A Los Angeles area physician faces five counts of federal fraud after a seven-year investigation alleged she sold more than $1 million in herbal "cancer cure" concoctions to as many as 55 patients around the country.
Christine Daniel, MD, of Mission Hills, CA, was arrested last week on charges that she used her position as a Pentecostal Minister and her appearances on a religious television show, "Praise the Lord," to make false claims about her product, which she called "C-Extract," according to the 71-page indictment.
The indictment accuses Daniel of telling many cancer patients to forego cancer treatments because chemotherapy "did no good" or "didn't work." Instead, she marketed her remedies to the "Evangelical Christian Community," saying they would work along with prayer, according to the document.
She is charged with setting up an elaborate scheme to acquire, mix, and package ingredients from caffeine, meat flavoring, celery seed, and other "botanical" products to desperate patients and their families, according to documents filed with the U.S. District Court.
The documents described 25 patients who were persuaded to travel across the country and stay in Los Angeles area motels in order to receive the treatments starting in early 2001. Some patients and their families paid a range of prices between $1,050 and $6,375 for a month's supply, and some were persuaded to spend $20,000, and in one case, $61,956.
Daniel was released from jail Friday on $150,000 bond. She is scheduled for arraignment Oct. 19, according to spokesman for the U.S. Attorney in Los Angeles, Thom Mrozek. Mrozek said Daniel faces 30-year prison terms for each count.
The indictment says in part, "By deceiving victims into paying money based on the above misrepresentations, defendant Daniel and employees working at her direction induced approximately 55 victims to send in excess of $1.1 million to the Sonrise Medical Facilities."
Patients who saw her show on national Trinity Broadcasting Network show, "Praise the Lord," heard her state that her "array of herbs" that are made in her laboratory "combined with prayer" had resulted in a "60% cure rate for the lowest level we have."
For cancer sufferers who could afford another treatment that may last longer, and was more expensive, the cure rate was said to be 80%, according to the federal documents.
"We have people that have bone metastasis, lung metastasis, and metastasis to the pericardium. We have a lady from Michigan; she had stage 4B spread of breast cancer to her brain, within two weeks, the tumor marker dropped to normal," the documents allege her to have claimed.
She also made the statement, "I have not really found radiation to be effective, maybe in certain cases."
After persuading some of the patients against undergoing chemotherapy, several patients died within weeks or months later, according to the accusation.
Daniel's practices were chronicled in a lengthy article in the Wall Street Journal in January 2007. In that article, she denied selling substances, and said she only provides palliative end of life care. She described federal investigators as "nut cases" and "evil."
Daniel is still licensed
Asked why the investigation took most of the decade, Mrozek said a search warrant of her home three years ago "essentially shut her down" at that time.
He added, "things take time. There's paperwork, and you want to make sure you have it right."
Daniel's attorney, Manuel Miller of Tarzana, CA, said, "We believe she is totally innocent. They've had this case for awhile, but they've just now handed down an indictment. We don't want to fight this case in the media."
Daniel, who documents claim is also known as Chika Chima, Christina Ononando Chima, and Christine Chika Chesman, is still licensed to practice medicine in California and works out of her Sonrise Medical practice in Mission Hills, in the San Fernando Valley.
A spokeswoman for the Medical Board of California, whose investigator was involved in an undercover capacity during many years of the U.S. Food and Drug Administration federal investigation, said Daniel is still under state scrutiny.
"One of our investigators participated in her arrest last week," said Candis Cohen of the Medical Board of California. "We are discussing our options on this case with prosecutors from the Attorney General's office."
The imaging community is getting increasingly nervous.
After rebounding from severe cuts several years ago enforced under the Deficit Reduction Act, the radiology community and others who bill for CT, MRI, X-ray, ultrasound, and related services face further cuts under a variety of health reform proposals.
But now they face a new threat. Last week, the Office of Inspector General unveiled plans to look into the payments and appropriateness of many scans performed in emergency rooms under Medicare Part B.
A blast on the American College of Radiology's Web site yesterday warned providers "to be prepared. Radiologists and their staffs should properly document the medical necessity of and correctly code for their services."
