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CRAIN’S DETROIT BUSINESS
September 7, 2009
Page E1
Extra
GOOD FOR PATIENTS –
AND THE BOTTOM LINE?
Hospital food goes
healthy, Page E6
Monthly news for health care professionals
People
We have quadrupled
“
the number of cases (we
Nayana Dekhne,
M.D., is the new
chair of William
Beaumont Hospitals’
breast care
program. Dekhne
has been interim
director of the
program since
April 2008.
Dekhne
Eric Ayers,
M.D., an assistant
professor of internal
medicine/ pediatrics
and associate
program director of
internal
medicine/pediatrics
with the Wayne
State University
School of Medicine,
Ayers
was the blue ribbon
winner of the Parents’ Pick Awards
2009 program conducted by
ParentsConnect, the online parenting
Web site of television broadcaster
Nickelodeon.
Rhonda Walker,
B.A., R.N., MBA,
CLNC, has been
named nursing
manager for surgical
services for Doctors’
Hospital of Michigan
in Pontiac. Walker
has a long
background in
Walker
operating room
nursing as well as health care
consulting through her own company,
Walker & Associates.
Frank McGeorge, M.D., emergency
department physician at Henry Ford
Hospital, has been appointed president
of the Michigan College of Emergency
Physicians.
McGeorge will serve as official
representative of Michigan College. He
will chair its board of directors and
executive committee.
Mark Juzych, M.D., M.H.S.A.,
professor and associate chair of
ophthalmology for the Wayne State
University School of Medicine and
Kresge Eye Institute and associate
dean for graduate medical education
for the School of Medicine, was
appointed chairman of the
Ophthalmology Residency Review
Committee for the Accreditation
Council for Graduate Medical
Education for a four-year term.
John Carethers, M.D., has been
named chair of the University of
Michigan Department of Internal
Medicine effective Nov. 1, pending
Board of Regents approval. Carethers, a
Detroit native whose medical degree is
from Wayne State University, currently is
chief of the University of California-San
Diego School of Medicine’s Division of
Gastroenterology.
He succeeds interim chair John Del
Valle, M.D., professor of internal
medicine.
investigate and prosecute
in Detroit).
”
Terrence Berg (left), U.S. attorney
FACTS ABOUT FRAUD
Health care insurance fraud is a felony
under Michigan’s Health Care False Claims
Act, punishable by up to four years in prison,
a $50,000 fine and loss of health insurance.
Since March 2007, when the Medicare
Fraud Task Force began operations in Miami,
Los Angeles, Detroit and Houston, more than
293 individuals have been indicted. Those
individuals or organizations they represented
are accused of improperly billing the Medicare
program for more than $700 million.
In 2008, Medicaid fraud units collected
more than $1.3 billion in restitution, fines,
penalties and settlements, according to an
annual report issued last month by the HHS
inspector general’s office. The Medicaid fraud
units, most of which are housed in each
state’s attorney general’s office, also led to
1,314 convictions and the exclusion of 755
providers from participating in Medicare or
other federal health programs.
From 1980 to April 2009, Blue Cross Blue
Shield of Michigan either referred to law
enforcement for recovery or saved through
nonpayment approximately $267 million. Of
34,988 cases opened, Blue Cross closed
33,473, referred 3,645 cases to law
enforcement and had 2,090 convictions.
The
fraud
files
MEDI-SCAMS
Types of fraud include the following:
Billing for services not rendered or not
medically needed, and “up-coding,” or billing
for a higher medical diagnosis or more
services that are more lucrative.
Kickbacks — receiving and giving money,
assets or services for patients.
Physicians who financially benefit by
working with outpatient providers — including
home health agencies, durable medical
equipment firms and rehabilitation providers
— to improperly approve medical services.
Recruiters in Detroit who go door-to-door
and solicit Medicare beneficiary numbers to
sell to health care providers.
NATHAN SKID/CRAIN’S DETROIT BUSINESS
Expanded team gets tougher on health care cheats
BY JAY GREENE
CRAIN’S DETROIT BUSINESS
I
t is well known that Michigan and metro
Detroit have a great national reputation
for health care quality and innovation.
Many top providers
— including the University of Michigan
Health System and The problem: Is
Henry Ford Medical fraud increasing?
Group — are based in Page E3
Advice: Keep your
the state.
But Detroit also is guard up, Page E4
known as a top region for health care fraud, which is why
the federal government has targeted
Southeast Michigan and assigned eight
FBI agents and three additional prosecutors to beef up investigations, seek indictments, send people to jail and collect
FIGHTING BACK
fines and restitutions.
Over the past nine months, the Detroit
Medicare Health Care Fraud Strike Force has
announced two major sets of indictments
involving nearly 60 health care executives and medical providers, said U.S. Attorney Terrence Berg in Detroit.
The providers were indicted for allegedly billing Medicare for services, including infusion therapy, physical therapy and home health services, that were
either unnecessary or never provided,
Berg said.
Other areas targeted by Medicare
fraud investigators include durable medical equipment companies, occupational
therapy and rehabilitation providers.
Hospitals, physician clinics and nursing homes also may become targets, depending on tips from whistle-blowers or
suspicious billing trends, Berg said.
“We have quadrupled the number of
cases” we investigate and prosecute in
Detroit,” said Berg. “Between May and
late June, we charged 53 people. By announcing them all at once, this will have
a more of a deterrent effect than if we just
charged one at a time.”
The Detroit fraud strike force is part of
a larger, national Health Care Fraud Prevention and Enforcement Team, known as
HEAT. It includes the FBI, the U.S. Department of Justice, the Centers for Medicare
and Medicaid Services, the Department of
Health and Human Services’ Office of Inspector General and Blue Cross Blue Shield of
Michigan.
