Quest Diagnostics Inc., and its subsidiary Nichols Institute Diagnostics (NID), entered into a global settlement with the U.S. government that includes a $40 million criminal fine and a $262 million fine to resolve False Claims Act allegations.
NID pleaded guilty to charges of felony misbranding of one of its products, a test called Nichols Advantage Chemiluminescence Intact Parathyroid Hormone Immunoassay. Laboratories use the test to measure parathyroid hormone (PTH) levels in patients. According to the U.S. Department of Justice (DOJ) press release, the tests provided elevated results that lead to unnecessary medical treatments for patient who were thought to have high levels of PTH.
The DOJ asserts NID manufactured, marketed, and sold the test kits despite knowing they produced inaccurate and unreliable results. Along with the settlement, Quest also entered into a corporate integrity agreement (CIA) with the OIG.
The April 15 settlement comes nearly five years after whistleblower Thomas Cantor filed a qui tam suit. Cantor will receive a $45 million share of the settlement.
Cantor's determination was key in bringing this False Claims Act case to a settlement, says Norm Werner, FACHE, corporate compliance director for Continuum Health Partners in New York.
"This was years in the making," he says. "Cantor really persevered."
It all started when Cantor found a dramatic increase in parathyroidectomies after laboratories began using NID's test kits. Physicians performed the surgeries because the test kits lead them to believe they were necessary, Werner says.
With the government consistently cracking down on healthcare fraud and abuse, this large settlement is a significant victory, he says.
"This will definitely be a deterrent going forward," he says.
The CIA should also help in preventing future similar cases. "Now they have to be that much more compliant by having to adhere to the CIA," Werner says.
The United States is drowning in healthcare costs, which are projected to top a whopping $4 trillion by 2015. President Barack Obama's healthcare reform plan includes funding for workplace wellness programs.
When he signed the stimulus package, Obama said, "Wellness initiatives will keep millions of Americans from setting foot in the doctor's office for purely preventable diseases."
But most companies have reported low and stagnant participation rates in workplace wellness programs. With so much riding on prevention to help cure America's healthcare system, how can wellness programs fulfill the promise of lowering healthcare costs?
Here are eight tips to ensure a successful wellness program:
Assess—Conduct research to understand your participants: What motivates them, both from a rewards and recognition perspective? How do they want to be communicated with? What are the current realities of your health and productivity program?
Design—Develop a program that is both fair and fun, taking into consideration your unique member population as well as which goals are realistically achievable and measurable along the way.
Manage—Ensure one person or partner is managing all aspects of the program. Make sure the wellness movement starts at the top. Executive management needs to embrace wellness as a business imperative, not a "nice to have," and they need to live up to that mission.
Reward—Develop a continuous rewards and incentives program with personally meaningful, memorable, and motivating rewards. Many organizations are using incentives as a one-time "carrot," or a simple "do this, get that" approach. However, because the required behavior changes are new, challenging, and difficult to sustain, programs must include incentives and rewards throughout the year in order to drive long-term program engagement in healthy behaviors.
Communicate—Share ongoing reminders, feedback, and recognition using multiple media and taking into account member preferences. This is the single biggest reason wellness programs fail. There is not enough budget or emphasis given to the importance of communication either in content or frequency. Effective communication continues to reinforce attention on the wellness movement and it answers five key questions for employees:
What do you want them to do?
Why do you want them to do it?
How do you want them to do it?
What's in it for them?
How are they doing?
Segment—Know the demographics of your workforce. Demographics are a key data point that allow you to disseminate the appropriate communications and rewards. In addition, we suggest going a step further to take the pulse of your population and its readiness for change. Understand what they expect and prefer, as well as the types of tools, communications, and rewards that may actually engage them to adopt healthier behaviors.
Measure—Help members understand how they are doing individually and track the success of the overall program. This will help both members and program managers make the necessary tweaks to stay on track.