"The Medicare people are looking for money, and they've latched on to imaging as a place where they can mine more of that money," said Shawn Farley, ACR spokesman. "But we feel they're a bit short-sighted in their request."
Farley explained that federal officials are licking their chops when they see growth rate charts published by the Medicare Payment Advisory Committee this March. Those charts show dramatic annual increases for imaging services between 2002 and 2006 of 4.7% average per year. For example, advanced CT scans rose 11.1%, echography rose 10.1%, breast imaging increased 9.4%, and advanced MRI imaging tests increased 12.6%. And all those percentages are average annual increases for each of those years.
But after the Deficit Reduction Act imposed cuts several years ago, those percentage increases have dropped. Overall, imaging services grew only 2% between 2006 and 2007. Advanced CT rose 5.4%, standard breast exams rose 4.7%, advanced MRI increased only .8%, and echography was up by 7.3%, the MedPac report showed.
Farley says the real culprits in rising utilization of imaging services are not radiologists, but those in non-radiologist physicians who purchase relatively inexpensive scanning devices, such as X-ray or ultrasound machines, for their offices.
In an effort to tell Congress how they feel, 14 advocacy groups plan to rally on the Rayburn Building on Capitol Hill tomorrow to persuade Congress not to cut imaging payments, saying "drastic repercussions" would ensue.
Specifically, they say that it would force many practices that offer such services to go out of business, and the impact "would hit rural communities the hardest" forcing patients to drive even farther to get the imaging services they should have.
The American College of Radiology is not among the 14 groups. Those who plan to rally include the American Federation for Aging Research, the American Pain Foundation, the Brain Injury Association of America, and the Emergency Coalition to Save Cancer Imaging.
The groups plan to release a new analysis by the Moran Company showing a continued decline in growth of volume of advanced imaging services under Medicare for 2008.
The Medical Group Management Association has made administrative simplification one of the key goals of its healthcare reform advocacy, and several provisions in the reform bills currently being considered by Congress could save billions being wasted on administration if approved.
Changes that could alleviate administrative headaches include:
Machine readable patient ID cards. Nearly $2.2 billion related to clerical errors and waste could be avoided each year if the healthcare industry adopted machine-readable patient ID cards, William F. Jessee, MD, FACMPE, president and CEO of MGMA, claimed at the annual conference in Denver on Monday. MGMA has made ID cards a central focus with Project SwipeIT, which has gotten 1,000 pledges from insurers, providers, vendors, and other organizations to adopt the cards.
"I'd love to see Medicare lead the way on this," said Jessee. Being able to walk into a doctor's office and swipe a card to accurately provide insurance information was a "no brainer," he added. Currently the three healthcare reform bills under consideration in the House and Senate include provisions for adopting patient ID cards.
National health plan identifiers. CMS has already been authorized to move forward on national health plan identifiers, but has yet to take substantial action. All three healthcare reform bills would finalize the process for setting up the identifiers.
Electronic claims attachments. The current paper claims attachment process adds administrative time to the payment process and increases labor costs, Jessee said. Although the House healthcare reform bill includes a provision to establish rules allowing electronic claims attachment, neither bill in the Senate addresses the issue, according to Leah S. Cohen, MA, government affairs representative with MGMA.
Standard insurance operating rules. Most insurers have different operating rules for eligibility verification, claims processing, and other payment procedures. Standardizing the operating rules among all insurers has the potential to remove more than $40.4 billion in costs over 10 years from the system, said Jessee. All three healthcare reform bills currently have provisions that would move the standardization forward.
Real-time processing. The Senate Finance Committee bill and HR 3200 contain provisions that would allow real-time processing for eligibility verification and other steps of the payment process. This would save practices time and eliminate some unnecessary administrative headaches when managers need to verify whether a patient is eligible for coverage or to settle claims.
Although each simplification is being considered in at least one bill, it is still early in the process to determine whether they will make it to the final legislation. MGMA and other organizations are lobbying Congress to include administrative simplifications when the Senate bills are merged, and then during the conference committee to combine the final House and Senate legislation.
