Stop POPTS-Facts and Updates about Physician Owned Physical Therapy Services and Referral for Profit

The old saying is that the society has short-term memory syndrome.  In other words, society is quick to forget.

Because referral for profit is patient abuse by CMS definitions, it’s worth reminding anyone that stumbles by this blog that there’s a large body of evidence that concludes that referral for profit is draining the finances out of our healthcare system…and does not result in the quality of care that paying patients deserve.

In this blog report we finding the heading “License to overuse” very appropriate.

Dr. Mitchell’s comment sums up the problem with respect to imaging (MRI, CT, x-ray):

“This is a huge problem,” says Jean Mitchell, PhD, a Georgetown Public Policy Institute economist who has studied self-referral. The Medicare Payment Advisory Commission (MedPAC) has estimated that 1 in 3 imaging studies may be unnecessary. That would equal about $55 billion of the $170 billion spent on imaging annually, according to Jeff Goldsmith, PhD, president of Health Futures, coauthor of a book about medical imaging, and a member of MANAGED CARE’S Editorial Advisory Board.   click here for more

Another blog post summarizing Mitchell’s study on the over-utilization of surgery:

She [Mitchell] specifically looked at three types of surgeries:  carpal tunnel repair, rotator cuff repair and knee arthroscopy.

Anyone care to take a wild guess as to which group performed more surgery?

Age- and sex-adjusted odds ratios indicate that the likelihood of having carpal tunnel repair was 54% to 129% higher for patients of surgeon owners compared with surgeon nonowners. For rotator cuff repair, the adjusted odds ratios of having surgery were 33% to 100% higher for patients treated by physician owners. The age- and sex-adjusted probability of arthroscopic surgery was 27% to 78% higher for patients of surgeon owners compared with surgeon nonowners.  click here for more

While outsiders almost always place blame on the insurance companies for failing to address or ignoring this behavior, we find this quote, especially in light of our battle with the CA Medical Association & CA Orthopedic Association, to be a more accurate summation of why referral for profit continues to exist:

“Private payers could just stop paying for it, but they are more afraid of pushback from providers,” she says. “The providers really bully the insurers.”

We applaud Dr. Mitchell for her persistence and continuous efforts to expose some physicians for their unethical and unchecked referral for profit behavior.

If only consumers were aware of the abuse…

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Happy New Year! January 1st, 2013 is finally here! The moratorium on law enforcement against POPTS is OVER! The Physical Therapy Board of California is now required to investigate and discipline therapists working for illegal POPTS. In baseball the umpire calls you OUT on the third strike. In the case of POPTS, law enforcement officials should call POPTS therapists OUT after failing to pass a bill legalizing their employment arrangement FOUR years in a row! And that’s the way the rules go in the ol’ ball game, but one should expect CMA to stall again or attempt to ‘buy’ the Speaker’s favor again. (picture source: prweb)

A second option for the CMA and COA would be to get a different legislator to run another POPTS legalization bill. STOPPOPTS suspects that the new author would be an apprentice of Speaker Perez and will be ‘forced’ to run the bill if he or she ever wants to get anywhere in their political career.

A third option for POPTS sympathizers would be to run a bill or insert language into an existing bill (as Senator Steinberg did) extending the moratorium on law enforcement by suggesting that there might be a “legislative fix” to physicians’ monopoly over the physical therapy industry. STOPPOPTS believes the items that really need fixing are conflicts of interest, substandard health care, and government that encourages it.

So STOPPOPTS asks………Who will CMA’s next stooge be now that Mary has left the building?

Rumor has it that the Las Vegas odds board just opened up today! Here are the highlights:

Senator Price 1,000,000,000:1
Senator Walters 1,000,000,000:1
Speaker Perez 10:12
Larry 7:1
Curly 8:1

Place your bets wisely!

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View more videos at: http://nbclosangeles.com.

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Frank Snepp wrote several excellent articles about the corrupt efforts of the California Medical Association to legalize abusive referral for profit.

