client had any knowledge of the Ponzi scheme or that he had raked in the vast riches alleged. “Despite the astronomical numbers mentioned by the Trustee in his complaint, the bulk of the funds alleged to have been distributed to Mr. Chais were in fact distributed to his investors,” his statement said.

Keeping the Scheme Going

At key moments, Madoff’s investors came to the rescue to keep the scheme going. The first instance came in 1992, when the SEC shut down a feeder fund run by the accountants Frank Avellino and Michael Bienes, then Madoff’s largest, accusing the pair of operating a Ponzi scheme. Avellino and Bienes admitted they had acted as unregistered investment managers, but insisted the money had been invested with Madoff, who promptly returned more than $300 million.

Ironically, the SEC mistook Madoff’s ability to raise that amount so quickly as proof that his business was legitimate and “the money was where we [the agency] would expect it to be,” a staff attorney told the SEC’s inspector general last year. Almost two decades later, investigators suspect Madoff may have tapped his circle to collect the cash while scrambling, with the help of his right-hand man, Frank DiPascali, to fabricate trading records, a scene detailed in the agency’s case against DiPascali.

Identifying precisely who helped Madoff repay Avellino and Bienes’ investors is currently an area of inquiry for law enforcement, according to a person familiar with the investigation.

Despite his ever-growing network of feeder funds, Madoff had another liquidity crisis in November 2005. According to a federal complaint [11] filed against his employee Daniel Bonventre, Madoff’s investor account had an end-of-day balance of about $13 million to cover about $105 million in wires scheduled to go out over the next three days.

Two days later, one of Madoff’s investors, identified in the complaint [11] as “Client A,” sent about $100 million in bonds to Madoff, which he used as collateral to secure a $95 million bank loan to continue the Ponzi scheme. The following January, Client A gave Madoff $54 million more in bonds, which were used as collateral for a $50 million loan.

Investigators have not revealed the identity of Client A, but a person close to the investigation said he was among Madoff’s group of longtime close associates.

The final bailout came toward the end of 2008, when Madoff was hit with a tidal wave of redemption requests from investors caught up in the larger financial crisis. Toward the end of 2008, he looked to Shapiro, who pitched in $250 million.

Shapiro and his family have said repeatedly through spokesmen that they were unaware of the true nature of Madoff’s business. The spokesman declined to comment on the $250 million.

No civil or criminal complaints have been filed against Shapiro, but a court filing by the trustee raised questions about the nonagenarian’s “contentions that he is a victim of Madoff’s scheme,” alleging “inconsistencies between Mr. Shapiro’s counsel’s account of the family history with Madoff and the records available to the Trustee.” The trustee is negotiating with the family to recover profits made over the years.

The emergency cash infusion failed. Just 10 days later, Madoff says he confessed to his sons that “it’s all just one big lie,” finally ending the scheme.

The Case-To-Date

So far, efforts to hold Madoff associates accountable have met with mixed results.

Civil claims by the SEC [10] against Jaffe, Cohmad and Cohn were largely rejected by Federal District Judge Louis Stanton, who ruled in February that the agency had failed to prove they “knew of, or recklessly disregarded, Madoff’s fraud.” The judge left the door open for the SEC to refile its complaint by June 18, if it can strengthen its case.

Lawyers for Maurice Cohn and Cohmad released the following statement in response to the ruling: “As we have maintained all along and Judge Stanton agrees, the SEC’s complaint supports nothing other than “the reasonable inference that Madoff fooled the defendants as he did individual investors, financial institutions and regulators.”

Assessment

If there were others involved in the Ponzi scheme, building federal or state criminal cases against Madoff’s circle may prove difficult. Though their relationships go back decades, most of their dealings were done verbally, and there isn’t a lot of correspondence, according to a person with knowledge of the investigations. Federal investigators are working with DiPascali to get a clearer picture of the degree of complicity of others in the scheme.

Illness and age also may become factors. Though a grand jury could consider charges against Chais by mid-June, he suffers from a rare blood disorder and is in and out of the hospital. Shapiro, too, is said to be in ill health.

The trustee is expected to file more lawsuits in coming months as the date approaches when the statute of limitations runs out.

Criminal cases brought against several former Madoff employees have already eroded the notion, lodged so powerfully in the public imagination, that Madoff worked alone, said Daniel Richman, a professor at Columbia Law School and a former prosecutor. With each additional case, he said, it may well crumble further.

