Brian Wedgeworth, 47, posed as a surgeon and operated the scam nationwide over five years, using at least 13 'Doctor' aliases.
A sham doctor in Florida who swindled $1.3 million from women he duped at online dating sites was sentenced to nine years in federal prison this month after pleading guilty to more than two dozen counts of mail fraud, wire fraud, aggravated identity theft and money laundering, the Department of Justice says.
The defendant Brian Brainard Wedgeworth, 47, formerly of Tallahassee and Center Point, Alabama, operated the catfishing scam over five years, using at least 13 "Doctor" aliases, including: Dr. Brian Anderson; Dr. Anthony Watkins; Dr. Brian Adams; Dr. Edward Chen; Dr. Brian Chris; Dr. Chris Williamson; Dr. Brian Christopher Williamson; Dr. Brian Edmonds; Dr. Brian Ammerson; Dr. Brian Lamar Wilson; Dr. Brian Wilson; Dr. Brian Mims; and Dr. Brian Lamar Sims, prosecutors say.
He pleaded guilty in May to 25 counts of wire fraud, mail fraud, aggravated identity theft, and money laundering, says Jason R. Coody, U.S. Attorney for the Northern District of Florida.
"Our citizens should not be preyed upon by fraudsters who steal through overtures of affection," Coody says. "(This) sentence should serve as a significant deterrent to criminals of like mind."
Court documents showed that between October 2016 and March 2021, Wedgeworth defrauded more than 30 women across the country who he met through online dating forums by falsely claiming he was a physician, wooing them, and inducing them to send him more than $1.3 million in money and jewelry.
Wedgeworth's sentence will be followed by three years of supervised release, and he will also be required to pay more than $1.1 million in restitution. The investigation was led by U.S. Postal Inspection Service and the Internal Revenue Service Criminal Investigations unit.
HHS announces additional $35 million to improve 988 Lifeline access in tribal communities.
Call volumes to the 988 Suicide and Crisis Lifeline grew by 45% in August, when compared with August 2021, while response times shortened by 72%, the Department of Health and Human Services reports.
The nation in July transitioned to 988, formerly known as the National Suicide Prevention Lifeline. In August 2022 – the first full month of performance data -- the 988 Lifeline answered 152,000 more contacts (calls, chats and texts) compared to August 2021 and significantly improved the average speed to answer across all contacts to 42 seconds, down from 2.5 minutes in August 2021, HHS data show.
HHS Secretary Xavier Becerra credited the improvements to the Biden administration's 18-fold increase in funding for 988 Lifeline – rising from $24 million to $432 million.
"Our nation's transition to 988 moves us closer to better serving the crisis care needs of people across America," Becerra says. "988 is more than a number, it's a message: we're there for you. The transition to 988 is just the beginning. We will continue working towards comprehensive, responsive crisis care services nationwide to save lives."
Becerra also announced that HHS -- through the Substance Abuse and Mental Health Services Administration (SAMHSA) – has created an additional $35 million grant opportunity to support 988 Lifeline in tribal communities.
The U.S. had one death by suicide every 11 minutes in 2020, according to the Centers for Disease Control and Prevention, and suicide was the second leading cause of death for young people aged 10-14 and 25-34 in that span.
From April 2020 to April 2021, more than 100,000 people died from drug overdoses.
Chronically Underfunded
Although it was created in 2005, the Lifeline initiative has been hamstrung by chronic underfunding.
The tribal communities grant is part of the $150 million allocated for the 988 Lifeline under the Bipartisan Safer Communities Act signed by President Joe Biden on June 25.
That funding builds upon the $432 million already provided by the Biden administration to support the 988 transition, which includes $105 million in grants to states and territories under the American Rescue Plan to improve response rates, increase capacity, and ensure calls are routed to local, regional, or state crisis call centers.
"We want everyone to know that there is hope. Whether you're experiencing thoughts of suicide, a mental health or substance use crisis, or any other kind of emotional distress, there is compassionate, accessible care and support," says Miriam E. Delphin-Rittmon, PhD, HHS' assistant secretary for mental health and substance use, who also leads SAMHSA. "With rising levels of anxiety, depression, and other mental illnesses – and the devastating number of overdose deaths – it is crucial that people have somewhere to turn when they’re in crisis."