The nearly 30-member Detroit health
fraud task force includes the eight fulltime FBI agents, four prosecutors and
See Fraud, Page E2
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September 7, 2009
CRAIN’S DETROIT BUSINESS
Health Care Extra
Fraud: Expanded team targets health care cheats
■ From Page E1
about 15 investigators working on
cases, Berg said.
“That is a real difference in
terms of manpower. Each one of
our attorneys team up with FBI
agents, OIG agents and Blue Cross
if fraud is involved,” Berg said.
Since March 2007, more than 300
providers have been indicted in
similar investigations in Miami,
Los Angeles, Houston and Detroit
for suspicion of falsely billing
Medicare for more than $700 million.
It is not known how much fraud
exists in Detroit. The federal government estimates, however, that
5 percent of the nation’s $2 trillionplus annual health care bill involves fraudulent payments to
providers. Another 15 percent of
that tab is either unnecessary or
the result of duplicative services.
“It is hard to say if there has
been an increase in health care
fraud and complaints in Detroit,”
Berg said. “The data that Medicare
keeps shows an increase (nationally) in fraudulent billing.”
In May, 53 medical providers
and health care executives, including two physicians, were indicted
in Detroit for allegedly defrauding
the federal government out of approximately $50 million.
Last December, owners and employees of eight home health agencies in Southeast Michigan were
indicted by a federal grand jury in
Detroit on charges they were part
of a scheme to pay kickbacks in exchange for Medicare patient referrals.
Berg said one of the possible reasons more fraud exists in the home
health industry in Michigan is the
ease of opening a company here.
Agustin Arbulu, CEO of Dearborn-based Metro Home Health, said
the lack of state licensure for agencies and certificate-of-need regulatory process has contributed to an
explosion of agencies in Southeast
Michigan in the past decade.
“The competition for patients
and ease of entry contributes to the
problem (of health care fraud),”
said Arbulu. “Willie Sutton was
asked once why he robbed banks.
He said, ‘because that is where the
money is.’ Medicare is the new target for the new Willie Suttons.”
Founded in 1976, Metro Home
Health competes with more than
500 other agencies in Southeast
Michigan. The company operates
in 10 counties with a daily patient
census of about 250 and more than
200 employees.
Arbulu said one popular fraudulent scheme is called “patient
churning.”
For example, Medicare pays for
up to 60 days of home health services if a physician certifies the
patient needs the services and submits a plan of care. Patients are allowed another 60 days if a physician submits a recertification
application with reasons why
more care is necessary.
“You get a patient well, where
they are stable, and you discharge
them. Then what happens is they
get picked up by another agency,”
Arbulu said. “I feel much of this is
inappropriate, because we do not
discharge people unless they are
stable.”
Medicare is the
“
new target
for the new
Willie
Suttons.
”
Agustin Arbulu,
Metro Home Health
NATHAN SKID/CRAIN’S DETROIT BUSINESS
U.S. Attorney Terrence Berg (center) and U.S. Department of Justice trial attorneys
Ben Singer (left) and John Neal — all part of the Health Care Fraud Strike Force —
talk at the lectern where they hold press conferences in Detroit.
Arbulu said agencies must be
careful and not discharge a patient
too early, because there is the danger they could take a turn for the
worse and be readmitted to a hospital.
But Arbulu also said some unscrupulous agencies team with
physicians to certify a patient for 60
days’ worth of billings. After the 60
days are up and the patient is discharged, the same physician will
certify the patient at the second
agency and collect what could be
considered fraudulent referral fees.
“There are only a certain number of patients available, and some
agencies work together to keep
billing Medicare for the same patient,” Arbulu said.
Here are some typical home
health schemes:
䡲 “Ringers” go to potential entrepreneurs and help start a home
care agency for a fee.
䡲 Paying for referrals. Home
health agencies pay other home
health agencies, physicians, hospitals, case managers, outpatient
therapy, nursing homes and
Medicare beneficiaries.
䡲 Buying Medicare beneficiary
numbers. Agencies then bill
Medicare for services not rendered
or not necessary.
“It is important to clean up these
problems for the integrity of the
industry,” Arbulu said. “People
make mistakes in coding. But this
type of fraud is deliberate misrepresentation and dishonesty. You
are trying to collect Medicare payments that you aren’t entitled to. It
should be stopped.”
Fraud also drives up health care
costs.
Medicare spending on home
health totaled $12.9 billion in 2006,
up 44 percent from 2002, according
to a 2009 report by the U.S. General
Accountability Office.
Michigan was the seventhfastest-growing state in the nation
in percentage growth of home
health spending. From 2002 to 2006,
spending grew in Michigan 42 percent, compared with 90 percent in
Florida, 62 percent in Illinois and
44 percent in Indiana.
But Michigan was the fifth-highest state in the number of home
health
agencies
that
billed
Medicare during that period. There
was a 62 percent increase in agen-
cies billing Medicare in Michigan,
compared with Texas and Florida,
the top two that had more than a 100
percent increase, and Nevada with
a 75 percent increase.
To address home health and other fraud, Berg said his office uses informants, anonymous tips, information technology and monitoring
by Blue Cross and other insurers to
identify potential fraud, Berg said.
“The task force uses Medicare
data and analyzes that data to look
for trends,” Berg said. “If you have
incredibly large number of claims
for infusion and injection treatments in a short amount of time,
you look at how many people receive those treatments, and then
you begin to look at something
that is suspicious.”
In Detroit, the cases are being
prosecuted by Assistant U.S. Attorney F. William Soisson and attorneys from the fraud section of the
DOJ’s Criminal Division, including
Deputy Chief Kirk Ogrosky, trial attorneys John Neal and Benjamin
Singer and Special Assistant U.S.
Attorney Thomas Beimers.
