Kaiser Settles Dialysis Patient Transport Payment Squabble

After years of scandals, it's becoming pretty clear that Kaiser Permanente prefers dead kidney patients to live ones.

Kaiser Settles Transport Payment Squabble
By PHILIP A. JANQUART
Courthouse News Service
December 06, 2013

(CN) - A stipulation agreement has led to the dismissal of claims that Kaiser Foundation Health Plan failed to pay a company that transported patients to dialysis.

ProTransport-1 LLC, which claimed to transport Kaiser patients with end stage renal disease, had filed the lawsuit under the False Claims Act in 2012.

It said that Kaiser takes hundreds of millions of dollars from the U.S. government to care for seniors and patients with special needs, but that it pockets the money and has contractors like ProTransport bill the California Medical Assistance Program, known as Medi-Cal, for services rendered. Claiming that the Medicare Act allegedly requires Kaiser to pay the company in the first instance, ProTransport said the insurer's conduct amounted to fraud.

The complaint spared no words in blasting Kaiser as an "unscrupulous" entity whose "greed" compels it to steal from and defraud the government.

This past August, U.S. District Judge William Orrick refused to let ProTransport advance claims that the alleged billing was part of Kaiser's plan to kill its patients.

The complaint had stated: "Of course, Kaiser knows very well that without dialysis, these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."

But Orrick had no patience for the "scandalous" allegation.

"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," he wrote.

[Maura Larkins' comment: In fact, Kaiser treatment guidelines include delaying diagnostic tests and ignoring test results. Kaiser seems to have a particular antipathy toward helping patients with kidney issues. At one point, Kaiser actually kept many of them off eligibility lists for transplants. These policies have resulted in quick deaths rather than long years of care, producing a huge amount of profit for Kaiser Permanente. Kaiser is interested in finding cheap treatments for common diseases, but it carefully picks and chooses when it comes to treating patients who have expensive problems.]

ProTransport eventually dropped seven of its 10 claims.

The parties agreed to mediation in late August and ProTransport's attorney, George Azadian, of The Matthews Law Group in San Marino, Calif., revealed this week that they entered a stipulation agreement to dismiss the case.

Azadian stressed stipulation agreements are generally confidential and that he could not reveal the conditions of ProTransport's agreement with Kaiser.

Attorneys for Kaiser did not return a request for comment.

Orrick dismissed the case Tuesday.


See court order from August 2013 in this case.

Kaiser Contractor Can't Allege Schadenfreude
By JONNY BONNER
Courthouse News Service
September 03, 2013

(CN) - A federal judge sidelined "scandalous" allegations that Kaiser welcomes the death of its patients, but left room for amended claims under the False Claims Act.

In a 2012 complaint, ProTransport-1 LLC claimed that Kaiser Foundation Health Plan failed to pay for its services transporting patients with end stage renal disease to dialysis treatment.

The Oakland-based Kaiser allegedly required ProTransport to seek reimbursement from the California Medical Assistance Program, Medi-Cal.

ProTansport said it complained about the conduct and that Kaiser then retaliated by refusing to pay for any transports made by ProTransport and excluding ProTransport from bidding to provide future services to Kaiser.

Since the Medicare Act allegedly requires Kaiser to pay ProTransport in the first instance, the insurer's conduct amounts to fraud, according to the complaint.

Kaiser moved to dismiss the complaint and to strike references that it called "immaterial and improper," leading ProTransport to voluntarily dismiss seven claims. It wanted to preserve only its claims under the federal False Claims Act and California laws against retaliation and unfair competition.

ProTransport drew the court's ire with its claims that Kaiser welcomed, caused and profited from patients' death.

In its complaint, ProTransport said: "Of course, Kaiser knows very well that without dialysis these patients will die within weeks. That is part of Kaiser's plan. Dialysis is expensive, so is transporting patients to and from dialysis. By killing off these patients, Kaiser is left with a much more profitable patient base, resulting in billions in profits."

U.S. District Judge William Orrick on Wednesday called the allegations "immaterial and scandalous."

"References to Kaiser welcoming deaths, causing deaths or profiting from deaths - unsubstantiated by factual allegations - are immaterial and scandalous and should be stricken," the ruling states.

Though Kaiser claimed that the False Claims Act claim was just a disguised attempt by ProTransport to obtain payment for its services, ProTransport insisted that it is trying to secure recovery for the United States.

