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A check of Medicare's new database of payments to physicians confirms that at least $6 million in 2012 went to doctors who had been indicted or otherwise sanctioned. (iStockphoto)

Medicare Kept Paying Indicted, Sanctioned Doctors

by Charles Ornstein
Apr 16, 2014

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In August 2011, federal agents swept across the Detroit area, arresting doctors, pharmacists and other health professionals accused of running a massive scheme to defraud Medicare.

The following month, several of those arrested — including psychiatrist Mark Greenbain and podiatrist Anmy Tran — were suspended from billing the state's Medicaid program for the poor.

But the indictment and Medicaid suspensions didn't deter Medicare from continuing to allow the doctors to treat elderly and disabled patients — and didn't stop the physicians from billing taxpayers for their services.

In 2012, Medicare paid Greenbain more than $862,000, according to newly released data on Medicare payments to physicians. Tran received $155,000.

Greenbain and Tran were among dozens of doctors identified by ProPublica who kept getting Medicare payments after they were suspended or terminated from state Medicaid programs, indicted or charged with fraud, or had settled civil allegations of submitting false claims to Medicare.

Outlays to these doctors amounted to more than $6 million in 2012, ProPublica's analysis shows. That's only a small fraction of the $77 billion Medicare has publicly reported paying that year for doctors' visits and outpatient services in its Part B program. But it signifies a hole in regulators' ability to protect the program — and patients— against fraud and abuse, say current and former government officials and fraud experts.

The total dollars paid to sanctioned doctors is likely much higher. Only a handful of states post online the names of doctors terminated from Medicaid programs in a way that can be accurately matched to Medicare Part B payments.

"If you've been suspended or terminated in one of the federal programs ... I would think that you'd be suspended in the other programs, just as a basis of good practice," said Louis Saccoccio, chief executive of the National Health Care Anti-Fraud Association.

Part B payments to doctors were released last week for the first time. A court injunction that had kept the information secret for 35 years was lifted last year as a result of a lawsuit by Dow Jones & Co., parent company of the Wall Street Journal.

Aaron Albright, a spokesman for the Centers for Medicare and Medicaid Services, said he could not discuss the status of individual doctors, such as Greenbain and Tran, both of whom were finally barred from billing Medicare this month.

By that time, Greenbain had pleaded guilty and been sentenced to four years in prison. Tran had been found guilty and trial and was sentenced to five years. She is appealing her conviction.

Albright said the Medicare payment data may not reflect money already recovered by his agency or held back from providers suspended from billing the program.

Preventing improper payments is a top priority for CMS, Albright said. The agency has employed new enrollment screening techniques to prevent high-risk providers from getting into the system, he said, and is using advanced data analytics to spot fraudulent billing before payments are made.

Last year, ProPublica reported that doctors who had been booted from Medicaid — or who had been disciplined by state medical boards — were able to continue prescribing medications to beneficiaries in Medicare's drug program. The finding prompted Sen. Charles Grassley (R-Iowa) to push for better coordination.

Among the physicians ProPublica found who continued to collect Medicare Part B payments after being flagged by law enforcement or other oversight agencies:

  • Dr. Lawrence Eppelbaum, a Roswell, Ga., pain doctor convicted last year of inducing patients to be treated at his Atlanta pain clinic by paying their travel fees through a purported charity he controlled. Eppelbaum was indicted on the charges in March 2011, but Medicare paid him $500,000 to treat 80 patients the following year. This February, Eppelbaum was sentenced to 50 months in prison and fined $3.5 million. He is appealing. In a sentencing memorandum, Eppelbaum's lawyer maintained that Medicare did not lose any money because of the doctor's conduct.