Analysts' report offers dire predictions for healthcare cost growth.
Higher-than-projected inflation is fueling healthcare cost growth and could add another $370 billion to national healthcare expenditures within five years, according to a report from McKinsey & Company.
That additional spending could balloon to $600 billion by 2027 when factoring in a possible recession and the lingering disruptions caused by the COVID-19 pandemic.
Before COVID-19 shuttered the global economy, Centers for Medicare & Medicaid Services' Office of the Actuary projected that national healthcare expenditures would grow at a rate of 5.5% through 2027.
However, the McKinsey analysis shows that the additional costs associated with the pandemic would push up the rate of NHE growth to 6.8%, about 2.5 percentage points above forecasted GDP growth.
"These are not in the Office of the Actuary's projections yet, but if you take their baseline, what they would have said is $370 billion more of cost," says Shubham Singhal, a senior partner at McKinsey.
In turn, that additional cost would be foisted on employers, who Singhal says will pass the cost to employees.
"We did a survey recently asking employers if they were to see price acceleration, what would they do?" Singhal says. "Anything that is 4% or higher, almost all of them said they're going to pass it on to their employees."
Singhal says a separate McKinsey poll of healthcare executives predicted 9% cost growth.
"That's a pretty big differential," he says. "If we get all the cost growths we've talked about employers are not going to be willing to just absorb those."
The report also predicts that:
COVID-19 healthcare labor shortages will continue to rise post pandemic, with shortages of 200,000 to 450,000 registered nurses and 50,000 to 80,000 physicians by 2027;
Through 2027 an estimated 100 million COVID-19 cases per year will add $222 billion in national healthcare expenditures.
The report says the healthcare sector can address the cost growth through care delivery transformation, improved productivity, technology enablement, and organizational growth and transformation.
AHA examines the causes behind 136 small hospital closures since 2010.
Low reimbursement, staffing shortages, low patient volumes, regulatory barriers, and COVID-19 disruptions all played a role in the shuttering of 136 rural hospitals between 2010 and 2021, including a record 19 closures in 2020, the American Hospital Association reports.
Those problems appear to be worsening as rural hospitals contend with rising costs for labor, drugs, supplies and equipment, threatening care access for rural Americans, AHA says.
"While many hospitals and health systems are facing unprecedented challenges, those faced in rural America are unique," AHA President and CEO Rick Pollack says."We must ensure that hospitals have the support and flexibility they need to continue to be providers of critical services and access points for patients and communities."
"One of the things that COVID-19 did for us, as devastating as it was, it shone a light on the importance of local healthcare, especially hospitals," Fadale says. "The organizations that stepped up and filled the gap were hospitals, and especially rural hospitals."
"If we weren't there, the likelihood of those patients getting the life-saving care they needed at the time they needed it would have been very slim," he says. "Every one of those hospitals that closed was providing for a community that has needs. When that hospital closes, all the support around them, primary care, diagnostics, imaging, all that go away."
"We have not seen an adjustment of payment from state and private payers to reflect the added financial burden to care for the patients we are serving," Yaroch says. "We also are seeing a higher level of care required by our aging population that often have multiple comorbid conditions."
Rural hospitals comprise 35% of all hospitals in the U.S. and include Medicare-designated critical access hospitals, frontier hospitals, and sole community hospitals.
In addition, rural hospitals are often the biggest employers and economic drivers in their service areas, supporting one-in-12 rural jobs across the nation, and contributing $220 billion in economic activity in their communities in 2020, AHA says.
Yaroch says that, because of the increased care costs and slimmer operating margins, "we are not able to invest in the infrastructure, capital needs, or innovative technology," Yaroch says.
"It also impacts the dollars we can put back into the community. It has a global impact that goes beyond our four walls and into our communities," she says.
The AHA report recommended "a number of pathways" to stabilize rural hospital finances, including flexible care models, lowered regulatory hurdles, partnerships, and state Medicaid expansion.
The AHA is also calling on Congress to extend the financial support provided under the Medicare-dependent Hospital and enhanced Low-volume Adjustment programs. Both programs expire on Sept. 30, 2022 unless Congress acts.
