from yourarewithinthenorms.com
NORMAN J CLEMENT, RPH, DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PharmD, BELINDA BROWN-PARKER, L. JOSEPH PARKER MD, IN THE SPIRIT OF ROBERT L. THOMAS RPh., PHARMD., IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC.T. SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS MD, PH.D., AISHA GARNER, DAVID STEIN, MD IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
HETZNECKER: UNDERMINING DEA’s ANNE MILGRAM “RISK ASSESSMENT” CONCEPT; “THE MONEY BALLING” OF MEDICAL PAIN CARE IN AMERICA
Washington, D.C. – October 28, 2023 — The United States Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have recently ramped up their efforts to combat healthcare fraud, leaning heavily on data analytics, Generative Artificial Intelligence (AI), and Machine Learning.
While the government claims significant success in identifying instances of fraud, some experts warn that these advanced technologies may inadvertently target innocent healthcare providers and practices.
The federal government’s utilization of digital solutions and data mining to combat healthcare fraud is not a new concept. However, the recent surge in hiring scores of prosecutors and FBI agents specializing in new technological advances in AI and Machine Learning marks a notable shift in strategy.
These efforts are primarily focused on detecting “fraud, waste, and abuse” in the healthcare industry, which has proven quite lucrative for the government.
WHO DEFINES MEDICAL CARE: YOUR HEALTHCARE PROVIDER OR LAW ENFORCEMENT?
WARNING: YOUR HEALTHCARE IS BEING THREATENED BY DEA OVER-REACH
DEA DIRECTOR ANNE MILGRAM HAS BETRAYED THE PUBLIC TRUST
According to the DOJ and HHS, their investment in data analytics yields a return on investment of $4 or greater for every $1 spent on healthcare fraud detection and enforcement. They attribute much of this success to their reliance on data analytics as a key driver.
However, the rush to employ these new tools has led to unintended consequences, with many innocent physicians, clinics, hospitals, and health systems being accused of wrongdoing merely because they exhibit statistical anomalies or are considered outliers in their practices. The critical question raised by this approach is whether it inadvertently identifies some legitimate practices and providers as fraudsters.
“Data analytics is a good tool to suggest the need for further investigation, but it should not be used to determine misconduct conclusively,” says Jacob Foster, Principal Assistant Chief of the DOJ’s Health Care Fraud Unit. Foster emphasizes that “data is not the truth” and that “we have to go out and investigate.”
Unfortunately, the government hasn’t always heeded Foster’s advice. Healthcare providers and legal experts have witnessed situations where data analytics resulted in innocent individuals bearing the substantial financial and reputational costs of defending against federal enforcement actions simply because their data points differed or exceeded those of their peers.
In several cases, individuals have been wrongly accused of fraud but later had their names cleared after providing the necessary context to the government.
In July 2019, one such case involved Dr. Neil Anand and the technology company DrChrono, which supplied the government with records related to Dr. Anand’s Pennsylvania-based practice. He was being investigated for allegedly distributing drugs to patients who didn’t request them, raising concerns about the implications of advanced data analytics in such investigations.
Qlarant, a Maryland-based technology company, has developed algorithms to identify questionable behavior patterns related to controlled substances and opioids, partnering with various state and federal enforcement entities, including the Department of Health and Human Services’ Office of Inspector General, the FBI, and the Drug Enforcement Administration. To flag providers, these algorithms analyze a wide range of data sources, including court records, insurance claims, drug monitoring data, property records, and incarceration data.
“By focusing “HER BASEBALL MONEY BALLING,” statistics, this method perpetuates the symptoms of an unjust system without addressing the root causes”
William Mapp, Qlarant’s Chief Technology Officer, underlines that the final decision on what to do with the information generated by their algorithms lies with people, not the algorithms themselves. He acknowledges the potential for errors and the company’s continuous efforts to minimize them.
Concerns about these unreviewed and unknown algorithms have also reached the American Medical Association (AMA). Bobby Mukkamala, MD, chair of the AMA’s Substance Use and Pain Care Task Force, highlights the significant impact on physicians, stating that “these unknown and unreviewed algorithms have resulted in physicians having their prescribing privileges immediately suspended without due process or review by a state licensing board — often harming patients in pain because of delays and denials of care.”
The ongoing debate surrounding the use of artificial intelligence and advanced data analytics in the fight against healthcare fraud emphasizes the need for a balanced approach that prioritizes accurate investigations and fairness in targeting potential wrongdoers. As the government continues to refine its strategies, healthcare professionals and legal experts urge a cautious and responsible application of these technologies to prevent the wrongful targeting of innocent parties.
“Pre-Crime “and the Danger of “Risk Assessments”
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“Pre-Crime” and the Use of “Risk Assessments” in Modern Law Enforcement
The concept of “pre-crime,” once relegated to science fiction, has taken on a chilling reality in contemporary law enforcement practices. In a thought-provoking article titled “Pre-Crime” and the Danger of “Risk Assessments” authored by Paul J. Hetznecker, the issue of “pre-crime” and the utilization of “risk assessments” by law enforcement is brought to the forefront.
The article, originally published on September 12, 2016, questions the implications of these practices, emphasizing their impact on civil liberties, racial bias, and the erosion of constitutional protections.
Hetznecker delves into the development of these risk assessments, explaining that they rely on data extracted from police and court records. Factors like the suspect’s neighborhood, family criminal history, income, and education are scrutinized.
However, the author underscores that this data-centric approach fails to address the underlying systemic issues, such as poverty, lack of education, economic opportunities, and racism, which contribute to criminal behavior. This one-sided narrative perpetuates the symptoms of an unjust system without tackling the root causes.
THE DEA KNEW AND HAS KNOWN DOCTORS, PHARMACISTS, DENTISTS, NURSE PRACTITIONERS, DRUG MANUFACTURERS WERE NEVER THE CAUSE OF THE SO-CALLED OPIOID EPIDEMIC
FOR NOW, YOU ARE WITHIN
THE NORMS