  • Michigan ophthalmologist Matthew Burman was suspended by the state's Medicaid program in 2009 after he was convicted of a misdemeanor count of criminal sexual conduct arising from a patient's accusation against him. He was paid $379,000 by Medicare in 2012. (Medicare has not released payment data for prior years.) Burman, who continues to practice in Michigan, said he could have re-enrolled in Medicaid but chose not to. "One has nothing to do with the other," he said. "I didn't violate any Medicare rules. Medicare has nothing to do with why I'm not a Medicaid provider."

  • Louisville Dr. Steven Stern and his practice paid $350,000 to settle allegations of overbilling Medicare in September 2011. He and his practice were accused of overbilling Medicare for infusing Infliximab, a drug used to treat rheumatoid arthritis. In 2012, Stern received more than $3 million in payments from Medicare, including $2 million for infusing Infliximab. He did not return a phone call seeking comment.

Even a guilty plea sometimes wasn't enough for Medicare to cut off payments. Dr. Anthony Jase of New Orleans pleaded guilty to two counts of health care fraud in October 2011. He still collected $97,460 for Medicare billings in 2012. Last fall, he was sentenced to 15 months in prison and ordered to pay $360,293 in restitution.

"It certainly looks like there is a need for more attention," said Mark McClellan, former administrator at CMS who is now at the Brookings Institution.

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A check of Medicare's new database of payments to physicians confirms that at least $6 million in 2012 went to doctors who had been indicted or otherwise sanctioned. (iStockphoto)

The Ultimate Animal Experience? Losing A Memory Quiz To A Chimp

Apr 16, 2014

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Time to be embarrassed. You're about to be bested by a young chimpanzee in a memory test.

Many have tried to outperform Ayumu (that's the chimp's name), but when you see how easy it is for him, how matter-of-factly he gets things right, it's clear he's got a talent that's built in. It's not a talent you'd expect a chimp to have, but hey, this isn't a trick. Nature isn't pro-human or pro-chimp. It's just nature.

So here's the deal: You will see a screen. A bunch of numbers between 1 and 9 will flash on, but you will see them for less than a second. They show up in scattered spots, here, there and very quickly (650 milliseconds later for beginners, even faster in advanced versions). They will then be covered by little gray patches. You won't see them anymore.

Your job? Remember which numbers were where, and touch the white patches in ascending order: 1, then 2, then 3, then 4, etc.

If you're intimidated, don't be. It's not easy to beat this chimp. It's best to just watch.

How'd he do it? Well, says science writer Virginia Morell in her new book Animal Wise, "it's impossible to track each number's position with one's eyes; you had to take in the entire pattern with a single glance." And yet, "Ayumu nearly always got the sequence right. His success rate was close to 80 percent."

Photo-Flash Memory

This tells Japanese scholar Tetsuro Matsuzawa "that he has an actual picture memory, an eidetic memory. ... He takes a picture with his mind and holds it." Even if he turns away from the screen to do something else, the information stays in Ayumu's head. "You and I," says Matsuzawa, "we cannot do this. ... It is something special for the chimpanzee mind. It is not a matter of training for them. It is their way of seeing the world."

Ayumu learned his computer skills sitting on his mother's lap, watching. She is also a laboratory chimpanzee and has a computer of her own. Her son didn't interfere, didn't touch the keys. When Professor Matsuzawa gave him a little computer with a small touch screen, he explored it, but cautiously.

"The mother does not offer any explanation. And her child, the apprentice, learns by careful observation," the professor says. But over time, he's gotten good. Is he exceptional? Will he stay this sharp when he's older? We won't know till we've tested many other chimps. But for a species that grows up in dense forests, where food is hiding in plain sight, a photographic memory might be very useful.

Don't Tell Me I'm More Stupid Than A Chimp

Still, his performance leaves lots of people feeling uncomfortable. "How does he do that?" writes one YouTube reader. "I can barely see the numbers flash. ... I am more stupid than [a] chimp. Why God, why?"

"This is not helping anyone," writes another. "It's decadent and it's wrong," writes someone else. "That's a million times better than I can ever do."

"Well it's official. I am dumber than a chimp," says one more.