However, 'high risk' providers billed the program for $127.7 million for telehealth services in the first year of the pandemic.
First the good news.
Only 1,714 of the 742,000 providers who billed Medicare and Medicare Advantage for telehealth services for about 28 million beneficiaries during the first year of the pandemic "posed a high risk" to the program integrity, a federal audit shows.
Now the not-so-good news.
These high-risk providers represent only 0.2% of the audit sample, but they billed for about 500,000 beneficiaries and collected $127.7 million in Medicare fee-for-service payments for care provided between March 2020 and February 2021, according to an audit by the Department of Health and Human Services, Office of the Inspector General.
The first year of the coronavirus pandemic saw massive infusions of federal money and relaxed oversight by HHS of telemedicine services, as more than 28 million Medicare beneficiaries —about 2 in 5 — used telehealth in that first year of the pandemic, about 88 times more than in the previous year.
Using Medicare claims and Medicare Advantage encounters data for the 12-month period, auditors flagged providers for violating one or more of seven measures developed by OIG investigators to identify high-risk billings for fraud, waste, or abuse. OIG says it "set very high thresholds to identify providers whose billing poses a high risk to Medicare."
Each of the 1,714 flagged providers hit on at least 1 of 7 measures and warrant further scrutiny. The report called for "targeted oversight of telehealth (to) help ensure the benefits of telehealth are realized while minimizing risk in an effective and efficient manner."
Auditors also recommend five steps HHS could take to improve program integrity:
Strengthen monitoring and targeted oversight of telehealth services,
Provide additional education to providers on appropriate billing for telehealth services,
Improve the transparency of "incident to" services when clinical staff primarily delivered the telehealth service,
Identify telehealth companies that bill Medicare,
Follow up on the providers identified in this report.
"Although these high-risk providers represent a small proportion of all providers who billed for a telehealth service, these findings demonstrate the importance of strong, targeted oversight of telehealth services," OIG says.
CMS agreed with the recommendation to monitor flagged providers but "did not explicitly indicate whether it concurred with the other four recommendations," OIG says.
Oversight Challenges
Auditors say it's likely that there is additional leakage that their audit did not detect.
“Because this data brief focuses on specific measures with very high thresholds, it does not capture all concerning billing related to telehealth services that may be occurring in Medicare," the report says.
"Additionally, this report does not confirm that any particular provider is engaging in fraudulent or abusive practices. Any determination of fraud or an overpayment would require additional investigation."
The audit also acknowledged "challenges" for oversight of Medicare "incident to" billing because it allows clinical staff services under a practitioner to be billed under the supervising practitioner's identification number.
“It is critical for program integrity efforts to identify the individual who delivered the telehealth service that is billed to Medicare," OIG says. "To address these limitations in the data, we developed measures for this report that aim to minimize the effect of "incident to" billing on the results of the claims analysis."
ATA Responds
The American Telemedicine Association and affiliate ATA Action called the report "another clear statement outlining the resounding success of telehealth during the COVID-19 pandemic."
"Their report found that only a 'very small proportion of providers' billed Medicare inappropriately, indicating that the measures put in place to safeguard against fraud, waste, and abuse related to telehealth worked well to maintain program integrity," says Kyle Zebley, senior vice president, public policy at ATA and executive director of ATA Action. "We are incredibly proud of how telehealth was able to respond during the pandemic and extremely pleased at another very positive report from OIG."
Zebley noted that the 28 million Medicare beneficiaries who used telehealth in the first year of the pandemic "represents a dramatic increase from previous years."
"As we focus on finding ways to solve for health disparities in our country, this report sheds important light on populations that were most likely to use telehealth, including beneficiaries in urban areas, Hispanic beneficiaries, younger beneficiaries and female beneficiaries," Zebley says.
The suit alleges that Indivior violated antitrust laws to preserve its Suboxone monopoly.
A federal judge in Philadelphia has ruled that 42 states may go forward with their antitrust “product hopping” lawsuit against Indivior Inc., the maker of the addiction treatment drug Suboxone.
The class-action suit, led by Wisconsin Attorney General Josh Kaul, alleges that Indivior in 2010 switched from a tablet to an under-the-tongue film strip while simultaneously attempting to "destroy" the market for tablets to preserve its drug monopoly.