He summarizes in this excellent discussion here:

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It’s pretty clear to us at STOP POPTS that at least one corrupt leader is on her way out.

Great news for Californians, patients and physical therapists…we hope.

Mary Hayashi, the corrupt criminal that pleaded no contest to $2500 of shoplifting, is in last place in the race for Alameda County supervisor according to the polls.

Considering the recent revelations, we couldn’t be happier.

Here are some of the recent stories that turn our stomachs:

Hayashi Giving Big Raises to Her Friends to Save Her Home

A couple months back Mary Hayashi got caught with her hand in the cookie jar again.  She was reportedly losing money on her Castro Valley home so what did she do?  She gave her aide  a sizable raise and then rented her home back to him (Chris Parman) to finance her own mortgage.  Just another transgression in a long line of abuses committed by this criminal.

Darrell Steinberg Cites Hayashi’s “Values” and Endorses Her (click on the link for more)

Darrell Steinberg, Senate President pro Tem, that did a number on CA physical therapists by offering the compromise bill, SB 924, then let it die (don’t be fooled into thinking this was just John Perez’s doing), endorsed Mary Hayashi.  More evidence to us at STOP POPTS that Steinberg is corrupt, in the pockets of the CMA, and SB 924 was not only a bad bill, but had no chance in the first place.

Mary Hayashi is a Great Fundraiser Because She’s a Liar

Why is Mary Hayashi still around?  It’s because she can raise money.  That’s the only reason.  Why else would the democratic party tolerate her disingenuous, criminal behavior?  But how does she do it? Mary Hayashi misleads her Constiuents into thinking she voted in favor of issues that matter to her constiuents.  The reality, she doesn’t vote at and then changes the record after the fact as reported in this Associated Press story picked up by the SF Gate:

“Assemblywoman Mary Hayashi, D-Hayward, who is seeking a seat on the Alameda County Board of Supervisors in November, altered her vote more than any other member of the Assembly.

She failed to vote on legislation 291 times and then changed the record afterward to reflect a “yes” vote nearly every time.”

(click here to read the entire story)

Dr. Gaspar Had Enough and Started the MORALS PAC

Dr. Paul Gaspar, physical therapist, who has made great sacrifices for Californians and the PT profession, made a statement when he started the MORALS PAC (Masses Organizing Research Against Lying & Stealing) to educate citizens of Alameda County about Mary Hayashi’s transgressions.  We asked him about his PAC and he simply said,

“This woman has no business making decisions for Californians .  There’s no place for a criminal in our legislative system.”

Here’s the ad he ran:

The MORALS PAC Story Picked Up by the News Media

It appears that the media is interested in Mary Hayashi’s problems and the battle between her and Dr. Gaspar.  You can read more here:

• Sac Bee Story on Mary Hayashi
• SF Gate on Hayashi
• Mercury News – San Jose

We Commend Dr. Gaspar for His Dedication to Patients and the Profession

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Today, Reuters reported:

Ninety-one people including doctors, nurses and other medical professionals were charged criminally in a new sweep of Medicare fraud involving seven U.S. cities and $430 million in alleged false billing, officials said on Thursday.

Fraud is rampant and is occurring right here in California every day with the continued operation of Physician Owned Physical Therapy Services (POPTS).

The story goes on to state that health care providers are: “writing prescriptions for patients in Dallas who did not qualify for them”. 

This is exactly what goes on in POPTS clinics.  Patients receive prescriptions from corrupt physicians for unnecessary physical therapy treatment, diagnostics, and drugs and each time the doctor writes the prescription, they profit and the expense of the patient.

Once more, the California legislature and Darrell Steinberg condone this illegal activity writing laws that prevent the Physical Therapy Board of California from investigating and disciplining physical therapists that are illegally employed by hundreds of medical corporations here in California.

Stop the Madness!!!!

Stop POPTS

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View the story on NBC by clicking here.  

