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Providers and Legislators Seek Changes in Rules Implementing No Surprises Act and How Physicians, Labs, and Other Providers Can Bill Patients

Provider groups and members of Congress say the rules favor payers, federal judge agrees, but path forward in how providers bill patients remains unclear

Groups representing healthcare providers—including pathologists—are challenging the Biden administration’s implementation of the No Surprises Act, a bill passed in 2020 that aims to protect patients from surprise medical bills.

This will be of particular interest to pathologists who—as a study from the Health Care Cost Institute (HCCI) found—were second only to emergency room physicians among providers with the highest percentage of out-of-network billing.

Dark Daily’s sister publication The Dark Report covered the HCCI study and its findings in “Federal Rule to Revise Out-Of-Network Billing.”

The College of American Pathologists (CAP) and American Society for Clinical Pathology (ASCP), both of which supported the No Surprises Act, are now among numerous provider groups claiming that the bill’s rules for resolving payment disputes unfairly favor payers.

These groups have bipartisan support in Congress, Bloomberg Law reported, noting that some legislators are urging Health and Human Services (HHS) Secretary Xavier Becerra to change the rules. The lawmakers may seek to amend the law or turn to the courts if Becerra does not follow through on their requests.

“Either we legislate, we go to court, whatever it takes,” Rep. Brad Wenstrup (R-Ohio) told Bloomberg. Meanwhile, a federal district court judge has sided with the Texas Medical Association (TMA) in two lawsuits over the rules, Healthcare Dive reported.

“We need to make sure that the administration is implementing what we passed consistent with the legislative intent,” Sen. Michael Bennet (D-Colorado) told Bloomberg Law regarding the No Surprises Act. “We had a very complicated coalition of people to come together to support this legislation.” (Photo copyright:

Details of No Surprises Act

The No Surprises Act aims to protect patients from “balance billing,” in which they receive surprise bills for out-of-network medical services even when they use in-network providers. The bill was signed into law in December 2020, with most provisions taking effect on Jan. 1, 2022.

As Dark Daily reported in “ASCP and CAP Support New Legislation That Bars Surprise Medical Billing,” following passage of the bill, patients who unknowingly receive services from out-of-network providers are liable only for costs they would have incurred for in-network care. Providers and payers then have 30 days to negotiate a payment. If they can’t agree, an arbiter determines the payment as part of a federal independent dispute resolution (IDR) process.

Passage of the bill required the federal Department of Health and Human Services (HHS), Department of Treasury, and Department of Labor to craft regulations and guidance to implement the law—including the IDR process—according to the American Hospital Association (AHA).

Legal Pushback to Arbitration Rule

One contention was an interim rule that instructed arbiters to use the “qualifying payment amount” (QPA) as the primary basis for ruling in favor of either insurers or providers in payment disputes.

Writing in MedPage Today, pediatric radiologist Richard Heller, MD, National Subspecialty Lead for Pediatric Radiology at Radiology Partners in Chicago, and Radiological Society of North America (RSNA) Board Liaison for Public Information and Corporate Relations, described the QPA as “the insurer’s median in-network rate.”

Heller wrote that “the calculation methodology does not result in real world, market-based rates. Further, insurers calculate their own QPA, and may do so in a non-transparent fashion, raising questions about QPA integrity.”

He added, “The departments have repeatedly tried to establish the QPA as the primary factor arbiters should use in their decision making. These attempts have twice been rejected by a federal court. Recent guidance issued by the administration as a result of the second Texas Medical Association lawsuit more closely reflects the balance that Congress intended.”

In its first lawsuit, the TMA characterized the QPA as “an opaque and flawed insurer-calculated amount” that would result in reduced payments to providers. The lawsuit claimed that Congress, instead, intended for the dispute resolution process to look at “a range of factors.”

Federal Judge Jeremy Kernodle ruled in the TMA’s favor and ordered HHS to change the rule. He also sided with the TMA in another lawsuit, which alleged that a final rule issued in August 2022, while “formally abandoning the QPA rebuttable presumption,” unduly restricted use of non-QPA factors, according to a litigation update for certified IDR entities from Sidley Austin LLP.

The final rule “nevertheless continues to place a thumb on the scale for the QPA by requiring arbitrators to begin with the QPA and then imposing restrictions on the non-QPA factors that appear nowhere in the statute,” the judge stated in his ruling, the American Medical Association (AMA) reported.

