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Friday, May 9, 2008

Blue Cross Blue Shield Vs. Private Family Physicians...Corruption in Texas Part One


This is Dr. Doug Curran and the picture you are looking at is an advertisement he did for Blue Cross/Blue Shield. This testimonial and the story that surrounds has major implications on the way that health care is determined today. This is the first of a three part series that will examine Curran's role in a serious and systematic corruption by Blue Cross Blue Shield. In the first part, I will lay out some serious charges against Curran and some other colleagues as well as Blue Cross Blue Shield itself. In the second part, I will lay out the evidence to prove those charges. In the third part, I will give my conclusions for what all of this means in the larger health care debate.




Dr. Curran is a private family practioner in Athens, Texas at the East Texas Medical Center. By appearing in this advertisement, Curran appears to have violated the Texas Medical Practice Act's ban on so called testimonial advertising. Furthermore, he violates all sorts of ethics regarding conflicts of interest by appearing in an advertisement for his most significant insurance carrier. The whole affair becomes even more curious when only a few months later a puff piece with quotes from BCBS hierarchy as well as references to BCBS finds its way through the internet.


Dr. Doug Curran is everywhere these days. The longtime Athens-based family physician has been spotted in a few magazines you may have heard of, such as Newsweek and Sports Illustrated.

Through his longtime association with Blue Cross Blue Shield of Texas, Curran appears – wearing his white lab coat, clutching a stethoscope and looking more serious than one usually finds him – in a series of their print ads.

While those ads have garnered him the most attention over the last few months, a less visible appearance in another magazine carries even more prestige.On page S-18 of December's Texas Monthly (S for Super), Curran's name is listed under the Family/General Practice section of "Texas Super Doctors 2005."



...



Dr. Dee Whittlesey describes Curran as "a physician's physician.""He's a man who cares deeply for his patients and will go to any lengths to make sure they get the best care," said Whittlesey, who serves as VP in the Office of Physicians Advocacy for Blue Cross Blue Shield of Texas. Before that she worked 23 years in obstetrics and gynecology.



As you can see, besides appearing for an advertisement for BCBS, Dr. Dee Whittlesey of BCBS is quoted within this article. Furthermore, his connection to BCBS is mentioned multiple times throughout the article. It is one thing to have a good and professional relationship with your insurance provider, however it is quite another to simply get into bed with them. This article and the advertisement previous to it are two examples of a long and winding story in which Curran wasn't merely friendly and professional with BCBS, but in bed with them.




Besides being a small town doctor, Dr. Curran was also, for several years, the head of the Texas Academy of Family Physicians (TAFP). This is the Texas branch of the most powerful organization that represents the INTERESTS OF FAMILY PHYSICIANS. Furthermore, Dr. Curran is one of three members of super secret committee of the Blue Cross Blue Shield Texas Medical Advisory Board. This is a committee that the general public is likely not supposed to know exists. This committee reviews the performance of other family physicians that are contracted with Blue Cross Blue Shield and determines if any have stepped out of bounds. Furthermore, this committee is intimately involved in determining proper punishment for those physicians that Blue Cross Blue Shield determines to have stepped out of bounds. In other words, Dr. Curran is playing both sides of the proverbial fence. Not only is he representing the interests of family physicians, (Of course, many times those interests confront the interests of BCBS) but he then turns around and represents the interests of BCBS against family physicians.




Curran serves on this BCBS committee with two other physicians, Dr. Keith Miller, and Dr. Fred Merian. Dr. Keith Miller was also the long time head of the Texas Medical Board Disciplinary Committee and Merian was the head of the Texas Medical Association. Furthermore, Miller is a private family physician in a town called Center, Texas. This is a town of a few thousand, and Miller has spent his entire professional life serving in relatively small towns like Center, Texas.

Several issues should already come to mind. Why are three such powerful people also in a position of power at BCBS? How does a doctor centered in a relatively small town wind up finding himself in the middle of so much disciplinary and decision making power? The answer is that these three were put there by BCBS to corrupt the system to punish private family physicians in Texas that BCBS determined were too expensive.