“I imagine the paradigmatic Ponzi scheme with the evil genius who keeps all the secrets to himself and engineers this massive crime, like most stick figures, will probably not hold true,” he said.

Link: http://www.propublica.org/feature/the-madoff-circle-who-knew-what

Conclusion

Industry Indignation Index: 99

Conclusion

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As the Health Care Vote Passes

Another Troubling Insurance Story

By Marian Wang, ProPublica – March 17, 2010 2:03 pm EDT

[picapp align=”none” wrap=”false” link=”term=health+insurance&iid=8337843″ src=”c/e/5/3/President_Obama_signs_baf7.JPG?adImageId=11734822&imageId=8337843″ width=”380″ height=”484″ /]

Reuters filed a stunning report [1] recently about a health insurance company that targeted policyholders with HIV to drop their coverage. It opens with the case of Jerome Mitchell:

Patient Jerome Mitchell

Previously undisclosed records from Mitchell’s case reveal that [health insurance company Fortis [now known as Assurant Health] had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators ….

Insurance companies have long engaged in the practice of “rescission,” whereby they investigate policyholders shortly after they’ve been diagnosed with life-threatening illnesses. But, government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.

The Three Minute Rule

A South Carolina judge who ruled on the case noted that in the meeting in which the rescission committee [2] reviewed Mitchell’s case and decided to cancel his policy, there were more than 40 other customers whose cases were up for review, and “an average of three minutes or less” was spent per customer. Assurant Health told Reuters [1] it doesn’t comment on individual customer claims, while a spokesman added the company disagreed with “certain of the court’s characterizations of Assurant Health’s policies and procedures.” 

Link: http://www.propublica.org/ion/blog/item/as-health-care-vote-nears-another-troubling-insurance-story

Assessment

As the story notes, it’s not just this one insurance company that has been engaging in aggressive rescission. In California, state regulators fined five major health insurance providers—Health Net, Anthem Blue Cross, Blue Shield of California, PacifiCare and Kaiser Permanente—for dropping more than 6,000 sick policyholders. The terms of those settlements, reached in 2008 and 2009 [3], have yet to be implemented in most cases, according to news reports [3] from last week.

Industry Indignation Index: 39

Conclusion

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Need a New Career in Dentistry – Become a Consultant

Or – Maybe Just a Hobby

By Darrell K. Pruitt; DDS

One might ask how much knowledge of dentistry is required before a person is qualified to call oneself a “dental practice management consultant” – beyond maybe being able to spell HIPAA with only one P, and Hippocrates with two.

Meet Jill Coon, Inc

An anonymous management consultant who works for Jill Coon, Inc of Florida posted this brave suggestion on the company Facebook today:

“Why not take 3 max anterior PA’s and 1 mandibular PA once a year with bitewings to check for caries in front teeth? We actually bill insurance for 3 PA’s not 4. Hygiene production just increased!”

My Translation 

Here is a translation of her question from dental-speak to English:

“Why don’t dentists take routine x-rays of front teeth like they do for back teeth, when doing so increases hygiene production and payments from the insurance companies?”

[Dental team members, please sit on your hands for this one].

Bonus Round 

Bonus question: Can anyone think of any reason why one might not want additional routine x-rays – even if insurance pays for it at 100% (of usual and customary fees)?

Hint: It can be trickier to avoid irradiating the thyroid when taking anterior x-rays than while taking routine bitewing x-rays.

Assessment 

I’ll be back soon with the tricky opinion I will have posted on Jill Coon, Inc Facebook. It will be her first if nobody beats me to it.

http://www.facebook.com/home.php#!/pages/West-Palm-Beach-FL/Jill-Coon-Inc/125510596754?v=wall&ref=mf

Conclusion

Is there anyone out there with almost no knowledge of dental care who wants to match wits with a sales rep for a consulting company that “specializes in dental insurance billing and treatment planning for dental practices”?

Industry Indignation Index: 47

How about it – HHS Secretary Kathleen Sebelius, JD?

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On New York’s Medicaid “Rip-Off” Artists

Or … Just  Accidentally Billing Dead Patients?

By Staff Reporters

Sixty-six New York state healthcare providers billed Medicaid for services provided to 287 patients they later admitted were “deceased at the time of service,” says the office of state Medicaid Inspector General James Sheehan.

Assessment

The inappropriate billings, which the providers attributed to clerical mistakes, totaled less than $1 million.

Now, read the entire New York Post article, complete with identifiers; and then page Dr. Frankenstein.