"The cost of critical medication must not be inflated through anticompetitive tactics," Kaul said in a media release. "I'm proud that Wisconsin DOJ is leading this multistate litigation and thank AAG Cooley for her tireless efforts to hold the makers of Suboxone accountable."
In an 86-page ruling, the U.S. District Court Mitchell Goldberg denied Indivior's motion to toss the suit, saying the complaint against the drug maker was backed by sufficient facts and favorable law.
The multistate coalition filed a lawsuit in 2016, claiming that Indivior's tactics were anticompetitive and designed only to maintain Indivior's monopoly, a scheme known as a "product hop," which the states claim violates state and federal antitrust laws.
Indivior has claimed the switch was done to address safety concerns.
She succeeds Nadine Brooks Harris, MD, the state's first surgeon general.
Veteran public health expert Diana Ramos, MD, has been appointed California's new surgeon general by Gov. Gavin Newsom.
Ramos, 55, of Laguna Beach, described by the governor's office as "registered without party preference," is director of state public health and prevention programs at the California Department of Public Health's Center for Healthy Communities, a position she has held since 2021. Before that, she spent four years as CDPH's public health medical officer.
She succeeds Nadine Brooks Harris, MD, the state's first surgeon general, a post that pays $216,420 a year.
Ramos says she is "humbled and honored" by the appointment, and thanked Newsom "for this once-in-a-lifetime opportunity."
"And while this has certainly been a challenging time for all of us, I view this as an opportunity to do the good work California has become known to do. To do the good work this office has been known to do."
Newsom created the surgeon general's office in 2019 on his first day in office, reasoning that the state needed a leadership voice on public health issues.
"Dr. Ramos is a distinguished leader in medicine and a trusted public health expert who brings a lifetime of experience protecting and promoting the health of vulnerable communities," Newsom says. "I look forward to her partnership in advancing urgent priorities for the state on women's health, mental health, addressing the gun violence epidemic, and more as we continue our work to lift up the health and well-being of all Californians."
Ramos' resume also includes stints as an adjunct assistant clinical professor at the University of Southern California Keck School of Medicine – where she also earned her medical degree -- since 1999, and a per diem physician at Kaiser Permanente since 1998.
Ramos is also the founder and one-time CEO of Gami-Fi Health since 2018, and the former director of reproductive health at the Los Angeles County Department of Public Health's Maternal, Child and Adolescent Health Division from 2005 to 2017.
She was CMO at Alpha Medical Center Inc. from 2003 to 2005. She was a Senior Regional Medical Research Specialist at Pfizer Inc. from 2000 to 2003 and a Staff Obstetrician at Clinica Humanitaria from 1999 to 2000.
The California Nurses Association railed against the "backroom deal."
Just days after the collapse of an alleged backroom deal with hospitals to swap relaxed seismic standards for higher wages, a California healthcare workers' union opened its push to enact a statewide $25 healthcare minimum wage.
More than 200 members of the Service Employees International Union – Union of Healthcare Workers West will meet with state lawmakers to press for the statewide wage hike that has already been enacted in four Southern California cities.
"Through the process of passing local ordinances and talking to elected officials about statewide legislation, we've discovered an enormous appreciation for healthcare workers among lawmakers and the public and an understanding of how low wages are making the healthcare staffing crisis worse," says Dave Regan, SEIU-UHW president.
"There is a broad understanding that it was frontline healthcare workers, not greedy hospital executives, who put their lives on the line and continue to carry California through the COVID crisis. We are calling on every city in the state to pass a local ordinance establishing a $25 minimum wage immediately. We are calling on the legislature and, if necessary, the state's voters to establish a $25 minimum wage within the year."
In a media release, the union claimed that the California Hospital Association "walked away from a conceptual agreement that would have broadly established a healthcare worker minimum wage of up to $25 and update the timeline and scope for seismic upgrades to hospitals."
"The hospital industry demanded a loophole that would have allowed hospitals to evade the new minimum wage by outsourcing or moving work to other facilities. The hospital industry also refused to commit to using properly trained construction workers to ensure safety in seismic upgrades of their facilities," the union says.