The relationship between private family physicians and BCBS, and other insurance companies frankly, is a naturally confrontational one. Unlike doctors at big hospitals, private family physicians get paid by the medical version of commissions. Ulike doctors at large hospitals or hospitals associated with universities, private doctors only get paid when they have patients. Furthermore, there is a sliding scale that BCBS, and other insurance companies use, to determine how much they get paid. The more comprehensive leads to more fees. This is determined by patient evaluation forms that doctors fill out. Whereas doctors at hospitals rarely if ever fill these forms out, private doctors use this as the lifeblood of their business. Think of private family doctors as the ultimate capitalist in the medical field. They have to fight for every nickel they make, and they are the ones most motivated to fight for it.




The BCBS Texas Medical Advisory Committee reviews the billing of private doctors in Texas. Keep in mind that Dr. Miller, for one, is himself a private Texas doctor. This is of course an obscene conflict of interest. Unfortunately, the corruption doesn't end there. BCBS employs these three to procure a practice known as sham peer review. Sham peer review is the corrupted process of medical peer review . Instead of determining whether or not a doctor stepped outside of medical guidelines, sham peer review merely punishes doctors that powerful forces deem a threat. The process can be summed up the phrase: judge, jury and executionor. The corrupt force finds a way to bring up trumped charges, they have someone on the panel's jury, and they usually have someone presenting the evidence. Dr. Miller's position as head of the disciplinary board puts him in a unique position to corrupt a legitimate peer review and turn it into a sham peer review. In other words, these three don't merely work for BCBS to perform private physician evaluations, but rather, they are strategically placed by BCBS within all parts of the medical system to corrupt it to punish those doctors that BCBS determines to be a threat.

As such, these three doctors have gotten into bed with BCBS in order to help BCBS root out those of their colleagues that they determine too expensive to keep around.

In part 2, I will tell the story of Dr. Shirley Pigott. She is just one of those doctors that BCBS determined too expensive to keep around, and as such, she wound up crossing paths with all three as she was systematically retaliated against through sham peer review.


12 comments:

Anonymous said...

no bcbs provider would risk retaliation to post here unless it is anonymous

mike volpe said...

If that is your fear, but you want your story told, please contact me by email and I will maintain your anonymity.

kmerian said...

You have a lot of nerve maligning my father like that. I am Dr. Merian's son.

My father is the most ethical and caring doctor there is. And your labeling him as some corporate shill is downright libeleous. And since when is it wrong to go after doctors who are overcharging their patients?

Do you even attempt to contact the three Doctors whom you labeled with this article? I know all three, and they have impeccable reputations with both their patients and their fellow Doctors.

All of these Doctors earned their positions, is being from a small town mean you are not qualified to make policy in this state? Do you have to be from Houston or Austin in order to be qualified to hold a position of leadership?

mike volpe said...

By maligning, I assume you mean identifying his position concurrently as head of the Texas Medical Association and the Blue Cross/Blue Shield Medical Advisor Board. In your attack, I notice you didn't refute that charge.

I guess your father didn't explain to you the despicable conflict of interest that someone working concurrently on behalf of their fellow doctors at the same time they are secretly working for the insurance companies.

If you believe that Keith Miller and Doug Curran are doctors of exemplary reputation that observation speaks for itself.

Furthermore, this piece mentioned significantly more than three doctors. You just happened to notice only three that were portrayed negatively.

The doctors aren't overcharging, and that is something to be decided between the doctor and the insurance company. Of course, in this particular story, the doctor was brought up on charges of not getting out a medical report in a timely manner. Since when should doctors lose their careers because they don't get out a medical report within fifteen days.

No one said that doctors need to be from big cities to earn positions of power and influence, what this story clearly shows is that corrupt doctors in position of power and influence are a cancer to the system.

kmerian said...

What position? He sits on a Physician advisory panel. All Insurance companies have those. And, I am not aware of any Doctor who is part of the TMA who was not aware of my fathers position, it was hardly a secret. Insurance companies and Doctors do not have to be adversaries, and this is something my father has long worked for. Also, this board does not discipline or "punish" doctors in any way. Nor does it review any records.