We wanted to get it on our site before the powerful, corrupt assembly democrats attempt to take it down. In an unprecedented move blocking access to affordable and smart health care, Speaker Perez referred SB 924 to the Assembly Rules Committee on August 24, 2012 and it died on August 31st without being heard. Perez and Hayashi were the only 2 members of the legislature rejecting direct access. There were 63 ayes votes and only one no vote (Mary Hayashi) on the PT direct access this year! Was Mary not a fan of direct access, or did she also want to kill SB 924 to STOPPOPTS?

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California Private Practice Group Indicates Democrats Amended California Senate Bill 924 in Assembly Appropriations Committee, Favoring California Medical Association Requests

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Los Angeles, California (PRWEB) August 20, 2012

According to the leaders of several respected physical therapy groups, top California Democrat leaders have amended and advanced Senate Bill 924, a bill rapidly approaching the Governor Brown’s desk, which would legalize physician ‘kickbacks’ and preclude California physical therapists from being paid for treating Medicare patients. According to Doctor James Dagostino, physical therapist and Chair of Government Affairs for the California Physical Therapy Association, the events surrounding the Assembly Appropriations Committee hearing on Thursday, August 16th represent “a poor display of legislative transparency and irresponsible public policy.” Dr. Dagostino adds, “The policy decision and the manner in which it was accomplished are equally disturbing. This fiscal committee is not supposed to make non-fiscal amendments to legislation. Our original bill, SB 924, simply allowed direct access to physical therapists’ services, but now the powerful Appropriations Committee has amended our bill, in private suspense deliberations, to a form which may deny seniors physical therapy coverage and which legalizes ‘thinly-disguised kickbacks’ to physicians for referring patients to physical therapy services they own and operate illegally in California. The author of federal anti-kickback statues, Congressman Pete Stark-CA, has used the term ‘kickbacks’ when referring to the financial arrangement whereby physicians receive passive income by referring a patient to a physical therapy service he owns.

Doctor James Syms, President of the California Physical Therapy Association (CPTA), also questions whether the policy amendments in the Appropriations Committee were within legal and boundaries. “According to the Assembly Appropriations Committee’s website, this type of non-fiscal policy change is not under the committee’s purview. The committee is supposed to be a fiscal committee, but did not address any of their fiscal concerns in their ‘hostile’ amendments, which initially sent the bill to the suspense file.” Richard Katz, physical therapist and Payment Policy Chair for the California Physical Therapy Association added, “I worked hard to refute the erroneous Assembly Appropriations financial analysis (which sent the bill to the suspense file) while it appears that, all along, there was a separate agenda going on behind the scenes to amend our bill.” Doctor Dagostino concluded, “The worst part is that, as of Sunday evening, August 19th, we still cannot get a written or online copy of the amendments to our bill, even though they were decided upon on Tuesday, August 14th without any opportunity for public debate. Today, I am embarrassed to be a citizen of California.”

Doctor David Straight, physical therapist and Chair of the California Physical Therapist Private Practice Group summarized, “I am dismayed that it took only 16 seconds (in committee) for the Appropriations Committee to disenfranchise senior citizens and deny them full rights to physical therapy care.” Richard Katz, Payment Policy Chair of CPTA confirms the “poorly-conceived” language that the California Medical Association requested to be amended into the bill would prevent physical therapists (who earn doctoral degrees) from ‘diagnosing’ their patients prior to treating them, and would keep them from being paid for treating Medicare beneficiaries, according to federal regulations.”

Doctor Paul Gaspar, Director of the Physical Therapy Business Alliance (PTBA) indicates he was present, in January 2012, at high-level meetings with Senate pro-Tem Darrell Steinberg and various medical associations when the ‘diagnosis’ issue was discussed and claims it was agreed that the the term, should not be included because physical therapists need to be paid for treating seniors. Dr. Gaspar added, “The current form of the bill, which overlooks millions of dollars of demonstrated California Workers Compensation system ‘kickbacks‘, and denies seniors coverage to physical therapy services is an insult to Californians. Senator Steinberg, Speaker John Perez, and Assembly Member Mary Hayashi appear to be responsible for most of these legislative decisions impairing patients’ rights to access physical therapists.” According to Doctor Gaspar, the top leadership in the majority party is typically involved in critical policy positions and he suspects they were in this case because of the significant departure from the normal legislative process which occurred in the Appropriations Committee.