Link: http://www.nypost.com/p/news/local/rai_ing_the_dead_in_medicaid_rip_Ocmt6BxwUyL8WO3OwwmCVI

Conclusion

Industry Indignation Index: 24

And so, your thoughts and comments on this ME-P are appreciated. Could this only happen in the bi-polar State of New York? How about at Manhattan’s famed Bellevue Hospital?

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A Quality Story all Doctors and Patients Should Re-Read

[Mis] Adventures in Cardiology

Reposted by Ann Miller RN MHA

[Executive Director]

According to the author of this re-posted e-journal, Johns Hopkins Medicine has a long tradition of prioritizing patients, and striving for the bottom rung that are the anonymous poor.

And, many agree this is true. In fact, our Publisher-in-Chief grew up in Baltimore Maryland and has written about this venerable institution on the ME-P before.

Outliers

If, for example, you catch a bullet on a Baltimore street corner, or your mother presents you at the ER as a feverish welfare child, then it us open season for the medical students, well meaning as they may be. They can practice on you because if  their actions result in an adverse outcome—which is to say that if you are mangled or killed—nobody will question said outcome, precisely because … you are a nobody.

At the other end of the spectrum are wealthy and prominent patients, who get treated by doctors who have already learned what not to do from the mistakes inflicted upon the lower classes.

Of … Quality Medical Care

However, sometimes mistakes happen, and medical errors do occur as we all are human. But, what is reported to have happened to one journalists’ wife – Pam – at Johns Hopkins Hospital in March of 2002 is beyond the pale.

As a middle class citizen, she landed somewhere in the middle of the bell shaped curve. Maybe she got snookered by all the hype from US News into thinking that she was going to be treated by the best doctor at “The Best Hospital in America” … You decide.

Assessment

This is the story of what happened to Pam; as reported by her journalist husband Don.

Link: http://adventuresincardiology.com/

Conclusion

Indignation Index: 96

We trust medical quality guru Bob Wachter MD will opine. And so, your additional thoughts and comments on this ME-Pare also appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Ask an Advisor – Must an Insurance Claim CramDown be Accepted?

Calling on Insurance Professionals to Expose the “Wizard” Behind the Curtain

By ME-P Staff ReportersOp-Ed

We received the following request recently. Apparently, this ME-P reader-nurse sustained a covered loss with valid home insurance property-casuality claim. It resulted in disagreement with her insurance adjuster [a common occurrence]. The adjuster cited his/her supervisor’s insistence on claim settlement and closure.  The nurse’s general contractor thinks the monetary amount is significant [$50,000 range after three independent estimates]. The insurance company wants to settle for about half that amount. 

What say you about this scenario?   

INSURED

Dear Big Insurance Company Adjuster

”Many thanks for reaching out to us by phone yesterday. Please be aware that we did not agree to partial payment or supplements and are sorry for any confusion. 

We would however, be pleased to assist by informing your management of our declination of same. Thus, there is no need to issue any payments at this time.

It seems to make far more sense to get all the numbers together with our general contractor and then arrive at a consensus before moving forward. As you know, this was our original plan. We appreciate your deeper understanding of these very complex issues.”

Your Small Client 

INSURANCE ADJUSTER

Dear Client

“This email will serve as a follow up to our telephone call yesterday. I am sorry we were disconnected but I attempted to call you several times and I was unable to leave a message. I am attaching a copy of the updated Big Insurance Company estimate which reflects those changes made due to additional information gathered during my second inspection of your property on September 8th.  Also you will find an updated Replacement Cost Letter.

As discussed, due to the fact we know we owe you the value of the attached estimate, I am processing the actual cash value payment in the amount of $ XYZ. Any additional payments will be handled as supplements. Please feel free to contact me with any questions.

Your Big Insurance Company Adjuster

MANAGEMENT

Dear Client

Also, my management told me I need to proceed with issuing payment based on the amount I know I owe you [insured] as of now, and that I should handle any further negotiations as supplements. I have already discussed this with your husband.

Your Big Insurance Company Adjuster

Assessment

After some internet research, our RN reader discovered that abut 85% of all folks accept inadequate PC insurance payments after being strong-armed by their insurance company in various ways. She is determined to be made whole and indemnified. She also understands that future negotiations and “supplements” after acceptance are typically not favorable to her, and she wishes to maintain her leverage by not accepting them. Can she refuse to cash the check, if sent to her, until satisfied? She is not feeling in good hands, at the moment!

