I Was One of Those Companies

The post: Kimberly shared Wendell Potter's piece on healthcare's middlemen: insurers, PBMs and distributors that earn billions managing payment for care without delivering any. She asked how many companies need to get paid before a patient gets care.

Read Kimberly Carleson's original post on LinkedIn →

My comment:

Her question — how many companies need to get paid before a patient gets care — is the one I'd answer from the other side of it.

I was one of those companies.

I built a management company (MSO) that sat between physicians and the money. I never touched a patient, I was in skyscrapers. I wasn't a doctor. I put physicians' names on the ownership documents because Michigan doesn't let a non-physician own a practice, and my MSO swept fees off work performed by people whose licenses were on the paperwork and in a calculated manner showed loss on their end.

That structure is legal. Thousands of MSOs operate that way honestly. What made mine a crime was that I wrote the protocol underneath it — one being, facet injections twelve times a year against a clinical standard of four.

I pleaded guilty to $150 million, served eight and a half years, and still owe a balance of $51 million in restitution.

The point I'd add to this chart: the middleman layer isn't dangerous because it's greedy. It's dangerous because it separates the decision from the consequence. The person deciding how much medicine gets delivered never has to look at the patient receiving it. I never did. Not once in ten years.

Originally posted as a comment on LinkedIn.