Dr. Gaspar points out that SB 924 passed the Senate unanimously and it cleared the Assembly Business and Professions Committee Hayashi chairs 8-1, with only her dissenting. Hayashi has a three-year history of blocking bills which would improve patients’ access to physical therapists. She was the only ‘no’ vote on a physical therapy direct access bill, AB 721-Nava in 2009, (leginfo.ca.gov), but the bill failed because a majority of committee members declined to vote. AB 721 died because Hayashi failed to grant it reconsideration in the second year of the legislative cycle, which is considered professional courtesy and is always extended. Finally, in 2011, Hayashi authored AB 783, which aimed to legalize physician ownership of physical therapy services. AB 783 was killed in 2011 in the Senate Business and Professions Committee with only three ‘aye’ votes.

Dr. Gaspar also points out that Mary Hayashi, John Perez, and Darrell Steinberg are among the largest recipients of campaign donations from the California Medical Association and Hayashi is among the top fundraisers for the California Democratic Party (maplight.org).

CA PPG suggests that the public should not believe the Democratic leaders’ statements on physical therapy related issues because the events and history indicates do not they may not be trustworthy. Doctor Straight asks, “Who should the citizens trust, the words of respected physical therapists or legislators who appear to have conflicts of interest and/or difficulty playing by the rules?”

Doctor Gaspar concludes, “If SB 924 passes, seniors may be subjected to unnecessary physical and emotional suffering, as well as exposure to more expensive or risky medical interventions, such as injections, imaging, surgery, and/or chronic pain medication usage.”

In an era of health care reform, the California Private Practice Group asserts that top Democrat leaders have, once again, chosen ‘politics as usual’ instead of standing with the citizens of California, who want improved access to quality health care.

Source: California Private Practice Group, a section of the California Physical Therapy Association

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Last Thursday, August 16th, the CA Appropriations Committee, passed SB 924 thru.  In our last post, we noted that that the chair of the committee, Assembly Member Mike Gatto, noted that amendments on diagnosis, limitations of 30 days of treatment (not 30 business days), and technical language were added.

Funnier yet, as of the date of this blog post, we can’t find the bill with its new amendments anywhere online – another example of corruption!

This newly amended bill, if passed, will have absolutely devastating results!

• If SB 924 passes, it will dilute direct access to the point of having little to no value.
• It will of course, legalize POPTS.
• It will also write into the CA physical therapy practice act the limitation that does not allow physical therapists to make a diagnosis.

Federal regulations require physical therapists to put an ICD-9 code on the HCFA billing form with a diagnosis that is within their scope of practice rather than just regurgitating the diagnosis provided on the medical referral (which in 2/3 of the cases is either wrong or of no value – see that reference here).

If PTs can no longer diagnose, they cannot be paid by CMS for the treatment of Medicare patients.

It seems that Mary Hayashi and John Perez, with the blessing of Darrell Steinberg, are going to eliminate treatment to all Medicare patients by physical therapists in California.  STOPPOPTS understands that that the pictured legislators are not literally ‘pushing Granny over a cliff’, but such satirical cartoons have been drawn to depict others doing so for far less!

Stop the Madness!

An all new low of corruption paid for by special interest groups – the California Medical Association and California Orthopedic Association.

PS: seems Mary Hayashi’s pattern of behavior is consistently corrupt. She did the same thing to another group that can cut costs by 87.5% for care rendered to pets as well. You can read that story here. It’s hard to believe that special interests would plant a lobbyist and then fabricate a story like they did. Another fine example of the corruption that runs deep in Sacramento.

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