Industry Indignation Index: 85%

Audio Razz: Click to play :

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Must our reader “accept assignment” in the form of this under payment cram-down? How can she expose the Wizard of Oz manager behind the curtain? Will she be the “squeaky wheel” of informed insureds who “get the economic grease” they deserve. Should our Industry Indignation Index percentage be higher, or lower? Is the audio razz deserved, or not. What can she do? Insurance agent and attorney input is appreciated.

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den window

On the Patient Friendly Google Health Initiative

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Data Integrity and Health 2.0 Accuracy Concerns Linger

google3

[By Staff Reporters]

According to its’ website, and mission statement, Google Health aims to put patients in charge of their digital health information. It’s safe, secure, and free.

Triple Play of Benefits

Google Health purports to:

  • Organize health information all in one place.
  • Gather medical records from doctors, hospitals, and pharmacies.
  • Share information securely with family members doctors and caregivers, etc.

Google says members are always in control of how data is used. It will not sell information. Members decide what to share, and what to keep private.

Link: privacy policy

Blogsite

Google health was launched in the spring of 2008. Since then, it even maintains its own blog-site, which stated on 3/4/09.

 “We continue to learn a tremendous amount since launching Google Health in the spring of 2008. We’re listening to feedback from users every day about their needs, and one issue we hear regularly is that people want help coordinating their care and the care of loved ones. They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network”

Link: http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html

Good thing too!

A Cautionary Tale

However, privacy advocates worry about the vast amount of data that Google is redacting. Growing consumer market clout means the early-adopter patient who cares about digital records, and eHRs, may have fewer choices in the future. And, for medical professionals, what does this say about CCHIT, Allscripts and the Military, etc; or, the emerging Wal-Mart eMR initiative for doctors?

Assessment

For example, when one now [in]famous patient named Dave deBronkart – a tech-savvy kidney cancer survivor – tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, he was stunned at what he found.

Read this Link: http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt

Is MSN’s Health Vault any better?

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Conclusion

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Is JAMA Censoring Physician Dissent?

Allegedly Stoops to “Name-Calling”

By Dr. David Edward Marcinko; MBA, CMP™dem24

According to the Wall Street Journal Health Blog, Jonathan Leo, a professor of neuro-anatomy from a small university in Tennessee, critiqued a study published in the Journal of the America Medical Association [JAMA], and pointed out an association between the study’s author and a pharmaceutical company. He posted his thoughts on the website of the British Medical Journal [BMJ].

JAMA Responds

According to the report, a none-too-happy Leo then received calls from JAMA’s executive deputy editor, one Mr. Phil Fontanarosa. And surprisingly, Editor-in-Chief Dr. Catherine DeAngelis, MD got involved by asking Leo’s superiors to retract his post from the BMJ’s site. Sound familiar ME-P readers? According to Keven Pho MD, the WSJ called Dr. DeAngelis for comment, and this is how the interview allegedly went:

“This guy is a nobody and a nothing.”

She said of Leo.

“He is trying to make a name for himself. Please call me about something important.”

She added that Leo

“Should be spending time with his students instead of doing this.”

When asked if she called his superiors and what she said to them, DeAngelis supposedly said,

“It is none of your business.”

Environmental Scanning

One can only wonder if the AMA has adopted the strategy of former CDC Director Julie Gerberding, of Atlanta, GA. Local gossip suggests that one initiative under her noxious leadership was her so-called policy on “environment-scanning” or, monitoring the news-media, internet space, blogs, wikis and other venues to identify “emerging threats to the agencies” reputation.” WOWSA!

Link: https://healthcarefinancials.wordpress.com/2009/02/05/goodbye-julie-gerberding-md/

An Alternative Theory

My alternative opinion is the AMA might be taking censorship lessons from Blue Cross and Blue Shield of New Mexico [BCBSNM], and its’ public-relations representative and former reporter, Ross Blackstone of the Health Care Service Corporation [Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas].

Monitoring the ME-P?

Or, perhaps they are reading [Think: monitoring] this Medical Executive-Post itself? They may even be teaming up with Becky Kenny [media relations specialist with Blue Cross and Blue Shield of New Mexico] who goaded [threatened?] the trade magazine ModernHealthcare. As ME-P readers know, ModernHealthcare is an advertiser-driven media outlet that removed a perfectly acceptable post of diverging eHR opinion from its blogsite?