Over the past 20 years, federal investigations into health fraud has
changed from big-profile criminal
prosecutions to a combination of
criminal and civil proceedings that
seek to recover damages and restitution, said Mark Kopson, chair of
health care practice with Bloomfield Hills-based Plunkett Cooney.
“We are going
to see enhanced
activity. If you
look how much
revenue
the
fraud prosecutions have been
generating, the
current administration is clearly
contemplating
Kopson
recovering revenue to partially offset the cost of
health care reform,” Kopson said.
When health care executives
and physicians are convicted and
exhaust appeals, Kopson said they
sit in prison.
“Convictions were achieved
with tremendous financial costs,”
he said. “The tables began to turn
with the enhanced False Claims
Act. What once was a cost center is
now a revenue center for the federal government.”
In July, Michigan Attorney General Mike Cox proposed a new office to audit and investigate Medicaid fraud.
In announcing his new program, which would create an independent auditor who would use information technology resources to
data mine suspicious claims, Cox
said the auditor could save the
state $100 million annually.
“Twenty percent of the referrals
are from the Department of Community Health, but we are barred by
law to data mine,” said Matt Frendewey, an AG public information
officer. “Prosecutions have skyrocketed in other states that have
done this.” Those states are Florida, Texas, Illinois, Kansas, New
Jersey and New York.
The new agency would oversee
state Medicaid contracts, inspect
health care provider records and
investigate complaints of waste or
abuse within the state’s $10 billion
Medicaid budget.
New York reported recovering
$551 million in improperly paid
Medicaid funds during the 2008 fiscal year. Michigan has recovered
$143 million since Cox took office
in 2003.
Berg contends that anti-fraud efforts are a critical part of health
care reform.
“I don’t think the Medicare
fraud task force was created in order to be part of reforming the
health care system, but I think
that certainly anybody who wants
to have a good health care system
needs to have a vigorous antifraud component,” Berg said.
However, in a proposed health
care reform bill co-sponsored by
the late Sen. Edward Kennedy, DMass., and Sen. Christopher Dodd,
D-Mass., health care anti-fraud efforts would be expanded.
One provision would create a
health care fraud “czar” and a special general counsel to coordinate
detection and prevention of fraud,
waste and other abuse among
agencies. A private-public committee also would be formed to advise
the government on how to improve
anti-fraud efforts.
Berg said he is optimistic that
the fraud task force will be intact
for at least two more years and
probably be expanded, given the
emphasis on reducing health care
costs to pay for reform.
“We hope we will get permanent
resources, maybe add another attorney or two,” he said. “We will
be very active in stopping fraud.”
For more information on the
HEAT program, visit www.hhs.gov
/stopmedicarefraud.
Jay Greene: (313) 446-0325,
[email protected]
Rochester Hills
office building
to reopen with
medical tenants
A Rochester Hills office
building, vacant since 2005,
will reopen as a medical building in November.
The
52,000-square-foot
building at 75 Barclay Circle,
near Rochester and Auburn
roads, is now fully leased and
has secured its long-term financing piece, said Justine
Corday, chief development officer for Chicago-based Physicians Health Resources.
Physicians Health has
overseen the development
process.
Leases have been signed
with 11 tenants for the building, made up of physicians and
medical-related services, she
said.
Most of the tenants are also
part owners of the building
through its co-op structure,
she said, with two physicians
acting as managing members
of Barclay Medical Plaza Properties L.L.C.: Samir Al-Hadidi and
Kambiz Bral.
“They saw the opportunity
and the chance to capitalize on
a white elephant,” Corday said
of the physician-investors. “A
vacant, partially demolished
building that was an eyesore
will now be part of the medical
corridor that has developed
along Barclay Circle.”
The building has had a difficult recent history.
It was occupied as an office
building until ThyssenKrupp AG
put its Budd parts unit up for
sale in 2006.
A group of investors, Budd
Park L.L.C., purchased the
building while it was still
leased by Budd with the hopes
of finding a new tenant.
They were unable to fill the
building, said Mason Capitani, a principal with Troybased L. Mason Capitani.
The firm brokered the sale
of the building on behalf of
Budd Park.
Capitani said his team
found Physicians Health Resources, which assembled the
group of physicians to fill the
building.
“It turned out to be a great
medical conversion,” Capitani
said.
The group of physicians
purchased the building for
$3.2 million, and it is now valued at $9.2 million, Corday
said.
A phased occupancy of the
building will begin in November.
Edmund London & Associates
of Southfield was the architect on the project, and J.S.
Capitol
Construction
of
Rochester Hills handled the
interior build-out.
— Daniel Duggan
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Page E3
Health Care Extra
Blue Cross sleuth says health care fraud is increasing
BY JAY GREENE
CRAIN’S DETROIT BUSINESS
At Blue Cross Blue Shield of Michigan, Greg Anderson, vice president of corporate and financial investigations, has been tracking
down health insurance fraud for
more than 27 years.
In 1980, the Michigan Blues created the first anti-fraud unit in the nation within the Blue Cross Blue Shield
Association family, Anderson said.
“We were a pioneer in the
field
and
worked
very
closely with the
FBI, Secret Service and the U.S.
Attorney’s Office to pool resources and to
attack
the
Anderson
health
care
fraud problem,” Anderson said.
Over nearly 30 years, the Michigan Blues have identified more
than $267 million in fraud, or
about $14 million per year. Nationally, Blue Cross companies recovered or saved nearly $350 million
in 2008, an increase of 43 percent
from 2007.
“My personal opinion is that
(health fraud) is increasing,” Anderson said. “We have experienced
an increase of information coming
our way the last couple years as
our economy has changed.”
Each year, Blue Cross refers
about 150 cases to law enforcement
for additional investigations or
prosecution.
“Our plate is always full. We
have a limited capacity to receive
and investigate cases, but we work
very closely with government investigators,” he said.
