At roughly the same time that this billing dispute began, Dr. Pigott and her colleagues also began complaining to each other about how difficult the insurance companies were making it on them. Keep in mind that private family physicians have no salary. Everything they make comes from whatever they charge their patients. Since one third of patients in Texas can be expected to be covered by BCBS, BCBS is in a position to make things very difficult for family physicians if they so choose.
In about 2004, Dr. Pigott formed a group called the group of 35, of family physicians around the country, that decided that enough was enough. They decided that it was time for the American Academy of Family Physicians to fight harder for private family physicians. Initially, this group took three demands, or mandates as they are called, to the state levels of the AAFP. Dr. Pigott was given the responsibility of presenting these mandates to the Texas Academy of Family Physicians. The mandates essentially simply asked the TAFP to recognize the struggles that family physicians go through and fight harder for them.
Dr. Pigott presented the mandates to the proper committee within the TAFP. It was completely well received except for one doctor. That doctor's name is Dr. Doug Curran. Dr. Curran was then the President Elect of the TAFP. He wasn't even on the committee and was merely visiting the committee that day. Despite his objections, the three mandates passed the committee, the full TAFP, and eventually the AAFP.
At about this same time, Dr. Pigott received a complaint from the Texas Medical Board Disciplinary Committee. At the time, this committee was headed by Dr. Keith Miller. (as you can see if you go to most previous link Dr. Miller has been the subject of controversy and eventually resigned from the committee) In fact, this particular link minced no words in describing Dr. Keith Miller.
Notorious Texas Medical Board (TMB) henchman, Dr. Keith Miller, abruptly resigned his position on the TMB on Friday, September 7, 2007. Miller’s resignation was due to the intense scrutiny of his abusive and tyrannical actions against physicians while on the TMB.
(This will become important because my accuser will also go on to defend Dr. Miller)
The dispute involved a patient that demanded their medical records. Dr. Pigott customarily reviewed the medical records at a follow up appointment. This patient didn't make a follow up appointment and rather demanded the records be sent to their home. Since this broke protocol, Dr. Pigott didn't mail out the records for significantly longer than the law required which is 15 days. While this is a technical violation of the rules of medicine, it is a very mild one and should be the subject of a very mild punishment, if any at all.
Instead, because these records weren't mailed out on time, Dr. Pigott began a nearly four year battle against the TMB disciplinary committee. At one point, the board threatened all sorts of draconian punishments: one year probation during which she would be monitored by another physician, provide the board with random patient records upon request, a $500 fine and force Dr. Pigott to pay for the doctor that would monitor her, and this is among a whole host of punishments numerated 1-10 with several subsets for most. Again, these draconian punishments were in response to Dr. Pigott sending out medical records in an untimely manner. Furthermore, Dr. Keith Miller was later the subject of investigation of much corruption, including another story by me, and his nurse practioner Bridget Hughes was found by the Texas Nursing Board (must then click link download attachment) to have doctored 50 prescriptions of drugs like methadone. Furthermore, it was Dr. Craig McMullen, the doctor that employed Hughes prior to Miller, that discovered this. In other words, Dr. Miller hired Hughes despite knowing full well that she had committed a serious breach medical ethics.
Now, while her proceedings against the TMB disciplinary committee were going on, Dr. Pigott was continuing in a leadership role within the group of 35. She continued presenting mandates and continued fighting on behalf of private family physicians. At one such meeting, she came up against Dr. Doug Curran again. He was now the President of the TAFP and he visiting the committee she was presenting to, again, even though he wasn't a member of the committee. Once again, he confronted and objected to everything Dr. Pigott presented only this time most of the committee objected with him. Dr. Pigott told me that not only were her mandates rejected but she felt humiliated to the point of tears.
At around this time, Dr. Pigott discovered that Dr. Curran was the subject a full spread photo advertisement for Blue Cross Blue Shield, and then within weeks, she discovered this puff piece about Dr. Curran in which members of BCBS are quoted in glowing praise of him. Dr. Pigott began complaining to members of the TAFP as well as other medical authorities that she believed that Dr. Curran had a conflict of interest between his representation of doctors and his close alliance with BCBS.
Her complaints became so noisy that Dr. Curran confronted her and in the middle of their conversation Dr. Pigott says that he told her this...
Do you know that I am a member of the Blue Cross Blue Shield Texas Medical Advisory Board with Dr. Keith Miller, and Dr. Fred Merian.