Industry Shame

Such acquiescence is both a sign of shameful health insurance industry [BCBSNM] heavy-handedness, and poor journalistic ethos from ModernHealthcare’s leadership. The BCBSNM public relations hacks, and media representatives, also appear as clueless shills who are no-doubt glad they are employed in these troubling economic times.

In other words, do they do what they are told? Jump Rover! Fetch Fido; etc! Or; are they more like the innocent child who spills grape juice on a white carpet? Let’s simply forgive them for their brainless duplicity. Yet, MH capitulated; how unfortunate!

Link: https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

Doctors Censoring Patients [The Retro-Evolution]

By the way:

“What’s up with all this censoring?

The Internet has been publically available to the masses since 1995, and I was using electronic bulletin boards [eBBs] years before then. The next thing you know, doctors will start trying to censor the opinion of their patients, much like customers rate restaurants.

Ops! My bad! This has already occurred. Sorry!

The ironic thing here is that patients don’t know about quality care. But, they do know if they’ve been kept too long in the waiting room; or, if the doctor’s office staff was surly; or, if the doctor had a miserable bedside manner. So, the doctors are really being rated on their personality; not their medical acumen. I pity the fools. These medical guys, and healthcare guru gals, just don’t seem to realize that “perception is reality.”  But, they sure feign outrage at poor patient reviews.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/doctors-censoring-patients/

Assessment

From my perspective, this is another public-relations disaster for JAMA, and especially Dr. DeAngelis, who must have known she was on the record with a national newspaper. After all, she is the editor of JAMA. Maybe not however, as we have previously opined that professional experts are not necessarily professional journalists.

Link: https://healthcarefinancials.wordpress.com/2009/03/09/healthcare-experts-versus-health-journalists

Of Cover-Ups and Crimes

“But, one must still wonder aloud; is this cover-up becoming worse than the proverbial crime?”

Resorting to personal attacks is somewhat unbecoming of the editor-in-chief of a prestigious medical journal, and reflects poorly on JAMA; don’t you think? Then again, JAMA and the AMA itself, is not as prestigious as it once was; is it?

In fact, when I asked ME-P managing-editor and Professor of Health Administration, Hope Rachel Hetico; RN, MHA, CMP™ to opine on admitted third-party limited information; she graciously replied with the utmost gentleness:

“With less than 25% of the nation’s MDs in the AMA; JAMA is probably still somewhat prestigious to those who don’t know any better; but many of us do know better. The older generation just needs some-time to catch up to modernity, and transparency – or resign. The top-down and command-control model of leadership is long gone – please be patient with them.”

Link: www.CertifiedMedicalPlanner.com

Link: www.MedicalBusinessAdvisors.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Should Catherine DeAngelis MD resign over this incident? Please criticize or defend her actions. Is healthcare industry censorship on the rise – or is the industry just following-the-money? What do you think of ModernHealthcare or BCBSNM?

Is personal integrity – or scrutiny – the reason Joseph Biederman MD [Harvard’s controversial chief of pediatric psychopharmacology] ended his ties to the pharmaceutical industry recently for diagnosing bipolar disorder in children [as well as for the nature of big-pharma’s support behind his research]? Please opine.

Industry Indignation Index: 63

Disclaimer: I am not a member of the AMA. But, for a decade I was on the editorial staff of both a leading national medical, and surgical journal, back-in-the-day. I am currently the Editor-in-Chief of Healthcare Organizations [Financial Management Strategies] a 1,200 page, quarterly premium print-journal, available on a subscription basis.

Link: www.HealthcareFinancials.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Say it Ain’t So Kathy Sebelius

More HHS Nominee Tax Problems

[By Staff Reporters]56359795

Although it’s sounding more and more like comedian Bill Murray’s movie “Ground Hog Day”, according to Tracy Staton, Health and Human Services department secretary-nominee Kathleen Sebelius, became the second appointee for the agency to admit underpaying her taxes.

Unintentional Problems

Sebelilus fixed three years’ worth of returns due to “unintentional” problems, and paid almost $8,000 in back taxes and interest. The snafu may not be serious enough to jeopardize her nomination, however. Senate Finance Chair Max Baucus issued a statement saying the errors were “minor” and accidental, and that he supported her confirmation (The committee’s ranking Republican Charles Grassley is reserving judgment until after her confirmation hearing).

A Daschle “Do-Over”

We all know that Senator Tom Daschle’s nomination to head up HHS hit the wall after a tax review found he owed some $140,000 in back taxes and interest. Is this a similar KS do-over; aka “mulligan”?