Blue Cross, which has a 40-member anti-fraud staff that includes 23
investigators, works closely with
the Detroit Medicare Health Care Fraud
Task Force, which is part of national
Health Care Fraud Prevention & Enforcement Action Team, or HEAT.
“One of the things that impressed me is the commitment (at
the Blues) to treat (subscriber’s)
money as it was their own,” said
Anderson, who also spent 11 years
as an undercover narcotics detective with the Michigan State Police.
“In the early days, there was considerable amount of pressure to investigate doctors. We never once
backed away from the table because of pressure.”
But when the terrorists struck
on Sept. 11, 2001, Anderson said
health care fraud became a lower
priority than domestic terrorism.
“We are now refocusing our resources, and there is a concerted
effort between different agencies
to go after health care fraud
again,” he said.
Newer tools used to combat
health fraud include sophisticated
detection software programs and
the use of data analysis to identify
patterns of fraud.
Two years ago, Blue Cross purchased a new fraud-detection program called VIPS Star Sentinel to
supplement its homegrown system, Anderson said. Some 20 other
Blues plans use the VIPS program.
“We are using it to analyze paid
claims data in the Medicare business,” he said. “We are in the
process of deciding to transfer it to
our commercial business.”
The software uses data from
Blue Cross’s consumer anti-fraud
hot line — at (800) 482-3787 — and
helps prioritize the tips, Anderson
said. The hot line receives more
than 35,000 calls annually.
“It helps us identify subjects we
didn’t know about before who are
perpetuating fraud against the organization,” Anderson said. “We do
the preliminary investigation to
ferret out information, and once we
find a crime has been committed,
we forward to law enforcement.”
For example, Anderson said a
growing area of fraud has to do
with identity theft.
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group of people who have illegally
obtained data on patients. They
created patient files and sold those
files to entities that billed for services they were never rendered,”
Anderson said.
Other common health fraud occurs with billing for services not
provided and “up-coding” services. For example, a patient sees a
physician for 20 minutes, but the
office bills for a 45-minute session,
Anderson said.
“This is fraud. We have to determine if this is a one-time occurrence, a mistake, or if there is a
pattern and they intended to do it,”
he said.
Blue Cross investigators also
discover some health care
providers who fraudulently bill for
X-rays that were never performed
or drugs that were prescribed but
never taken, Anderson said.
“No one sector is immune from
fraud,” Anderson said. Hospitals,
physicians, nursing homes, occupational therapists and home health
agencies all have been implicated in
health fraud, he said. “It is more difficult for hospitals to defraud us.”
In 2003, however, several physicians and administrators at
Greenville-based United Memorial
Hospital in western Michigan were
prosecuted for billing Blue Cross,
Medicare and other insurers for
inappropriate pain management
procedures. The hospital paid
about $1.8 million in fines and
restitution to the health insurers.
Here are two other cases from
Blue Cross files:
䡲 In 2007, a Detroit physician
and his medical biller were convicted on 80 counts in a scheme to
defraud Blue Cross and Medicare
out of more than $1 million.
Dr. Zack Brown and Davell Culberson were found guilty in U.S.
District Court in Detroit of conspiring to submit more than 19,000
phony claims to Blue Cross.
During the trial, Brown and a
group of eight recruiters were
found to have recruited more than
26 people in the scheme to submit
phony claims for physical therapy
and injections. Recruiters were
paid up to $300 per person.
The Blue Cross members were
promised they could keep half of
the reimbursements, which averaged nearly $5,000.
䡲 In December 2007, Dr. Robert
Stokes, a dermatologist in Grand
Rapids, was sentenced to 10 years
in prison for reusing sutures and
other diagnostic instruments, and
billing for services not rendered.
He was ordered to pay back
$1.3 million.
Jay Greene: (313) 446-0325,
[email protected]
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September 7, 2009
CRAIN’S DETROIT BUSINESS
Health Care Extra
Update anti-fraud compliance programs, health care organizations told
BY JAY GREENE
CRAIN’S DETROIT BUSINESS
When it comes to setting up
compliance programs to train
workers and set up checks and balances to guard against institutional health insurance billing fraud,
there are three types of health care
organizations.
There is the large, sophisticated
health care organization that has
been in business for years and takes
compliance programs seriously.
There is the smaller or less-experienced health care organization that doesn’t have the financial
or human resources, or just hasn’t
had the time, to set up a compliance program.
Then there is the health care organization that has a state-of-theart compliance program.
“Nine out of 10 times when you
look at those organizations, they
have gotten in trouble with the federal government
and had to sign
a corporate integrity
agreement to create a
robust
program,”
said
Doug Clark, vice
president of audit, compliance
and tax services
at Henry Ford Clark
Health System in Detroit.
But in Southeast Michigan,
where the Detroit Medicare Fraud
Task Force is scrutinizing health
care providers’ billing practices,
Soni Mithani, a commercial litigator in health care and construction
in the Ann Arbor office of Miller,
Canfield, Paddock and Stone, said
providers would be wise to update
their compliance programs.
“I see a number of entities dusting off compliance programs and
figuring out whether they need to
be updated given the enforcement
efforts (in Detroit),” Mithani said.
One of the chief barriers facing
providers that want to update their
compliance program is poor cash
flow because of the down economy.
“From a resource standpoint,
providers are
hard-pressed to
divert resources
to compliance
efforts to protect
themselves,”
Mithani
said.
“There is a lot of
balancing of interests.
They
want to comply,
but they want to Mithani
make sure they can provide the
services in a cost-effective manner.”
While one reason to update compliance is the anti-fraud task force,
another is the Fraud Enforcement
and Recovery Act of 2009.