Even scientists got upset. "You must see this," Matsuzawa told Morell, holding a science publication in the air. "In it," he told her, "the authors say that humans 'with practice' are as good as chimpanzees at our memory test."

But why bother? Why would a bunch of scientists go to the trouble of training themselves to best a chimp?

"Really, I cannot believe this," Matsuzawa said. "With Ayumu, as you saw, we discovered that chimpanzees are better than humans at one type of memory test. It is something a chimpanzee can do immediately, and it is one thing — one thing — that they are better at than humans.

"I know this has upset people. ... And now here are researchers who have practiced to become 'as good as' a chimpanzee!' " he told Morell. "I really do not understand this need for us to always be superior in all domains. Or to be so separate, so unique from every other animal."

We are just members of the animal kingdom, he says. Talented, to be sure, but not always Best. We should get over ourselves.

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A cherry blossom tree on the Potomac. Not bad, eh? (Getty Images)

Lusting For Spring In Our Hearts

Apr 16, 2014

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A friend of mine grumbled on Facebook recently about the phenomenon of people moaning in despair over April's weather. There's often a cold snap around this time, she pointed out. There's often unpleasant rain. There's often unpredictability.

It's true, of course. The delicate dance of when to put away the warm clothes and take out the short sleeves must be repeated every year, and then re-repeated in reverse the first time you go outside in early September and feel that the air has become slightly less hospitable than it was yesterday. It's true that we shouldn't act surprised. It's true that we should look at our calendars, nod sagely, and say, "Right on time."

But somehow, we manage to summon every April the impatience and restlessness that can only mean one thing: we are lusting for spring in our hearts.

It really is remarkable, though. It should be old by now, but it isn't. It's amazing. I literally allow myself to be amazed by the effect of the earth going around the sun. It happened again! I think. My part of the globe is once again getting more direct sunlight more of the time! It's as if I feared maybe it wouldn't. Maybe this would be the year that we chugged to a stop and it stayed January forever. Or worse, February. I should, in theory, be no more impressed by the arrival of spring than by the arrival of morning. I happen to have a huge window through which I can watch the sun come up, and I often do at certain times of year. But I don't have feelings about it.

I have feelings about spring. Every spring, I look forward to that first day that I can drive with the window down, even though I've been driving with the window down since I was a little girl. (I recommend accompanying this trip with the New Pornographers' record Mass Romantic.) Every spring, there's that one day. That one day, when you turn the corner. You hit the farmer's market in a shirt you've washed and dried a hundred times until it's fuzzy and pilling. The tables are crammed with berries that are a little early but they are there, and you ease past somebody slathering sunblock on a kid in a stroller. You take your berries home, but you eat several of them in the car on the way there, because hey - they're grown without pesticides, right?

It's true: We shouldn't grouse about the way winter hangs around. (Even though, in many places, this winter was worse than most.) We should be used to it. It starts to get better, and then it rains, it gets cold again, and we feel suspended and impatient, snapped back and forth between cold and warm. But all that angst is just part of the dance. We talk about the bad weather in part because it preserves that feeling of that one day. It's going to happen soon here.

I sing "Spring, Spring, Spring" from Seven Brides For Seven Brothers to myself at least once every year. Just because. (Well, just because it's pegged to spring, while the other major kicky musical number about animals mating seasonally is specifically pegged to June, and I can never wait that long.)

This weekend was a false start to spring and summer, but I bought a comfortable chair for my little balcony anyway. I went out and propped my feet up on the railing and, admittedly, watched an episode of Orphan Black on my tablet rather than simply gazing out at the sunny day. But it was air, so much air, so much warm-ish, good-hearted air.

There's always some smug Californian who wants to explain when it's 20 degrees in D.C. that it's 80 in Los Angeles. They send ... well, they don't usually send a photo of the out of doors; they send a picture of their phone telling them what the weather is like. It never changes here! they taunt. It is never winter! We have no seasons! I wear the same clothing year-round!