Now, Dr. Keith Miller I have already touched on but Dr. Fred Merian is also the former President of the Texas Medical Association. Throughout my original piece, I refer to the BCBS Texas Medical Advisory Board as super secret. Of course, this is a bit provocative. It isn't hidden like secret parts of the CIA, however, you will find scant little information about it on the internet. You will certainly not be able to confirm on the internet who serves on this board. Most importantly, why are three doctors also working for the insurance company. This is of course an inherent conflict of interest.
Ultimately, Dr. Pigott discovered enough about what happened and then hired a legendary attorney and she wound up being given a slap on the wrist.
Several months later though, Dr. Merian's son found my article and found plenty to object to. Here is his first comment.
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?
Now, on one hand, I can understand and admire Mr. Merian's instinct to furiously defend his father's reputation. On the other hand, I found it rather peculiar that Mr. Merian was the one up in arms. After all, his dad was mentioned in passing and only because Dr. Curran identified him as one of three on this BCBS Medical Advisory Board. Furthermore, at this point, there is a mountain of evidence that Dr. Keith Miller is NOT a doctor of "impeccable reputation". I, myself, have presented several cases of corruption he was involved with. The Texas Medical Board's Disciplinary Committee was the suject of an investigation by the Texas legislature.
Furthermore, the reputation of the three is beside the point, the story that is the subject of the original piece speaks for itself. You either believe it and draw appropriate conclusions or you don't. That said, Mr. Merian wrote this response in which he attempted to take me to task for my reporting. Let's take things one by one. Here is how he concludes.
My father practiced medicine in Yoakum, Texas (pop 6000) before moving to Victoria, Texas (pop 45,000). Your implication here, of course is that individuals from small towns are inherently unqualified to serve in high profile positions, and therefore can only reach those positions through corruption and collusion. Again, you make this statement with no proof to back it up. In order for your allegation (that my father was put in the Presidency of the TMA by BCBS) to be true, you need to be able to back it up. My father (and Dr. Curran) were elected to their positions by the membership of their organizations. You are accusing thousands of Doctors of selling out to BCBS, all the while offering no proof at all. But challenging me to refute it. This is a logical fallacy known as "Shifting the burden of Proof" The burden is on you to prove your allegations, otherwise they are invalid and not credible.This statement is absurd on its face. The original story is split into three parts because it is so long. Even the introduction to this piece is probably too long and yet that is the only way I can present all of the relevant information of the story. Furthermore, this is not the only piece I have done about corruption within the Texas Medical Board. You either believe the story or you don't. I believe I have given plenty of supporting evidence to make my reporting solid. The audience can judge.
That said, if you believe this story, and furthermore, if you believe my other stories about the corruption at the TMB, it absolutely leads to troubling conclusions? I never said that doctors from small towns can't be in positions of power. I said that given the evidence I presented, we should all ask how these three got where they got. I find it very troubling that three doctors are in positions of power within the medical community all the while they are also working for the biggest insurance company in a position for which you can find scant information about.
We don't allow lawyers to represent both the plaintiff and the defendant. A lobbyist that concurrently represented a pro family group while they represented Planned Parenthood would be the subject of serious questions. Mortgage brokers can't also work for banks. By the same token, there is a serious conflict of interest if a doctor represents other doctors while they are also representing the interests of the insurance companies. That's exactly what is happening when Dr. Merian is President of the Texas Medical Association while working for the BCBS Medical Advisory Board.
Mr. Merian claims his dad is a pillar of the community and has dedicated his life to doing good. I don't doubt that however so are tens of thousands of doctors in Texas, and yet, it is his dad that concurrently was President of the TMA and part served on a board for the biggest insurance company in Texas. Given what happened to Dr. Pigott, and the role BCBS Texas Medical Advisory Board played, this should be troubling to everyone.
Then, Mr. Merian says this about the BCBS Medical Advisory Board.
A simple Google Search of the BCBSTX.com site pulled up quite a bit of information on it. Including this description:.The Texas Medical Advisory Committee and the Texas PeerReview
Committee serve in an advisory capacity to the Medical Director and HMO Blue Texas regarding health care delivery issues that affect members and participating network Physicians and other Professional Providers. The Committees participate in the development, implementation, and evaluation of required peer review activities
That's not quite a bit of information. In fact, this is a snippet as part of a web page related to something totally different within BCBS of Texas. This medical advisory board doesn't have its own web page. BCBS doesn't disclose who is on it and how they got there. They don't publish the minutes of the meetings. All that BCBS does is define what it is as part of a totally different web page. Again, given the role that BCBS Medical Advisory Board played within this story I find this lack of disclosure very troubling.