The Los Angeles Times, citing an internal CHA memo, said the deal "came together quickly and followed years of stymied attempts to delay a state law that requires hospital buildings to have earthquake upgrades by 2030," which would cost about $100 billion and force closures across the state.
CNA President Sandy Reding, RN, railed against the deal, saying "it is unconscionable that any union would demand handouts from our elected leaders to support a gift to the hospital industry instead of prioritizing the lives, protection, and safety of patients, hospital workers, and our communities."
"We call on California officials to reject this appalling proposed backroom deal that could endanger countless lives and access to essential care for many others across our state from the next major earthquake that is sure to come," Reding says.
Insurers deny allegations, say plans are already under rigorous oversight.
Senate Finance Committee Chair Ron Wyden, D-OR, is asking insurance regulators in 15 states to send him consumer complaints about Medicare plans using “potentially deceptive” marketing to sell coverage.
"I have heard alarming reports that MA and Part D health plans and their contractors are engaging in aggressive sales practices that take advantage of vulnerable seniors and people with disabilities," Wyden says in his letter to the regulators.
"I write seeking information about potentially deceptive marketing practices being conducted by insurance organizations offering Medicare benefits under the Medicare Advantage (MA) program and the Part D prescription drug program," he says.
Wyden notes that the Centers for Medicare & Medicaid Services got more than twice the numbers of complaints about Medicare Advantage plans in 2021 than it did in 2020.
The letters were sent to regulators in Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania, and Texas.
Health Plans Respond
The Better Medicare Alliance, a trade group financed by the nation's largest health insurance companies, took issue with Wyden's letter.
BMA President and CEO Mary Beth Donahue, said in a media release that "Medicare Advantage plans' marketing materials are already subject to careful regulation: they must be approved by CMS and are answerable to more than 50 pages of federal guidelines."
"With a 94% consumer satisfaction rate, it is clear that this program consistently lives up to its promise for seniors," Donahue says, citing a BMA-commissioned survey released in January.
Instead of overregulating health plans, Donahue says "policymakers must take action to modernize Medicare enrollment in ways that offer more transparency in coverage choices and empower consumers, rather than criticizing those standing in the gap to help beneficiaries navigate this difficult and complicated process."
Kaiser has about 50 mental health clinicians to provide care for the HMO’s 266,000 members in Hawaii. Their open-ended walkout starts on Aug. 29.
Kaiser Permanente mental health workers in Hawaii will soon join their California counterparts on picket lines to protest what they say is woeful understaffing for mental health services.
"Kaiser's business model is to starve its behavioral health services and short-change patients who can go months without care," says Sal Rosselli, president of the National Union of Healthcare Workers, which represents Kaiser mental health clinicians in California and Hawaii.
"Through strike activity our members are using their power to make Kaiser stop treating mental healthcare as a second-class service and start providing care that its paying customers are legally entitled to receive," Rosselli says.
Kaiser has about 50 mental health clinicians to provide care for the HMO's 266,000 members in Hawaii, according to the NUHW. The Hawaii clinicians held a three-day strike in May, and this latest walkout starts on Aug. 29 and will be open-ended, the union says.
Kaiser's accreditation in Hawaii is under "corrective action" with the National Committee for Quality Assurance after the clinicians filed a complaint documenting what clinicians say are dangerously long waits times for mental health appointments.
NCQA determined that the "lack of access to (behavioral health care) for Kaiser members poses a potential patient safety risk" and that "Kaiser's prior efforts to improve access… have largely been ineffective."
More than 2,000 Kaiser mental health clinicians in Northern California walked off the job on Aug. 15 to protest the HMO's chronic understaffing, which the NUHW says is continuing despite Kaiser having $54 billion in reserves. The striking clinicians are actively picketing Kaiser hospitals across Northern California.
Kaiser spokeswoman Deb Catsavas has called the walkout "perplexing" and the union’s tactics "unethical and counterproductive."
"In our last bargaining session we were about 1% apart in our respective wage proposals, and we came to bargaining … with hopes to bargain vigorously and bring negotiations to a conclusion," Catsavas said after the Aug. 15 walkout. "Unfortunately, union leadership delivered a fully new economic proposal from NUHW that avoids reaching agreement and pushes us further apart."