Orrick agreed that "payments to ProTransport for services provided in the past are not at issue. Nor are payments that might be made in the future, as ProTransport was allegedly barred by Kaiser from bidding to provide future services."

He nevertheless dismissed the claim as inadequately pleaded.

"While the complaint cites to various statutes and regulations to argue that Kaiser's Medical Advantage plan is required to provide the same level of coverage required under Medicare and that medically necessary transports are covered by Medicare, the complaint does not identify which law, rule or regulation Kaiser undertook to comply with that 'is implicated in submitting a claim for payment,'" the 18-page ruling states. "Moreover, the complaint does not identify what 'claims' Kaiser submitted that were 'impliedly' false."

In dismissing a claim for retaliation under the California Health and Safety Code, Orrick noted that the law does not cover "a non-contracted transportation service provider."

ProTransport can allege retaliation unfairness under the unfair competition law, but it cannot claim a violation under the illegal prong of that law, according to the ruling.

Orrick reasoned that this claim is barred because it stems from the nixed allegations under the False Claims Act and Health and Safety Code.

Lowering urates reduces kidney disease

Urate-Lowering Cuts Complications From Gout
Alice Goodman
Medscape
November 08, 2013

SAN DIEGO — Patients with gout who remain on urate-lowering therapy are less likely to develop kidney damage leading to chronic kidney disease than untreated patients, according to results from a large study.

There was an economic incentive to conduct this study, said lead investigator Gerald Levy, MD, a rheumatologist from Kaiser Permanente Medical Group in Downey, California. "Gout has increased dramatically over the past 20 years. With it, associated costs — including office visits, urgent care, emergency department visits, and hospitalizations — have gone up to about $1 billion per year."

Kaiser Permanente of Southern California covers 3.6 million people. "This is a big pile of patients," Dr. Levy told reporters attending a news conference here at the American College of Rheumatology (ACR) 2013 Annual Meeting.

"A number of studies show that people with renal disease can develop hyperuricemia, and some will also develop gout. We wanted to see if reversing uricemia would have an impact on renal disease," he explained.

Investigators identified 111,992 patients with serum uric acid levels above 7 mg/dL in the Kaiser Permanente database.

Of these, 16,186 had been tested for serum uric acid levels and glomerular filtration rates at least once in the 6 months prior to study entry and at least once during the follow-up period.

All of these patients were followed for 36 months from the first documented high serum uric acid level. Patients were grouped into categories: never treated with urate-lowering therapy (n = 11,192), on urate-lowering therapy less than 80% of the time (n = 3902), and on urate-lowering therapy more than 80% of the time (n = 1092).

Almost all of the patients receiving treatment were also on allopurinol (98.3%).

"Achieving serum uric acid below 6 mg/dL — as per ACR guidelines — was protective and associated with a 37% improvement in renal outcomes," Dr. Levy said. "These patients represent the real world."

Table. Effect of Urate-Lowering Therapy on Serum Uric Acid

Treatment Hazard Ratio 95% Confidence Interval P Value
Less than 80% of the time 1.27 1.05–1.55 .01
More than 80% of the time 1.08 0.76–1.52 .68
Serum uric acid at goal 0.63 0.50–0.78 <.0001

Patients taking urate-lowering therapy more than 80% of the time were older, sicker, and more likely to have a diagnosis of gout. They also initiated therapy earlier than patients in the other 2 groups.

Worse outcome was associated with age, being female, hypertension, diabetes, congestive heart failure, previous hospitalizations, higher serum uric acid level at entry, and rheumatoid arthritis. There was no difference in the number of deaths in the 3 groups.

A limitation of this study is that it was observational and retrospective, and some data points were missing, noted Dr. Levy.

"The next group of studies will assess whether we can actually improve renal function by lowering serum urate levels. We need to demonstrate this and see how long it takes to show improvement," he said. "We found changes in 36 months, and we believe these changes take place early. If we can prevent progression to chronic kidney disease and dialysis, this would have tremendous cost savings."

News conference moderator, Christie Bartels, MD, from the University of Wisconsin in Madison, noted that "the data for urate-lowering therapy in hyperuricemia are compelling, but we still need a prospective randomized controlled trial. The study findings are a plug for ACR guidelines for gout therapy, because many patients do not get to goal," she said.