I try to muster some obligatory fist-shaking, I really do. But on the inside, I am smug. On the inside, I am thinking: enjoy your terrarium.

I would miss this rhythm if I lost it. I would miss this fevered relief at something as predictable and scientifically neutral as the movement of planets.

And it is rhythmic. Because in the fall, when it's been 95 degrees and sweltering for weeks, I will be just as in love with the first day when the leaves are crunchy and I throw a scarf around my neck and drink hot cider.

None of this should impress me; it's literally just the repeating pattern of the universe. But while almost everything else in the world, literally almost everything else on the planet, gets old, the coming of spring never does. We are still this grumpy because we are so ready. We are leaning forward, sniffing the air, looking for blooms, grabbing a jacket for one more stupid day of stupid jacket weather, in part because we know there's an end. It will be spring. It will get warm. There will be sun.

Lust so rarely comes with a guarantee.

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A masterpiece in pieces. (npr)

Art In A Jar: A Puzzle In Blue, Yellow And Shred

Apr 16, 2014

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The Puzzle

The challenge: Guess the masterpiece — by looking at its pieces — in the jar.

Can you identify a great painting by a random arrangement of details? Can you find the whole not in the sum of the parts, but in some of the parts?

Please post your guesses in the comment section.

The Idea

The idea came from a library in Lawrence, Kansas. A librarian there took pages from a book, cut them into strips, put the strips in a jar and asked patrons to identify the book.

We tried. It was hard. We wondered if a famous painting might be easier to identify. Or at least make a prettier picture.

Surely it's been done before, we thought, but we asked Emily Bogle and Jim Tuttle of NPR's creative Visuals Team to make a photocopy of a famous painting. Cut the copy into strips. Place the strips in a jar so that it is a jumble of details. Snap a lovely photo. Et, voila.

The Question

The experiment might go some way toward answering the question: Can we see artistic greatness manifest in a snippet of a painting or must we see the whole work to get the full masterpiece effect?

"Works of art are complex and layered," says Linda Duke, director of the Beach Museum of Art at Kansas State University, after receiving our puzzle. "We apprehend them in various ways."

Paraphrasing the artist Donald Judd, Linda says "a work of art has a kind of presence or integrity that makes it art. It defies reduction. If it is reduced to parts, then it is no longer able to function as a work of art."

But maybe it still makes a pretty good puzzle. Here's a hint: The original belongs to the National Gallery of Art.

The Solution

We will eventually reveal the correct answer in the comment section, as well. And please remember: No real paintings were harmed in this process.

The Protojournalist: Experimental storytelling for the LURVers - Listeners, Users, Readers, Viewers - of NPR. @NPRtpj

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A masterpiece in pieces. (npr)

Dozens Of Girls Abducted In Nigeria

Apr 16, 2014

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Soldiers, "vigilantes and volunteers," CNN writes, are searching for about 100 Nigerian schoolgirls who are reportedly in the hands of the militant Islamist group Boko Haram.

The students, along with about 100 other girls, were grabbed by Boko Haram gunmen on Monday in the northeastern Nigerian town of Chibok after a firefight with guards at their school. The Associated Press says one soldier and a police officer died in the battle.

The Daily Post, a Nigerian online newspaper, reports that at least 80 girls either escaped or were rescued Tuesday when the truck they were being transported in broke down.

As Voice of America notes:

"There has been no claim of responsibility for the attack or the kidnapping. [But] the assault is similar to others carried out by the Islamist militant group Boko Haram, which is blamed for scores of attacks and thousands of deaths since launching an insurgency in 2009.

"The group, whose name means 'Western education is a sin,' wants to impose strict Islamic law on northern Nigeria."

Boko Haram is also being blamed for a deadly attack Monday near Nigeria's capital, Abuja. More than 70 people were killed and dozens more injured when a bomb went off at a bus station. The explosion set off other blasts as vehicles in the vicinity burned.

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