Industry Indignation Index: 45

Assessment

More importantly, are these so-called healthcare demagogues and gurus aware that “perception is reality”; especially in the healthcare space where integrity and trust matters most? Or, as ME-P Publisher Dr. David Edward Marcinko wondered aloud,

“Do politicians and/or those of us in healthcare really believe we are above it all?

Link: http://blogs.wsj.com/health/2009/04/01/sebelius-runs-into-tax-problems-but-daschles-were-bigger

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Advetising in “Worth” and “Bloomberg” Magazines

Advertisers – Give Me a Break!

By Dr. David Edward Marcinko; MBA, CMP™dr-david-marcinko16

Did you know that financial advisor Judith Zabalaoui, age 71, considered a pioneer of the fee-only business-model of financial services sales, pleaded guilty to using a Ponzi scheme to embezzle more than $3 million from her New Orleans area clients between 1993 and 2007? Yep, it’s true, but this is not really noteworthy to many pundits considering the current financial meltdown on Wall Street. But, do you know … the rest of the story?

Resource Management Inc.

Most of Zabalaoui’s clients came from Resource Management Inc. in Metairie, La., which she founded in 1974, according to the Times Picayune. Apparently, she became a Certified Financial Planner® in 1979, but the certification expired in 1999.

Link: http://www.nola.com/business/t-p/index.ssf?/base/money-1/1233728420253000.xml&coll=1

Assessment

So, here’s the rub. According to reports, Resource Management Inc. was the only firm in the country where each of the principals were allegedly “selected” by Worth [1996 to present], Money [1987] and/or both magazines as one of the top financial consultants in the country. The company also made Bloomberg Wealth Manager’s list of top wealth managers in 2004.

Industry Indignation Index: 55

Now, with all due respect and humility, I have been asked several times by Worth and Bloomberg to “promote yourself” in their “advertiser-driven” publications as a top financial consultant; but never Money magazine. I have always refused their selection charges for same of $12-18,000.

Full disclosure: I am the Founder of www.CertifiedMedicalPlanner.com and a reformed insurance agent, registered investment advisor and Certified Financial Planner™.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Was Judith Zabalaoui a fiduciary and what about these magazine “best-of” awards? Are they worthwhile monikers or worthless sales advertisements? What about all the so-called financial certifications, designations and charters; meaningful or meaningless? What is your opinion?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Frank Gehry, Health Reform and the Cleveland Clinic

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Las Vegas Hospital Uses Celebrity Architecture to Fight Disease?

By Dr. David Edward Marcinko; MBA, CMP

[Publisher-in-Chief]

dr-david-marcinko6According to the Las Vegas Sun Newspaper on March 2, 2009, the Cleveland Clinic is the newest top-tier player in Sin-City with an emerging health care system that will shake up the status quo, supposedly creating a multitude of direct and residual benefits for patients throughout the region.

Lou Ruvo Center for Brain Health

In its role as partner with the Cleveland Clinic’s Lou Ruvo Center for Brain Health, the hospital — ranked fourth best nationally by U.S. News & World Report — is projected to influence medical care in Nevada on the strength of its immense organization. And, it is being designed by, none other than esteemed architect, Frank Gehry.

A Huge Project

And, if you believe numerous websites, the behemoth project will include office towers, a park, a 60-story tower for jewelry trading, a hotel conceived by celebrity chef Charlie Palmer, thousands of apartments and a $360 million performing arts center. Of course, in typically flamboyant Gehry fashion, the highly embellished main facility is said to model curvy metallic shapes and “folds of the brain.” Other nescient drawings of the Ruvo Center show it divided in two sections. Offices and examination rooms will be housed in stacked rectangular blocks set slightly off kilter, like a fortress wall built by children.

The Architect

Gehry used this method to design his world famous Guggenheim Museum in Bilbao, Spain (1997) and his Peter B. Lewis Building for the Weatherhead School of Management at Case Western Reserve University in 2002. His style is well known.

Misplaced Priorities

But, with an estimated 40 million uninsured citizens, one only can wonder if this facility could have been built more cost effectively and/or more utilitarian?

Assessment

Moreover, some Clevelanders are grumbling about the clinic’s involvement in such a glamorous project far away, and imagine that the project will drain local resources just as sun-parched Western states have fantasized about tapping the Great Lakes.

Industry Indignation Index: 70

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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