I notice a charge you did not refute is that you made no attempt to contact my father, Dr. Miller or Dr. Curran for your article. All of your information comes from one source. And Dr. Pigott did not "lose her career", nor was she ever in any danger of it. She committed a minor infraction and was required to take some additional CE courses.

Also in your article, you stated: "How does a doctor centered in a relatively small town wind up finding himself in the middle of so much disciplinary and decision making power?" Implying that small town doctors can only achieve leadership positions by corruption or by being corporate shills.

The fact is, there is far more to this story. Things you would have found out, if you had done more research.

mike volpe said...

At least you all finally admit that the super secret Blue Cross/Blue Shield Advisory Committee exists. It isn't merely an "advisory committee" but rather the committee that decides if a doctor charges too much.

As for Dr. Pigott, yes, in the end, she wound up being slapped in the wrist but that was only after she fought the charges and hired a legendary attorney after gathering up evidence against folks including your dad.

Before that she was threatened with much more severe punishment and I published the original order.

As for someone being a doctor from a small town, yes, how in the world does an unremarkable doctor working in such a small town gain so much power?

If there is more to the story though, you are more than welcome to publish your response here or even on your own blog.

If my facts are inaccurate, you are more than welcome to point out how I am wrong. So far though, I have received nothing but rhetoric. Now, if you stick to the facts, that would be the best.

mike volpe said...

Mr. Merian, there is something very confusing to me. Please help me out. Your father is only supposed to have been tangentially involved in this story. After all, the TMA wasn't really involved in any of the proceedings. If, as you say, the BCBS advisory board is just a doctor/insurance co. advisory panel and there is nothing nefarious about it, how does he know so much? He wouldn't have been at any of the hearings, meetings, or anything. How are you, through him I assume, so knowledgable. It would have been fairly unprofessional for anyone to gossip about the contents of disciplinary hearings.

What possible more to the story could your father know about? After all, he wasn't directly involved and this advisory board, according to you, is standard and nothing nefarious. Can you explain that?

kmerian said...

You are right, my father is only tangentially involved in this story. However you had no problem accusing him of going along with the "persecution" of Dr. Pigott.

None of what I know did I hear from my father (its from Google). He does not gossip. He was not involved in her appearances in front of the TMB.

What I take offense to in your articles is your inference that my father is somehow involved in the unwarranted persecution of a fellow physician.

My father earned his position as President of the TMA through 30 years of caring for his patients and spearheading rural and border health initiatives. He also earned his position with BCBS as a physician adviser as he is considered an expert medical socio-economics, having served and chaired that TMA committee for many years.

mike volpe said...

Let me see if I understand you correctly, you learned everything from google and then you question my sources. I didn't insinuate anything. Your father is, or at least was, head of the TMA and concurrently part of a super secret BCBS medical advisory board. None of this you question and readily agree with.

Lot's of doctors do good work in the community and many in Texas have far finer resumes than your father, Doug Curran, and certainly Keith Miller, and yet it was those three that concurrently rose through the ranks of power within the medical community at the same time they were a part of this group.

Furthermore, this is not my only story about the corruption at the TMB. It is certainly not my only story about corruption. I have had plenty of folks like you come out with baseless charges that have no back up.

I wrote a piece that takes about twenty minutes to read and you attempt to refute it with three paragraphs most of which is nothing more than rhetoric.

You have refuted nothing. Thousands of doctors have been targeted by the TMB in the manner that Dr. Pigott was targeted. I have covered just a few of them. Keith Mller is a bad guy and that is well documented and the same google search that you claim to have done would also have discovered that. So, if your father worked on this committee with him and didn't figure that out, that speaks for itself.

No one in a position to affect the direction of a sub set of doctors, like family physicians, should also be in a position of influence with insurance companies. The conflict of interest there is blatant. For you to defend your father's dual role speaks for itself. You say that all insurance companies have such a committee, but how could you know such a thing.

I would be curious about this so called google search. I performed many google searches in preparing this article and I found no such "other story" as you claim.

I absolutely understand and appreciate that you would furiously defend your father, and I would do the same in your shoes. That said, it is time that you defend him with facts, not rhetoric. Saying that he spent thirty years "30 years of caring for his patients and spearheading rural and border health initiatives. " is not a fact, it is a slogan. Your father didn't do anything that thousands of other Texas doctors haven't done themselves. Yet, he dually rose to power within the Texas medical community at the same time he was part of a group working for the insurance companies. To dismiss that is irrelevant is nonsense.

kmerian said...