In its latest lawsuit, the TMA is challenging a big hike in administrative fees for dispute resolution, which went from $50 initially to $350 beginning last January.

Another issue with the law has been the sheer volume of arbitration cases. The administration originally estimated that payers and providers would submit about 17,000 claims per year, but between April 15 and Sept. 30, 2022, about 90,000 disputes were initiated, according to a government report cited by RevCycleIntelligence.

The No Surprises Act reflected lawmaker compromises about arbitration, Sen. Michael Bennet (D-Colorado) told Bloomberg Law. Bennet indicated to the news outlet that he is not happy with the current arbitration process.

Pathology Groups Weigh In

The CAP and ASCP joined other physician organizations in raising early objections to the Biden Administration’s plans to implement the independent dispute process.

“The skewed IDR process outlined within the IFC [Interim Final Rule with Comment Period] will remove a critical incentive for insurers to negotiate reasonable contracts with physicians by establishing the QPA as a reasonable out-of-network payment,” the ASCP stated in a Dec. 6, 2021, letter to administration officials.

On Dec. 23, 2021, the CAP filed an amicus brief in a lawsuit brought by the AMA and AHA challenging an interim rule issued that September. The regulations “must support an equitable and balanced system for resolving out-of-network payment disputes,” said CAP President Emily Volk, MD, FCAP in a statement accompanying the filing. “As of today, the rules heavily favor the insurers when their power is already too great.”

The AMA and AHA later withdrew the lawsuit after the Biden administration revised the rule, Healthcare Finance News reported. However, the groups still contend that the rule favors payers.

High Stakes for Pathologists

When the law passed Congress, it appeared likely it would have a disproportionate impact on medical laboratories and pathology groups. The HCCI report ranked pathology number two among six specialties responsible for the highest percentage of out-of-network bills. And when the interim final rule was published in the Federal Register, the HCCI data was cited in an accompanying commentary.

However, the CAP told The Dark Report that the statistics about pathologists, though accurate, were “presented in a somewhat misleading manner.”

The No Surprises Act does permit balance billing when patients have given prior consent, but pathologists were among a group of specialties barred entirely from the practice, Dark Daily previously reported.

—Stephen Beale

Related Information:

Surprise Medical Bill Disputes Spur Lawmakers to Seek Changes

The Six Provider Lawsuits Over the No Surprises Act: Latest Developments

HCCI: How Often Do Providers Bill Out of Network?

HHS and Federal Departments Issue Final Rules to Clarify No Surprises Act Dispute Resolution

Biden Administration Should Revise No Surprises Act Rules, Says ASCP

Judge Removes Disputed Element of No Surprises Act

New Joint Commission Report Shows Number of Adverse Patient Safety Events Increasing

From some adverse events, clinical laboratory tests may be integrally tied to delays in treatment and faulty care management events that cause patient harm and deaths

Adverse patient safety events are increasing according to The Joint Commission (TJC), a nonprofit US-based organization that accredits tens of thousands of US healthcare organizations and programs. Its 2023 annual report on “sentinel events”—patient safety breaches that can inflict serious harm or death—found that these events jumped by 78.1% from 2020 to 2021 and by 19.3% from 2021 to 2022. These are significant increases. What effect do they have on healthcare providers?

Of particular interest for clinical laboratory managers and pathologists is one finding by TJC involving “delay in treatment” as an adverse event. TJC determined that the cause of 38% of these episodes was due to “missed diagnoses.” It is likely that clinical laboratory test results have some role in this type of adverse event. Thus, this is a potential opportunity for medical lab leaders to add value by helping hospital administrators and physicians reduce the number adverse events tied to missed diagnoses.

Another consequence for hospitals and providers is lost revenue. Medicare will not reimburse care to providers when a medical error, fall, surgery on wrong site, or other “never event” happens, including misdiagnoses due to inaccurate clinical laboratory testing.

Thus, since patient safety is a priority and providers are tasked with reducing medical errors, The Joint Commission’s Office of Quality and Patient Safety has developed the Sentinel Event Database for tracking adverse patient safety events.

The de-identified and aggregate patient data includes “causes and outcomes of sentinel events, is analyzed yearly to help the nation in general—and accredited organizations in specific—gain insight into causes of sentinel events and develop mitigating strategies to prevent harm to individuals under their care,” according to The Joint Commission’s report, “Sentinel Event Data 2022 Annual Review.”