The amended act provides ways
to recover fines, penalties and treble damages from providers. It also
eliminates several loopholes by
which providers could claim their
subcontractor committed the crime
and they weren’t responsible.
“There also are whistle-blower
protections afforded to employees
of contractors (who work for
providers),” Mithani. “They are
protected from retaliation just like
employees of the provider organizations.”
Agustin Arbulu, CEO of Dearborn-based Metro Home Health, said
one problem that home health
agencies face is that most start out
as very small organizations.
“You can handle a census of 10
to 20 patients with a simple compliance program (or none), but two
years later you are at 30 to 40 patients and this is where it breaks
down,” said Arbulu, who said his
company regularly updates its
compliance program.
“We are always talking about
ethical behavior with our employees. We pay our employees on an
hourly basis, not based on referrals,” he said. “Bonus payments
get you in trouble.”
Clark said Henry Ford is in the
process of hiring several corporate
compliance employees to beef up
its 20-person companywide staff.
Like most integrated systems,
Henry Ford has a corporate compliance officer to oversee operational
units, but the actual compliance is
directed by compliance officers and
teams within each unit, Clark said.
Mark Kopson, chair of health
care practice with Plunkett Cooney in
Bloomfield Hills, said another concern for hospitals and physician organizations is the effort under way
to identify billing irregularities
through the Recovery Audit Contractor program, or RAC.
“If a RAC auditor detects widespread fraud, they will pass that
information on (to law enforcement),” Kopson said.
In Michigan, the RAC program
is expected to get under way this
month for some hospitals, Clark
said.
“If compliance programs have
been sitting on a shelf and not im- ios when health care organizations
plemented, people are in for a rude should consider revising their comawakening,” Kopson said.
pliance programs, including:
Henry Ford has formed a RAC
䡲 If a business relationship has
oversight team to make sure the expanded to include new partners,
system’s records are available and new locations or new lines of business.
current for investigators,
Clark
䡲 When new
contracts
or
said.
amendments to
“Medicare has
contracts are demade significant
veloped.
recoveries
in
“One of the
states where they
keys is to docuhave used RACs,”
ment whether
Clark said. “We
your employees
have done a risk
have received
analysis to look at
compliance
other states and
training,”
he
where institutions
said.
have paid back
Mark Kopson, Plunkett Cooney
When setting
money to make
up a compliance
sure we don’t have
program, the Office of Inspector Genproblems in those areas.”
In addition to the RAC program, eral of the Department of Health and
Clark said Henry Ford is retraining Human Services makes these seven
employees in two other areas: iden- suggestions:
tity fraud and medical privacy.
䡲 Implement written policies,
“We have an increase in con- procedures and standards of consumer fraud where individuals duct.
present to us for health care ser䡲 Designate a compliance offivices and they are not the person cer and compliance committee.
they say they are,” Clark said. “We
䡲 Conduct effective training
and education.
never saw this four years ago.”
Clark said staff is trained to look
䡲 Develop effective lines of comfor people who don’t seem to know munication.
their personal information, or
䡲 Enforce standards through
well-publicized disciplinary guidehave frequent changes of address.
“Even if they are suspicious, we lines.
still provide the service,” he said.
䡲 Conduct internal monitoring
“The front-line person contacts the and auditing.
right person to protect the identity
䡲 Respond promptly to detected
offenses and developing corrective
of the original person.”
Another emphasis is educating action.
“Smaller organizations may do
employees on revisions that go
into effect Oct. 1 to federal privacy a good job even with limited relaws under the Health Insurance sources. It depends on the leadership,” Mithani said. “If you desigPortability and Accountability Act.
“When there is a breach of pri- nate a compliance officer, appoint
vacy, we must notify regulators a high-level executive who deimmediately to protect the infor- mands respect.”
Jay Greene: (313) 446-0325,
mation of all patients,” Clark said.
Kopson suggested several scenar- [email protected]
If compliance
“
programs have been
sitting on a shelf and
not implemented,
people are in for a
rude awakening.
”
Beaumont seeks permission
to transfer 3 operating rooms
Named a Detroit Free Press
2008 Top Work Place.
William Beaumont Hospital of Royal Oak is seeking permission from
state regulators to transfer three
operating rooms to the children’s
surgery center, according to a letter of intent filed with the Michigan
Department of Community Health in
August.
All three operating rooms
would be moved from the hospital’s surgery center to rooms that
currently serve as procedure
rooms in the children’s surgery
center. Both wards are on the second floor of Beaumont’s central
tower.
The hospital would still have 47
operating rooms after the project,
which is slated to cost $30,600.
The following are selected certificate-of-need filings and decisions from Aug. 1-31 that can be
found online at
www.michigan.gov/mdch.
Decisions:
䡲 Approved, Oakwood Healthcare
CON Roundup
Inc., Dearborn, add fourth CT at
Oakwood Imaging Center, $1.82 million.
䡲 Approved, University of Michigan Health System, Ann Arbor, add
one operating room at Kellogg Eye
Center, $260,000.
䡲 Approved, Moroun Nursing
Center of Detroit L.L.C., Detroit, acquire Moroun Nursing Home of Detroit, $10.41 million.
Applications:
䡲 St. John Hospital and Medical
Center, Detroit, initiate pancreas
transplant services, no cost.
䡲 Select Specialty Hospital-Ann Arbor, Ypsilanti, renew five-year
lease at St. Joseph Mercy Medical
Center, $5.62 million.
Letters of intent:
䡲 Goodis Endodontic Specialists,
Grosse Pointe Woods, initiate dental CT scanner, $90,000.
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September 7, 2009
Page E5
Health Care Extra
CMU granted applicant status for new medical school
Central Michigan University has
been granted applicant school status by the Liaison Committee on
Medical Education, initiating the
formal process required to accredit a new medical student education
program.