Rheumatologists need to give patients a reason to stay on medications, Dr. Bartels added, and the fact that urate-lowering therapy might prevent a gout attack and preserve the kidneys could be that reason. " This is especially important in gout patients who present with kidney problems initially," she noted.

Dr. Levy and Dr. Bartels have disclosed no relevant financial relationships.

ACR 2013 Annual Meeting: Abstract 857. Presented October 27, 2013.

Woman Blames Kaiser for Multi-Organ Failure

Woman Blames Kaiser for Multi-Organ Failure
By BARBARA WALLACE
Courthouse News Service
July 31, 2013

PORTLAND, Ore. (CN) - A Kaiser patient started to bleed internally during an elective surgery to remove a mass from her kidney, and within days she was debilitated due to Kaiser's slow response, she claims in Multnomah County Circuit Court.

Patricia and Joseph Moore sued Northwest Permanente, Kaiser Foundation Hospitals and Kaiser Foundation Healthplan of the Northwest dba Kaiser Permanente for $9.5 million for medical malpractice and loss of consortium.

Within hours of the surgery Moore's abdomen was distended. Other symptoms "consistent with acute hemorrhage" followed, but it was not until shortly after midnight the next day that Kaiser "initiated their rapid transfusion protocol," according to the complaint.

Over the next two days Moore's complications escalated, including falling blood pressure, increasing abdominal distention, rapid heart beat and breathing problems, the complaint says.

"Following numerous transfusions, Patricia Moore sustained respiratory failure and was intubated. During the intubation she aspirated abdominal contents into her airway."

The next morning, "Patricia Moore was diagnosed with acute renal failure," and this was followed by removal of her left kidney and three months on a ventilator, after which she was discharged to a care facility, according to the complaint.

Moore blames Kaiser's failure to timely diagnose and surgically correct the internal bleeding for a host of problems she has experienced, including hemorrhagic shock, multisystem organ failure, acute respiratory failure, gangrene of her left leg and foot, anoxic brain injury and prolonged ventilator dependence.

The plaintiffs are represented by Timothy J. Jones and Ken L. Ammann of Salem, Ore.

Kaiser incorrectly told patient that surgery would be "routine"; kidney and lung damage resulted

Bleeding Risk Not Revealed, Kaiser Patient Says
By BARBARA WALLACE
Courthouse News
May 21, 2013

PORTLAND, Ore. (CN) - When a 410-pound woman consulted a Kaiser obstetrician-gynecologist about the feasibility of becoming pregnant, the doctor recommended uterine surgery but did not warn her about the risk of complications due to her weight, the woman claims in court.

Dr. Rachel Algenio told plaintiff Karen Carmocan about a fibroid tumor on her uterus in 2008, according to the complaint. Yet, "it was not until 2011 when Dr. Algenio advised Karen that the said growth would interfere with her ability to have children and because of such, Dr. Algenio recommended that Karen have surgery to remove the growth from her uterus. Dr. Algenio represented to Karen that if she had the tumor removed she should be able to give birth to a child," the complaint states.

Carmocan initiated a discussion with Dr. Algenio about pre-surgical blood storage in case she needed a transfusion, according to the complaint. However, Dr. Algenio dissuaded her, saying it was not necessary because the procedure was "routine," the complaint continues.

Carmocan lost a higher than usual amount of blood and she began to have complications in the days following the operation, the complaint says. The complications included nausea and vomiting, breathing difficulties, excessive coughing and an unusually high level of white blood cells, according to the complaint. "An elevated white blood cell count can be an indication of an infection in the body," the complaint says. She needed to use a walker to walk because the blood loss had made her anemic, the complaint continues. After another two days, Carmocan was given a transfusion, but the anemia symptoms continued, as well as the coughing and vomiting, according to the complaint.

A day after she went home, Carmocan was back in the hospital because of her continuing problems, where she was diagnosed with pneumonia and sepsis, the complaint says.

Carmocan blames Kaiser for the pneumonia and subsequent permanent lung damage, alleging it was caused by aspirated stomach contents from her untreated post-operative vomiting. She also claims excessive use of the antibiotic Vancomycin, given for the pneumonia, caused kidney failure and irreversible kidney damage. "Anemia played a significant role in the events that followed Karen's surgery," the complaint says, depriving her brain and other organs of red blood cells and oxygen for an extended period. Carmocan says Dr. Algenio breached the standard of care by causing the excessive blood loss, not anticipating anemia as a likely result and not replacing the lost blood sufficiently before sending her home.