Spend—Spend money to save money on healthcare costs. Too often organizations try to cast too broad of a net, spreading their investment dollars too thin. The result: a disjointed and haphazard program with very little strength to drive change. Make the most of your investment dollars and focus them on a couple of objectives with the idea that you can always phase in more services and interventions after the wellness movement gains momentum.
Creating a wellness movement in an organization takes time, resources, and investment. The last thing that you want is for it to fail. Taking some of these tips to heart may help in mitigating the risk of failure.
Mindy McGrath is vice president of strategy for Maritz's healthcare sector. She has more than 15 years of experience within the healthcare industry, including the pharmaceutical and health plan markets. She has served in multiple roles for companies such as Bristol-Myers Squibb, PricewaterhouseCoopers, and Medimedia. She also authors the healthcare blog,Rewarding Health.
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The marketing team at Baton Rouge (LA) General Medical Center (BRGMC) wanted to do something different for its annual breast cancer awareness campaign. But they had to do it on a shoestring: The organization wasn't the market leader in oncology service lines and had a smaller marketing budget than the competition, the hospital wrote in its submission essay for the HealthLeaders Media Marketing Awards.
"We are constantly focused on maximizing our creativity and doing a lot with a little," they wrote.
Because national breast cancer awareness month coincided with the 2007 elections in Louisiana and because the region has a rich history of political satire, the hospital devised a unique political campaign of its own: a mock online election featuring five well-known community members who agreed that the winner of the mock election would wear pink on Election Day.
Jokes about voting early and often and some of the funniest press releases our judges have ever read set the lighthearted and memorable tone for the campaign. Yard signs, campaign buttons, cardboard cutouts of the candidates wearing pink boas, and other creative collateral showed the thought and effort that went into this campaign. The team carefully vetted its candidates, choosing men who are well-known in the community, have a personal connection to cancer and a passion for early detection, and would embrace the campaign's spirit.
"Obviously, a lot of great strategic thinking went into this campaign, and it showed," said one judge. "Outstanding!"
The goal of the campaign was to raise awareness of breast cancer, of course, but also to increase name recognition and market share for BRGMC. During the four-week campaign, the microsite got 1.2 million hits and banner ads received 1.1 million impressions and 5,600 click-throughs. In all, 24,000 people cast votes, sent 150 e-mails to the candidates, and ordered 200 breast health shower cards. What's more, the campaign ultimately won BRGMC a platinum award among large hospitals in the community relations category at the marketing awards.
"Objectives were more than clear, and the results speak for themselves. This was truly an ambitious and successful initiative," one judge said. "You absolutely hit the target of raising awareness and engaged the entire community," said another.
This Campaign Spotlight was excerpted from Hospital Campaigns That Work, featuring the winners of the 2008 HealthLeaders Media Marketing Awards.
Marianne Aiello is an editor with HealthLeaders Media. Send her Campaign Spotlight ideas at maiello@healthleadersmedia.com. If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
Older Americans could see big changes in Medicare as a result of a healthcare overhaul, lawmakers and experts said as Congress began working on the sweeping legislation. Medicare should become the test lab for making the entire healthcare system less wasteful, experts told the Senate Finance Committee. Savings could be used to strengthen Medicare itself, or plowed into covering the uninsured.
The American Medical Association is developing a Web-based service offering doctors electronic prescribing, up-to-date reference material, and other resources. The goal is to make it easier for physicians to adopt technology President Obama is promoting for healthcare reform, to streamline their workload, and improve patient care.
The surgery was meant to take out the patient's gallbladder, but when the patient was sewn up a 13-inch medical instrument was left behind.
Operating room staff typically count sponges, sharp objects and instruments three times during and after surgery, but in this case, which occurred in January at Hartford Hospital, the final instrument count took place before the patient's incision was fully closed.
The case, cited in a report by Connecticut regulators, reflected a rare but potentially severe operating room occurrence: leaving objects in patients after surgery.