The Senate Finance Committee will hold a landmark vote on healthcare reform legislation on Oct. 13 and with few Republicans expected to support the bill, Democrats have already begun their own internal negotiations aimed at reconciling the various measures passed by House and Senate committees. Lawmakers are reviving ideas that had been discarded, including a new approach to a government insurance plan that appears to be gaining support with party moderates.
Medical groups ranked Medicare Part B higher than any other payer in a satisfaction survey released by the Medical Group Management Association at its annual conference in Denver.
Members were asked to rate their satisfaction with payers on issues related to responsiveness, transparency, prompt payment, credentialing, overall satisfaction with administrative functions, and other metrics. More than 1,700 MGMA members participated in the poll.
Medicare topped the list with an average ranking of 3.59 on a five-point scale. Aetna came in second at 3.14, and was followed by CIGNA, Coventry, Humana, Anthem, and UnitedHealthcare.
William F. Jessee, MD, FACMPE, president and CEO of MGMA, suggested that medical groups like Medicare's predictability and the clearness of its rules. However, Medicare received low marks for its credentialing process, he noted. The CMS form physicians must fill out to become credentialed is nearly 30 pages long and much more cumbersome than private-payer equivalents.
Overall, respondents were most satisfied with payers' fee schedule disclosure and prompt payment of claims. They expressed frustration, however, with the amount of leverage they have during the contract negotiation process, as well as the transparency of ratings systems and the claims denial appeals process.
Jessee attributed the frustration about the payer negotiation process in part to the lack of competition between insurers in many markets. Medical groups often find it tough to negotiate when only three or four payers dominate an area and have the upper hand when setting rates. Medical groups often make their margin from smaller insurers, who have less leverage when crafting contracts, Jessee said. However, this makes it more difficult for new payers to enter a market.
The study only addressed the payment process, and did not ask respondents about their satisfaction with payment rates. That would have probably found much more dissatisfaction, Jessee joked.
Mayo Clinic is no longer accepting some Medicare and Medicaid patients, raising new questions about whether it is too selective to serve as a model for healthcare reform. Mayo officials said that the move was a business decision that had grown out of longstanding concerns about what it sees as underpayment by Medicare and Medicaid. The White House has repeatedly held up for praise Mayo and other medical centers that perform well in Dartmouth College rankings showing wide disparities in how much hospitals spend on Medicare patients, the Washington Post reports.
A proposed tax on high-cost, or "Cadillac," health insurance plans started a clash between the Senate and the House as they wrestle over how to pay for legislation that would provide health benefits to millions of uninsured Americans. Supporters say that the tax is essential to tamping down medical spending and that over 10 years it would generate more than $200 billion, nearly a fourth of what is needed to pay for the legislation. Critics say the tax would quickly spiral out of control and hit middle-class workers.
Obama administration officials and Congressional Democrats have responded to a new insurance industry report that said premiums would climb sharply with the passage of comprehensive health legislation. The report said selected provisions of a bill from the Senate Finance Committee could increase premiums 18% more than they would otherwise rise in the next decade, to an average of nearly $26,000 for families and $9,700 for individuals in 2019. White House officials said the industry had ignored features of the bill that would lower costs for consumers, like subsidies for people who could not afford insurance.
As the Senate Finance Committee prepares to pass its plan to overhaul the nation's healthcare system, senior Democrats are acknowledging that it may be impossible to provide coverage to all Americans, a central goal of President Obama and his congressional allies. That acknowledgment is fueling growing alarm among hospitals and insurance companies, which have made universal coverage a condition of their support.
As Congress moves to expand health insurance coverage to millions of Americans, it's doing little to ensure there will be enough primary care doctors to meet the expected surge in demand for treatment, experts say. "I don't see anything in the legislation that will greatly increase the primary care pipeline," Russell Robertson, MD, chairman of the Council on Graduate Medical Education, told Kaiser Health News. In addition to making sure patients have access to care, increasing the number and proportion of primary care doctors is crucial to lowering health costs, he said.