Carmocan says Kaiser should have anticipated and warned her about "the problems that can occur during and following surgery performed on a person weighing 400 pounds," including "the increased risk of intraoperative bleeding in a patient when the surgical field is deep below an abdominal wall that is several inches thick" as well as "the increased risk of post-operative pneumonia in a patient whose extremely large body reduces the ability to breathe deeply and move about in the bed."

"Had Karen been advised by Dr. Algenio of the severity of risk of the procedure, especially the risks related to Karen's excessive weight, such as the increased risk of intraoperative bleeding," she would have decided not to pursue the surgery, she says.

Karen Carmocan gave up an educational goal of becoming a family counselor so that she and her husband, Dan, could try to have a family of their own, according to the complaint. However, "defendant's staff has represented to Karen that if she were to now become pregnant she would need to be placed on kidney dialysis during the time of the pregnancy, and even if she were to be placed on kidney dialysis, Karen would still have little chance of being able to bear a child," she says.

Karen and Dan Carmocan are suing in Multnomah County Circuit Court for $1.3 million.

Kaiser Urology Department in San Diego admits truth about removing the wrong kidney

In the article below, Kaiser says that its mistakes are "rare." The truth is that it is rare for Kaiser to honestly report its mistakes, and the policy of falsifying medical records is supported at the highest levels of Southern California Kaiser Permanente Medical group and Kaiser Foundation Hospitals.

Here's a link about how Kaiser Permanente's urology department in San Diego covers up the truth: comparison of hospital urology departments.

Also see: Kaiser kidney transplant scandal

Here's a list of recent Kaiser lawsuits taken from the Courthouse News website: Kaiser Bad News.

San Diego Kaiser Hospital Fined For Removing Wrong Kidney
City News Service
December 20, 2012

A San Diego hospital was among 10 medical centers across the state that were assessed administrative penalties today for actions that caused, or could have caused, serious injury or death to patients.

According to state Department of Public Health officials, Kaiser Foundation Hospital failed to follow surgical policies and procedures in 2010, leading to a surgeon removing the wrong kidney from an 85-year-old man.

Hospital officials said that while extensive safety measures were in place, staffers acted quickly to identify the cause of the error and implemented safety measures to help ensure such an event would not be repeated.

"We sincerely regret that this error in 2010 occurred at the Kaiser Permanente San Diego Medical Center. While these types of incidents are very rare, we take the matter extremely seriously,'' according to a hospital statement. "At the time of the incident, we immediately reported the matter to the California Department of Public Health, and fully cooperated with the investigation.''

The hospital was fined $75,000 -- the second administrative penalty the medical center has received.

The hospital was assessed a $50,000 penalty after a towel was left inside a patient who underwent surgery for gallstones in 2009, U-T San Diego reported.

The CDPH issued 12 penalties to hospitals in San Diego, San Francisco, Oakland, San Rafael, Harbor City, Arcadia, Visalia, Mission Viejo, Fountain Valley and Crescent City.

Administrative penalties for incidents that happened before 2009 carried a fine of $25,000. For later incidents, $50,000 was assessed for a first violation, $75,000 for a second and $100,000 for subsequent violations. Incidents before 2009 were not included.

Hospitals were also required to provide a plan to prevent future incidents. Kaiser's plan included updated policies and procedures, and staff training "to prevent the reoccurrence of a surgical procedure being performed on a wrong body part.''

Surgeons and operating-room nurses will also ensure all relevant imaging studies are available and any surgical or invasive procedure for which an image was obtained will be available and reviewed, according to CDPH documents.

A multidisciplinary surgical safety team that meets weekly to discuss ideas for continuously promoting safe operating practices was implemented in May 2011, according to hospital officials.

Hospitals can appeal an administrative penalty by requesting a hearing within 10 days of the notification.

Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries

Kaiser transplant center medical director Sharon Inokuchi

See more Kaiser cases.

Was Kaiser transplant director Sharon Inokuchi clueless? Or was she doing what someone at Kaiser wanted? By failing to obtain kidneys, Kaiser avoided the huge costs of transplant operations and years of follow-up and medication.