Then, Mr. Merian says this.
Now, it is obvious this board is not "super secret" so we will move on toThis may technically be true, however all of this folks were in positions of power within each of organization long before they became head of each of their organizations. Again, it is just absurd to say that being President of the Texas Medical Association, which he himself says is the face of Doctors, doesn't represent doctors. Furthermore, the fact that no one objected to Dr. Merian simultaneously serving on the BCBS Medical Advisory Board should be troubling not some validation. Furthermore, while the TMA may not have been involved in discipline and certification, the TMB Disciplinary Board was, and Dr. Keith Miller was head of that for several years, while he was part of this group.
some of your other allegations against my father.You also alleged:
Three doctors, Dr. Doug Curran, Dr. Keith Miller, and Dr. Fred Merian, were simultaneously in significant positions of power in the Texas medical community. Dr. Curran was the head of the Texas Academy of Family Physicians. Dr. Miller was head of the Texas Medical Board's Disciplinary Committee. Dr. Merian was head of the Texas Medical Association. At the same time, these three were also members of the super secret BCBS Texas Medical Advisory Board. In other words, they were playing both sides of the fence. They represented the interests of doctors, and at the same time represented the interests of BCBS against doctors.Dr. Curran was not sworn in as President of the TAFP until 2006, and he served 1 year (not several years as you claimed), Dr. Miller was not appointed to the Board of Medical Examiners until 2003. And my father took his office as President of the TMA in 2002, and he also only served one year. So, you are wrong in alleging that these three men held their offices simultaneously. Also, the President of the TMA while being the visible face of Doctors in Texas, holds NO power outside the TMA. The TMA is not involved in the certification, regulation or discipline of Doctors in Texas. It is also not involved in negotiating with insurance companies for doctors, nor in
the distribution of benefits. Therefore, there is no conflict of interest. Besides, that is a determination for the TMA Board of Directors, the ethics committee and house of Delegates. Both of which were aware of my fathers position, neither of which objected.
Then, Mr. Merian said this.
Physicians advisory boards advocate FOR doctors. You asked how I knew such
boards existed? Simple internet search. (and, I have worked in or around the insurance industry for over 10 years, there are all kinds of advisory boards) Here is the information for the board at Aetna Insurance. The kicker? 19 state Medical
Associations asked for such a board to be created. If such boards were so Anti-doctor, why would 700,000 Doctors demand such a board be created? They wouldn't.
This so called internet search is a google search of the words "physicians advisory board insurance". Of course, some combination of those words will come up a lot. That's how a google search works. Furthermore, if BCBS uses it in a nefarious manner it is reasonable to believe other corrupt insurance companies might want to create one as well. What's more, one paragraph after Mr. Merian painstakingly tried to convince the audience that the TMA doesn't represent doctors, he proclaims that 19 Medical Associations asked for such a board to be created. Who exactly were they representing when they asked for this?
I would also be in favor of such a medical advisory board. Only, if this board actually represented doctors, they wouldn't be a part of the insurance company. A board that looks to try to hash out the differences between doctors and insurance companies in a manner that is beneficial to both wouldn't be a part of the insurance company. Such a board would have representatives of doctors and representatives of the insurance companies working independently of either. Furthermore, their actions would be out in the open. They would have a web site. They would publish their minutes. They would publish their conclusions. This particular board does none of those things. It is very easy to take a well meaning concept and corrupt it. I never said that medical advisory boards are necessarily a bad idea. I said this one is corrupt and I proved it by several stories all split into three parts.
Furthermore, as it applies here, the board was used as a tool of intimidation. If you believe Dr. Pigott, then clearly Dr. Curran wanted her to believe that being a part of this board meant that he could damage her.
Which brings me back to the beginning. In his defense of his father, Mr. Merian never challenged any of the contents of the story. Dr. Pigott did become a leader within the community of private family physicians. She did work painstakingly to make the TAFP and the AAFP work more on behalf of private family physicians. While she was doing this, she was simultaneously brought in front of the TMB disciplinary committee because she didn't send out medical records in a timely manner. They did attempt to punish her in a draconian manner, and it was only after she identified this group within the BCBS that the TMB backed down. Those are the facts. I have backed up each of those facts.
My favorite latin phrase is Res Ipsa Loquitor, the facts speak for themselves. I believe the facts of this story speak for themselves.