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| Dear Friend,
Tie your strategy into what the other side is already thinking.
File it under life imitating art, a little slice out of John le Carré or a heaping portion of The Amerikans, a real life potential spy story that has a moral applicable to your medical group or your facility, and to your business dealings in ways that perhaps you’ve never imagined.
According to evidence offered by the United States government in connection with the ongoing prosecution of Walter Glenn Primrose aka “Bobby Edward Fort”, and Gwynn Darle Morrison, aka “Julie Lyn Montague”, Walter and Gwynn both attended the same high school (from 1970 -1973) and then the same college (1976-1979) in Texas; they were married in 1980. Things took a financial turn when, on December 21, 1987, their house was lost to foreclosure, a scenario not unlike the fate of many in the then recession. But that’s where the story diverges from the expected.
An affidavit filed by a federal investigator disclosed that in 1987, Walter and Gwynn obtained birth certificates for deceased American born infants and assumed their names. Walter became Bobby and Gwynn became Julie. The investigator further alleged that Walter/Bobby and Gwynn/Julie obtained Texas driver’s licenses and social security cards under their assumed names and then remarried as Bobby and Julie.
Along the way, “Bobby” obtained multiple U.S. Passports under that assumed name. And for some overlapping times, Walter also applied for and obtained a passport under his actual name. False identity passport allegations are made against Gwynn as “Julie”.
The allegations continue from there to include later-issued fraudulent state and federal identification documents, including, for Walter/Bobby, false Department of Defense identification, for, it turns out, Walter, as “Bobby”, enlisted and served in the U.S. Coast Guard for twenty years and held a secret clearance. Following his military service, he became employed by a defense contractor.
In support of their motion to detain Walter and Gwynn without bail, the current charges being related to the false federal documents, federal prosecutors allege that Walter/Bobby traveled out of the country without reporting foreign travel as was required per his secret clearance, that the two used additional aliases, that Gwynn/Julie had lived in then-communist Romania, and, to top it all off, that investigators discovered old photos of the couple wearing what have been identified as KGB uniforms.
With Whom Are You Dealing?
Although the news over the years abounds with stories of fake doctors, that’s not where I’m going with this, although, to be sure, if one can fake one’s way to a security clearance, it’s not out of the question.
Rather, on a more practical and extremely actionable scale, how much do you know about the people with whom you deal, their motivations, their interests, their pasts, their dreams, and where they think they are going? What do you know about their education (checked it?), their certifications (are the certifications even real or just another set of funny initials?), their prior jobs? How much do you take those and other attributes into account when negotiating with them, when hiring them, when enlisting their support, when cajoling them, or when holding them at bay as competitors?
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| | | Business Life in the Time of Coronavirus Mini-Series
The coronavirus crisis caused a short term economic crisis for many medical groups. Our mini-series shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
[If you haven't already seen them, follow this link to watch our entire series.] |
| | Watch Tuesday's video here, or just keep reading below for a revised, more polished version:
A few weeks ago I took this car, the rolling studio, into the dealer for service. Unfortunately, it’s about the only place that can work on my car.
I noticed that the guy I spoke with, the service manager, was probably the fourth or fifth service manager with whom I spoke at that same dealer over the past two to three years.
It’s like a game of musical chairs.
Which made me think about the fact that it’s really the same in terms of hospital administrators. The hospital administrator that I cut a deal with at “Hospital A” back in 2006 is certainly not at the same hospital, unless it is among the very few outliers.
For the most part, hospitals rotate through hospital administrators, CEOs even, like car dealers change service managers.
Which takes us to the point here, which is, the side deal.
Often hospital administrators will say to a group that's negotiating with them, “Look, I can’t put X in the contract, but trust me, I’ll honor X.”
Let’s assume that you could trust this person (a very big assumption).
What’s going to happen when his or her replacement arrives, a person who knows nothing about the side deal and who wouldn’t honor it anyway?
If there’s something important to you in a deal, you’ve got to negotiate it into the agreement. If you don’t, if you’re willing simply to trust the administrator, it better be something that you don’t really care if you get or not – because your chance of actually getting it when the administrator changes – is well, close to zero.
Sounds unfair, but at least know the score before you start playing the game.
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| | How to Deploy the Secret Sauce of Opportunistic Strategy
Webinar On Demand
They say that COVID-19 has changed the world, creating the "new normal." Many of your colleagues and many hospital administrators are running scared.
Others, leaders like you, know that crisis means opportunity.