Kaiser Permanente’s Kidney Transplant Program: Kaiser Mismanagement and Patient Injuries

Ruben Porras, a pressman in his 40s with the Sacramento Bee, had been waiting for a kidney at UC Davis for 3 years. In 2004 he expected to become eligible to receive a kidney very soon; that is, until Kaiser cancelled the program at UC Davis. Porras was put on inactive status in November 2004—so that he couldn’t receive a kidney—and was not transferred to Kaiser’s San Francisco program until September 2005. Because kidneys are given out by geographic regions, and it is more difficult to get a kidney in populous San Francisco than in Sacramento, Porras’ expected waiting period lengthened from the 3 years he had already waited to around 6 years. Porras wasn’t informed of the change in his situation.

In the meantime, several of Porras’ relatives had volunteered to donate a kidney for him and they were being assessed as possible donors at UC Davis. When Kaiser cancelled the contract with UC Davis, the assessments there were cancelled and no assessments were ever done at Kaiser. When relatives tried to call Kaiser to continue the assessments, no one at Kaiser returned their phone calls. Less than one month after his transfer to the long San Francisco waiting list was finally completed, Porras died from an infection connected to his continued dialysis treatment. He was 47...

Porras’ case is not unique. There have been many other reports of mismanagement at Kaiser’s new San Francisco kidney transplant program. In another case, 63-year-old James Klinkner quickly completed and sent in his forms when he was told that he was being transferred from the program at UC San Francisco to Kaiser’s San Francisco hospital. The form was apparently lost or not processed by Kaiser, and they sent Klinkner another one to fill out. He called the medical director of the program to find out what had happened, but his call wasn’t returned. Klinkner died from complications from dialysis just 3 days after he turned 64.

How did all this happen? And why? Up until mid-2004, Kaiser had contracts with UC Davis and UC San Francisco to handle Kaiser’s kidney transplant patients. Then Kaiser decided to open up its own kidney transplant program in San Francisco. Kaiser cancelled its contracts with UC Davis and UC San Francisco and its plan was to transfer all Kaiser transplant patients to the new Kaiser program. But the transfers did not go well, and some were delayed, leaving those patients without eligibility for a long period of time.

Reports now reveal that hundreds of patients were removed from transplant eligibility lists for months, and some were refused authorization for transplants at UC San Francisco when possible kidney matches became available. Complicating matters further, it is now difficult to find the patients who were affected because patients were never notified that Kaiser had cancelled its kidney transplant contracts with UC Davis and UC San Francisco. Kaiser is now under investigation by the California Department of Managed Health Care.



Where is Sharon Inoguchi now?
Still happily employed by Kaiser.
Kaiser doesn't appear to be upset with her.
Why not? Perhaps because she was doing
what they wanted when she kept patients
off lists to receive kidneys.

(from Kaiser website March 2011:)

Sharon Inokuchi, MD
Specialty--Nephrology
South San Francisco Medical Center
Joined Kaiser Permanente: 2003

..."I joined Kaiser Permanente after more
than 10 years in private practice, to join
a team with a real focus on quality
patient care. Kidney disease is
increasing in the U.S. Slowly and quietly
the disease will progress, damage
tissues and if unchecked, the failing
kidney will change life dramatically.
Unless something changes, this will
happen to so many of us. I believe that
the solution to this problem is to try to
prevent kidney injury, discover problems
early, fix the things we can and then
protect the kidneys from damage. This
is the right time and place to make this
happen.

"Patients I see often come thinking all is
over and the kidney is dead. For most,
there is hope. Changes in medicines,
diet and behaviors can often slow the
process and protect the kidneys. Doing
this will also improve health and help
control blood pressure and sugars. I
will work with every patient to try to make
this happen. And I expect my patients to
learn and try. We will work together. Our
goal is to make every life worth living.

"This is my life’s work. I love to teach and
working with patients has been a joy.

"In my leisure time, I enjoy reading,
needlework and spending time with
friends and family. Taking walks and
using the treadmill lets me eat an
occasional donut and helps to keep me
fit."

My Credentials

Medical school-- Harvard
Residency-- UC San Francisco Medical Center
Fellowship-- UC San Francisco Medical Center
Fellowship-- Veterans Affairs Medical Center, San Francisco, CA
Board certification-- Internal Medicine, American Board of Internal Medicine