Dr. Cam Enarson, a leading national expert in medical education
and interim dean of CMU’s medical school, filed the $25,000 application fee with the LCME in Chicago Aug. 5.
The LCME is the nation’s accrediting agency for M.D.-granting medical schools. Accreditation standards require CMU to address five
specific areas in the development
phase, including governance and
administration of the medical
school; the medical education program; support for students; policies
governing faculty recruitment, promotion and tenure; and finances, facilities and clinical affiliations.
Health Care Briefs
CMU’s board of trustees gave
formal approval to the establishment of a medical school at its
meeting in September 2008. The
first two years of instruction will
take place on the CMU campus
with the clinical experience in
years three and four to be delivered in partnership with clinical
affiliates in the region.
WSU College of Nursing
gets $285K for distance learning
The Wayne State University College of Nursing has received
$285,000 in federal funding to support the creation of a graduate distance learning program in psychiatric and public health nursing. It
is the only distance-learning pro-
gram in this specialty in the state.
WSU worked with Kalamazoo
Community Mental Health and Substance Abuse Services to bring the
three-year program to nurses in
Kalamazoo and surrounding communities via distance learning,
rather than requiring them to take
classes on Wayne State’s Detroit
campus. Local nurses who sign up
for the College of Nursing distance
learning program will receive
scholarships in exchange for a
commitment to remain in and
serve their southwest Michigan
communities.
WSU assistant dean wins $25K
Herbert Smitherman Jr., M.D., assistant dean of community and urban health and assistant professor
of the department of medicine for
the Wayne State University School of
Medicine, was named one of four
runners-up for the J.H. Kanter Prize.
The award, in its first year, recognizes physicians across the
country who have dedicated their
medical careers to enhancing
health care delivery and eliminating disparities.
Smitherman, who also serves as
president and CEO of Health Centers Detroit Foundation Inc., was
nominated by the Michigan State
Medical Society and the Wayne County Medical Society of Southeast Michigan. He will receive $25,000 for his
work in improving access to care
and addressing disparities among
the underserved in Detroit.
The prize, named for Joseph H.
Kanter, a pioneering health care
reform advocate for a personal
electronic medical database, is
sponsored by the Health Legacy
Partnership, a public-private partnership with the federal Agency for
Healthcare Research and Quality.
Short takes
Beaumont Hospital, Royal Oak
has been awarded a three-year accreditation in positron emission
tomography, or PET, in oncology,
cardiac and brain by the American
College of Radiology.
Douglas Marketing Group, a fullservice advertising agency serving
southwest Ontario and Southeast
Michigan, received a gold at the
2009 Aster Awards for excellence in
medical marketing and advertising for its “Clean + Sober” campaign for St. John Brighton Hospital.
Five Southeast Michigan
health care systems made Thomson
Reuters’ list of best hospital systems based on quality and efficiency. Two, Henry Ford Health System
and Trinity Health, made the top 10;
the other three are Oakwood Healthcare Inc., Detroit Medical Center and
McLaren Healthcare Corp.
Three metro Detroit hospitals take part in defibrillator study
Henry Ford Hospital, Beaumont
Hospital-Royal Oak and St. John Hospital were among 110 sites in 14
countries to participate in a landmark study that found early intervention with an experimental defibrillator
can
slow
the
progression of heart failure in
high-risk patients.
The study is published online in
the New England Journal of Medicine. It shows that patients implanted with a device called the
cardiac resynchronization therapy defibrillator, or CRT-D, had a 41
percent reduction in the risk of
heart-failure events and a 34 percent reduction in mortality compared to a traditional defibrillator.
CRT-Ds, which are awaiting approval before the Food and Drug
Administration, are small implantable devices that improve the
heart’s pumping ability by delivering small electrical impulses that
help synchronize contractions of
the left ventricle, the heart’s main
pumping chamber. They also monitor the heart for potentially fatal
heart rhythms, and if such a
rhythm is detected, the device delivers a lifesaving shock to restore
normal heart rhythm and prevent
sudden cardiac death, which occurs more frequently in patients
with heart failure.
Three suffer from using
steroid-enriched supplements
Three cases of patients suffering
from the adverse affects of steroidenriched dietary supplements
have been reported by researchers
at Henry Ford Hospital.
The cases, which include patients with liver injury and renal
failure, are discussed in the current issue of The Journal of Clinical Gastroenterology.
The Food and Drug Administration has issued a warning regarding the use of over-the-counter
body-building supplements that
are illegally enriched with anabolic steroids.
Research Roundup
The cases of three otherwise
healthy adult males, ages 21 to 38,
were reported with symptoms including nausea, anorexia, jaundice,
severe itching and renal failure.
Research briefs
A recent survey by University
of Michigan researchers shows that
black parents of asthmatic children rate their children’s doctors
lower than white parents in qualities that are linked to better adherence with asthma medications.
The survey suggests results could
be improved if doctors make sure
children see the same doctor each
time and allow time for parents to
ask questions.
The study appears in the May issue of the Journal of the National
Medical Association. Kathryn Moseley, M.D., an assistant professor of
pediatrics at the UM Medical School,
was lead researcher. Ericka Hudson,
M.H.S.A., a research associate at
the UM Child Health Evaluation and
Research Unit, is also an author.
The study was funded by the Blue
Cross Blue Shield of Michigan Foundation.
Women are under-represented in clinical cancer research published in high-impact journals, according to a new study by
researchers at the University of
Michigan Comprehensive Cancer Center. Taking into account the incidence of particular types of cancer
among women, studies included a
smaller proportion of women than
should be expected. The analysis
looked specifically at studies of
cancer types that were not gender
specific, including colon cancer,
oral cancers, lung cancer, brain tumors and lymphomas.