Let me provide you with the strategic tools and insights that you need in order to seize opportunities, whether they’re in the context of your current business relationships, the expansion of your business activities, or the creation of new ventures.
You will learn:
•Defense as a defective default: It’s necessary, but not sufficient.
•Exploiting weakness: Drop the guilt and identify opportunity.
•Flat line negotiation is fatal: Understand its myths and limitations.
•Negotiation reality: Learn to identify and deploy on multiple planes to affect the outcome.
•Maneuver: Harness the power of maneuver, both in overall strategy and in specific negotiation strategy.
Others see a crisis and freeze in fear. Learn how to see the opportunities and obtain the tools to increase your odds of obtaining them.
The price to attend is $479. The cost of not attending is astronomical. |
| | | Wednesday - The "Why" in Hospital Employment - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript:
Why become a hospital-employed physician?
Scanning the news recently:
- GM lays off over a thousand workers.
- Nurses around the country are on strike, over concerns of patient care amid increasingly long shifts.
- And around half of newly graduated residents and over sixty percent of established physicians moving to new jobs are placed with hospitals or their controlled medical groups.
So what could those doctors accepting hospital employment be thinking? That hospital employment is safer than traditional private practice? That it's easier? That it avoids the difficulties of independent practice?
But as the industry news also reports, hospital closures are negatively impacting the physician employment market.
And, as I've written before, hospital employment comes with an additional "benefit" -- a benefit to the hospital: The restrictions of fair market value compensation levels, as defined for healthcare compliance purposes, are neither fair nor at market value. They will result in lower and lower compensation as more physicians come under its purview.
Hospital employment is no cure for the ills of physician practice. And if you think it is, then consider that the cure is worse than the disease. |
| | | Listen to the podcast here, or just keep reading for the transcript.
A recent U.S. District Court ruling serves as a reminder that more than fair market value is needed to remove an arrangement from scrutiny under the federal Anti-Kickback Statute (“AKS”).
For example, I might pay you fair market value for providing consulting services in regard to my medical device, the “UpcodeExtractor 2.0” —but what if I engage your services as a reward for implanting the device? Or, what if the number of consulting days (paid for to the penny at the amount per day or even per minute opined to by 23 of the nation’s most recognized valuation experts) correlates to the volume of your use of UpcodeExtractor 2.0s?Then we’ve got a problem.
In February 2022, the Court in U.S. ex rel. Dr. Kuo Chao v. Medtronic PLC, et al., issued an order denying the defendants’ motion to dismiss. The case is a False Claims Act lawsuit brought by whistleblower/relator Dr. Kuo Chao, who alleges, among other things, that the defendants, collectively referred to as “Medtronic”, engaged in a multifaceted kickback scheme to compensate doctors for ordering a greater number of Medtronic “Pipeline” devices, an implantable device used to treat brain aneurysms.
The whistleblower alleged, among other things, that Medtronic maintains a proctoring program through with it regularly pays doctors for professional services. Those doctors were experienced in implanting Pipeline devices and, as paid proctors, they taught other doctors how to do the Pipeline procedure. Dr. Chao’s allegation is that Medtronic systematically and habitually overpays the proctors for their proctoring services as a disguised kickback meant to incentivize them to order more Pipeline devices for their own cases. Other alleged circumstances include other alleged overpayments for similar purposes.
The defendants argued that Dr. Chao did not specifically allege that the payments exceeded FMV and moved for a dismissal.
The Court’s response in its order denying the motion to dismiss was that, as has been established by case law, the payor of remuneration violates the AKS whenever one purpose of the remuneration was to induce future referrals or orders, even if the payments were also intended to compensate for professional services. The court also stated that even some fair market value payments will qualify as illegal kickbacks, such as when the payor has considered the volume of reimbursable business between the parties in providing compensation and otherwise intends for the compensation to function as an inducement for more business. It also stated, citing previous case law, that “neither a legitimate business purpose for the arrangement, nor a fair market value payment will legitimize a payment if there is also an illegal purpose (i.e., inducing Federal health care program business).”
Some takeaways for you:
1. Fair market value is an “ingredient” in AKS compliance. It’s not the whole meal.
2. Even if FMV is present, the analysis isn’t over by a long shot.
3. The underlying scheme, not the ink on the paper, governs legality versus illegality.
4. Every new, and every existing, financial relationship with anyone or any entity with which physicians and other healthcare providers do business must be vetted or re-vetted in light of enforcement reality. Immediately. |
| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this
time? How can we focus on solutions to your most pressing strategic concerns?
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back.
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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