You want some facts? Fine.

The fact is, my father was elected to the presidency of the TMA by the membership, he was not placed there by BCBS. Apparently the Doctors of Texas were satisfied of my fathers qualification for the job, so your opinion of his qualifications is quite ignorant.

Also, did you ever consider that the reason my father was invited to serve on that advisory panel was because of his qualifications? The same qualifications that made him the right choice to be Vice President and then President of the TMA and now a delegate from the TMA to the AMA.

And, you claim my father serving on that board and being president of the TMA constitutes a "conflict of interest". Yet you do not illustrate that. TMA is not involved in health insurance, nor is BCBS involved in health issues in Texas. So, I fail to see the conflict.

Finally, I do not have to prove anything to you. You are the one alleging my father is a lackey for BCBS. Therefore the burden is on you to prove it. All you can come up with is guilt by association. It is a logical fallacy to then attempt to shift the burden of proof to me to prove you wrong. That is poor journalism.

However, I will work up a detailed response to you, and I will post it either here or on my blog.

mike volpe said...

With all due respect, the only thing I accused your father of was concurrently serving on a super secret board and President of the TMA at the same time. Any doctor in a position of power working for the interest of doctors at the same time they are secretly working on behalf of the insurance companies has an inherent conflict of interest. Just because you deny it doesn't actually make it any less true.

If this board is so above board, why can't I find any website to it. Why is it impossible to confirm for sure on the BCBS website that your father belongs to it? Why, besids your dad, Keith Miller, and Doug Curran, is there no other doctor known to be on it?

No one is saying that BCBS overtly forced him on to the TMA, however BCBS of Texas services one third of all insured patients in Texas, and being in bed with them gains one significant influence. BCBS can easily influence all sorts of things in the medical community of the state. To say that BCBS is not involved in "health issues" is so absurd it is funny. If you don't see providing health insurance for about a third of the population of
Texas as health issues, that speaks loudly about where you are coming from.

Again, to represent doctors, as President of TMA, at the same time you represent the insurance company is to play both sides. It is no different than a politician backing a bill that will help his own real estate transaction. That is the conflict of interest. Frankly, your father is going to regret that you freely admit he is on the committee because proof that he is on the committee proves everything else. If you want to make this about whether or not being a part of this committee is in fact a conflict of interest that is a debate I can have all day long.

As for me having to prove something, well with all due respect, you are allowing your emotions to run wild. I didn't accuse your father of anything you didn't just confirm readily. I accused him of being president of the TMA, a doctor, and part of a secret group that represents BCBS. All of these things you confirmed throughout. There is no more burden of proof because everything I asserted you acknowledged.

You are at this point trying to pretend as though working for the insurance company at the same time you work on behalf of doctors is not a conflict.

Imagine if I were a lobbyist and I represented pro family groups lobbying senators on behalf of anti abortion legislation. Then, at the same time, I also lobbied on behalf of Planned Parenthood for pro abortion legislation. Now, imagine further, if I approached Planned Parenthood and told them that I was lobbying on behalf of the family group but that I would secretly lobby on behalf of them, and that I would really represent their interests while making it seem as though I was really representing the interests pro family group.

If it is all right for someone like your dad to represent the interests of doctors at the same time he represents the interests of insurance companies, why not let lawyers represent the plaintiff and the defendent. You can't play both sides. The relationship doesn't have to be confrontational and adversarial but it naturally is.

The sort of role you are pretending your dad was filling at BCBS would be done when a group of doctors formed a group along with a group from the insurance company. It wouldn't be accomplished when doctors work for the insurance company at the same time they are doctors.

That's why the government doesn't allow mortgage brokers to work for a bank at the same time. There is a natural conflict of interest.

With all due respect, you just stepped in it big time with this admission.

kmerian said...

I have posted a response to you on my blog.

http://kmerian.blogspot.com

And you were right, I was letting my emotions get the better of me, for that I apologize. I look forward to continuing our discussion.