Results of the study appear online in the journal Cancer and will
be published in the July 15 print issue. The study author is Reshma
Jagsi, M.D., D.Phil., assistant pro-
fessor of radiation oncology at the
UM Medical School.
The higher the number of
blacks in a U.S. county, the lower
the number of specialists who diagnose and treat colorectal cancer,
according to a study led by University of Michigan resident Awori Hayanga, M.D., M.P.H., who, with colleagues, analyzed data from the
2004 version of the Area Resource
File, a nationwide database of
health care, economic and demographic information. The report
appears in the June issue of
Archives of Surgery, one of the
Journal of the American Medical
Association/Archives journals.
Separate research by Hayanga,
published in the June issue of the
Journal of the American College of
Surgeons, reveals that segregation
decreases access to surgical care
in blacks and Hispanics.
Grants
Livonia-based Madonna University has been awarded a $700,000
federal grant to help expand its
new Doctor of Nursing Practice
program.
physicians!
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in the fast lane.
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Quality of Care / Efficiency / Patient Satisfaction
Take a trip on the Health Information Highway with MyWorkspace,
the ONLY physician portal that connects you to thousands of
physicians, labs, e-Prescribing, health plans and more!
To learn more, go to myworkspace1.com or
call Promotions at 248.593.0202.
20090907-NEWS--0006-RG1-CCI-CD_--
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Page E6
September 7, 2009
CRAIN’S DETROIT BUSINESS
Health Care Extra
Good-tasting medicine
Hospital food goes healthy, local for sake of patients, profits
BY MICHELLE MARTINEZ
SPECIAL TO CRAIN’S DETROIT BUSINESS
For decades, the food that hospitals served their patients and
visitors was a practice in irony.
Hospitals advised patients to
change their diet to help treat
chronic illnesses such as diabetes,
hypertension and heart disease,
but served up bland, salt- and fatladen foods bedside or in their
cafeterias.
But new food programs are allowing hospitals to practice what
they preach, serving fresh, healthy
and — increasingly — locally
sourced foods to patients, visitors
and even staff.
The change is a chance for hospitals and Michigan communities
to get “multiple outcomes,” said
Michael Hamm, a professor of sustainable agriculture at Michigan
State University, “a public-health
impact, an economic impact and a
land-preservation impact.”
Hamm in March co-wrote an article in the Journal of Hunger and Environmental Nutrition that estimated if Michigan residents ate the
recommended amounts of fruits
and vegetables and bought them
from local, seasonal sources, it
could add nearly 2,000 jobs and $200
million to the state’s economy.
Henry Ford West Bloomfield Executive Chef Frank Turner puts it another way: If more residents were
to spend “just $10 a week on locally
grown food,” tens of millions of
dollars would be put back into the
state’s economy, he said.
“We want to set the example for
the community,” he said.
Henry Ford Health System isn’t the
only one. Locally, Warren-based
St. John Health, Detroit-based Detroit Medical Center and Royal Oakbased William Beaumont Hospitals
are all finding new ways to offer
healthy choices to everyone who
passes through their doors. The
Michigan Health & Hospitals Association last November started a campaign to get hospitals to eliminate
trans fats from their vending machines, cafeterias and patient
menus by January.
Nationally, Arlington, Va.-based
Health Care Without Harm, a global
coalition of health care providers,
labor unions and environmental
groups challenged hospitals to
overhaul their food systems to
healthier and locally sourced models.
That group in June hosted its
FoodMed conference in Detroit,
addressing strategies and benefits
of instituting a healthy, sustainable food plan in health care settings.
More than 250 hospitals nation-
COURTESY OF HARPER UNIVERSITY HOSPITAL
Scott Gray, sous chef with Morrison Food Services at the Harper Hospital Café, serves up a mixed field greens salad, part
of the medical center’s focus on healthy eating and fitness.
wide have signed that organization’s pledge, Henry Ford West
Bloomfield and Chelsea Community
Hospital among them.
The practices are more important to recession-worn residents,
who may want to support Michigan economies, and to those more
interested in where their food
comes from in light of recent
peanut butter, spinach and meat
recalls, said Elaine Brown, executive director of Michigan Food and
Farming Systems, a nonprofit that
promotes sustainable agriculture.
In 2003, there were 90 farmers
markets statewide, she said. Today, there are 200 — including
weekly markets at Henry Ford
West Bloomfield, Beaumont Hospitals and St. John Health.
Henry Ford West Bloomfield
President and CEO Gerard van
Grinsven sees it, too.
The healthy and sustainable
communities concept is “the
whole theme behind what we’re
doing,” he said.
Van Grinsven in 2006 was hired
to head Henry Ford’s new West
Bloomfield hospital from his post
as vice president and area general
manager of the Chevy Chase, Md.based Ritz Carlton Co. The hospital
has become a lab for the seven-hospital system, where holistic health
care and fresh, local food preparation are tested for systemwide via-
bility.
Van Grinsven tapped Matt Prentice, the chef behind such restaurants as Coach
Insignia and Shiraz, and Prentice’s executive
chef,
Frank
Turner, to develop menus that
included fresh
local foods. Instead of institutional
food Prentice
workers,
the
pair hired 20 chefs, half of them
culinary students, to serve about
800 meals a day in the hospital.
West Bloomfield cooks patient
meals on demand from a large
menu. It has no deep fryers or
freezers. Its projected $100,000 annual food spending goes mainly to
regional farms and vendors such
as Maple Creek Farms, a community-supported organic farm in Yale,
in the Thumb; or Chef’s Garden, an
organic farm in Huron, Ohio.
A demonstration kitchen is on
hand for healthy-cooking classes,
drawing residents each week for
classes such as vegetarian cuisine
or healthy tailgate food, featuring
Michelle Bommarito, a TV chef
who has appeared on TV with
Martha Stewart and on the Food
Network.
Henry’s, the hospital café,
serves up dishes such as carrot
bisque and salmon burgers to
about 200 people a day who show
up at the hospital for no other reason than to eat, van Grinsven said.
Two months ago, a farmers market was added, drawing another
200 to 300 people to the hospital
every Wednesday.
Not everyone is throwing out
their fryers, but other local hospitals are moving toward more
healthy offerings.
Beaumont Hospitals has been
free of trans fats since May, said
Maureen Husek, director of nutrition and retail services. The threehospital system’s “My Healthier
Choice” program labels cafeteria
items that meet American Heart Association guidelines, Husek said.
Detroit Medical Center’s Harper
University Hospital labels each cafeteria item with its nutritional content and provides the Weight Watchers “point count” of certain items,
said Thomas Malone, hospital
president and CEO.
Signs posted around the hospital
indicate calories burned by taking
the stairs instead of the elevator,
or walking around the DMC’s Midtown “quad.”
St. John is trans-fat free and is
revamping its cafeteria menu to be
heart healthy, said Dina Ciaffone,
a district manager with global food
service company Sodexo Inc. posted at St. John and a former director of the system’s Detroit
Riverview hospital. The system
has rewritten its patient menus
along similar guidelines and alerts
patients when they’re butting up
against dietary restrictions with
each meal.
St. John has bought from local
growers and vendors for the past
15 years, Ciaffone said, spending
about $2.3 million a year for produce and dairy products alone to
prepare nearly 4 million meals for
patients and visitors a year.
See Page E7
NATHAN SKID/CRAIN’S DETROIT BUSINESS
At least three area health systems host weekly
farmers markets that bring fresh local produce like
this front and center.
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Health Care Extra
From Page E6
“We really believe that the less distance
food travels, the fresher it’s going to be, and
(it) cuts down on emissions,” she said.
The trend isn’t happening only at hospitals. Skilled nursing homes are overhauling
their food plans as well.
Nabil Hawatmeh, executive director of
food and nutritional services at MediLodge of
Sterling Heights, swapped the bland gravycolored entrees being served several years
ago for what he calls “upscale dining” options.
Now the residents are served from a colorful buffet that features five homemade entrees, healthy panini sandwiches, and fresh
fruit and salads.
If they get hungry during the night, they
can order room service from a 20-item
menu, Hawatmeh said.
Medilodge relies on Medicare and Medicaid for the majority of its revenue, but
Hawatmeh said the changes have made the
Sterling Heights location a coveted place for
prospective residents and drawn residents
out of their rooms to socialize more.
The $1 to $2 in extra food costs per patient
per day (the industry average is about $6 or
$7, Hawatmeh said) is offset by creating efficiencies in other areas, or accepted by the
administration because of the program’s
benefits.
“The No. 1 concern people have when they
come here is the food,” he said.
Health care industry food giants are taking notice.
“We’ve definitely changed our buying
patterns to accommodate (the increased demand),” said Diana Bott, senior director of
multiunit and health care sales for Sysco
wary patients warm up to healthier food creasing overall consumption of fruit and
choices has been a hurdle, Ciaffone said. vegetables is good for people and puts monDMC’s Malone agrees.
ey into local farm economies.”
Hospitals depend on revenue from cafeteVan Grinsven said that a condition of
rias and retail food chains
West Bloomfield’s radical
as part of their budget,
approach was that it didMalone said. The biggest
n’t cost more than conmoney
producer
on
ventional food service
Wednesdays at Harper
might.
Hospital’s cafeteria? Fried
The common-sense apchicken wings.
proach to serving patients
Offsetting cost is anothfood they want to eat when
er issue.
they want to eat has cut
National healthy-food
down on waste, Taylor
model Oakland, Calif.said.
based Kaiser Permanente
“You could feed a village
started buying local and
from the amount of food
healthy foods for its hospihospitals throw away,” van
tals in 2006 and saw an inGrinsven said.
crease in its total food
Revenue from Henry’s
spending of about 1 perCafé, cooking classes and
cent, said Jan Sanders, dithe upcoming culinary inPreston Maring,
rector, national nutrition
stitute will go to offset
Kaiser Permanente
services procurement and
any increase from buying
supply. But it offset that
organic or local food, he
cost with measures such as buying in-sea- said, but added that hard numbers on the
son produce, reducing the number of times cost of West Bloomfield’s expansive food
high-cost items appear on hospital menus, programs won’t be tallied until the end of
or replacing beef or poultry with vegetarian the year.
options.
The hospital opened in March and has
Preston Maring, the Kaiser Permanente only 113 beds of its eventual 300 on line,
physician who spearheaded the system’s with 192 scheduled to be available by the
farmers markets and healthy-food pro- end of the year.
grams, said most of its programs paid for
But early, small indicators are pointing
themselves and did boost the amount of in the right direction. Henry’s Café is
fresh fruits and veggies hospital visitors grossing $5,000 a day, matching early proand staff ate, he said.
jections. They aim to double it when they
“It’s difficult to say that someone healed a expand their dinner service later this year,
little bit faster because they had healthy said Sven Gierlinger, hospitality services
food on their tray, but we do know that in- administrator at West Bloomfield.
We do know that
“increasing
overall
consumption of fruit
and vegetables is
good for people and
puts money into
local farm
economies.
”
NATHAN SKID/CRAIN’S DETROIT BUSINESS
Mary Berman (foreground) and Toni Bonner,
volunteers at Henry Ford West Bloomfield, set up
a vendor station Aug. 26 at the weekly farmers
market hosted by the hospital.
Detroit, the local branch of Houston-based
Sysco Corp., boosting local produce buys
and increasing business with companies
such as Cadillac Coffee and Achatz Handmade
Pie Co.
But making paying cafeteria customers or
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