This graphic taken from The Joint Commission’s annual 2023 report on sentinel events shows the percentage of delays in treatment broken out by type. Delays in treatment is the second most common sentinel event, exceeding wrong surgery and medication management, according to The Joint Commission’s report. Only falls exceed delays in treatment, and since 80% of a patient’s health records are clinical laboratory test results, they could play a role in each of these adverse patient safety events. (Graphic copyright: The Joint Commission.)  

Most Common Sentinel Events

According to The Joint Commission’s report, “Of reviewed sentinel events in 2022:

  • “20% resulted in patient death,
  • “6% in permanent harm or loss of function,
  • “44% in severe temporary harm, and
  • “13% in unexpected additional care/extended stay.

“Sentinel events resulting in death were most commonly associated with:

  • “patient suicide (24%),
  • “delays in treatment (21%), and
  • “patient falls (11%).

“Events resulting in severe temporary harm were most commonly associated with patient falls (62%).”

The Joint Commission’s annual 2023 report on sentinel events shows the top 10 sentinel event types in 2022. According to the report, delay in treatment, which could be caused by inaccurate clinical laboratory tests, moved from fourth place in 2018, to third place in 2021, and is now in second place. (Graphic copyright: The Joint Commission.)

National Quality Forum ‘Never Events’

In 2001, Ken Kizer, MD, founding President and CEO of the National Quality Forum (NQF), coined the phrase “never events” to describe often fatal and usually preventable medical errors. Since then, the list of never events, according to PSNet, a national web-based resource of the Agency for Healthcare Research and Quality (AHRQ), has grown to include 29 “serious reportable events” in seven categories:

  • Surgical or procedural events
  • Product or device events
  • Patient protection events
  • Care management events
  • Environmental events
  • Radiologic events
  • Criminal events

Listed under “Care management events” is “Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results.”

In “Hospitals Take Steps to Drive Down Medical Errors in Their Emergency Departments,” Dark Daily wrote how one common source of errors in emergency rooms is lack of information that includes timely access to radiology or clinical laboratory test reports. Moreover, formal process improvement projects to identify and eliminate the sources of errors in emergency rooms can involve the hospital laboratory.

As medical laboratory managers know all too well, the fast-paced environment of a busy emergency room often contributes to errors such as hemolyzed specimens, a delay in transporting the specimen from the ER to the lab, or incomplete patient information on the laboratory test request form as it is received in the hospital laboratory.

Stuff of Nightmares

In an article he penned for Chicago-based thought leadership and advisory company 4Sight Health, longtime healthcare writer David Burda commented on The Joint Commission’s sentinel events report. He wrote: “Two things scared me from this eight-page report. First, The Joint Commission is publishing statistics and trends in reported sentinel events. How many go unreported? Second, surgeons still are performing the right procedure on the wrong patient or the wrong procedure on the right patient? Isn’t there a checklist to prevent this? The stuff of nightmares.”

Burda went on to note that “88% of the sentinel events in 2022 happened at accredited hospitals, and 90% were self-reported by accredited organizations. Patients, patients’ families, or current/former employees reported 10% of the sentinel events to The Joint Commission.”

The rapid rise of patient adverse safety events should be a concern for all sectors of the healthcare industry. Clinical laboratory managers should be especially concerned since nearly every medical decision precedes or follows a medical laboratory test.   

—Ashley Croce

Related Information:

Sentinel Event Data 2022 Annual Review

CMS Improves Patient Safety for Medicare and Medicaid By Addressing Never Events

Quick Safety 52: Advancing Safety with Closed-Loop Communication of Test Results

Sentinel Event Data Summary

New Sentinel Event Data Available for 2022

10 Most Common Sentinel Events of 2022: Joint Commission

Burda on Healthcare: Scared Healthy

PSNet: Never Events

Hospitals Take Steps to Drive Down Medical Errors in Their Emergency Departments

Global Biolabs 2023 Report Shows Most Dangerous Pathogen Testing Laboratories across the Globe

Of 27 BSL-4 labs assessed, Global Biolabs ranked only seven as having ‘good’ biosafety management

In a new report, a research firm assessed the conditions at the handful of laboratories across the world that handle the most dangerous pathogens. In the wake of the SARS-CoV-2 global pandemic, there is heightened awareness of the risks of a lab accident that might release such pathogens into the environment, putting humans at risk.

Medical laboratory scientists working in clinical laboratories worldwide understand the critical nature of biosafety laboratory (BSL) criteria. Nearly all clinical laboratories that test for infectious disease agents are biosafety level-1 and -2 (BSL-1, BSL-2).

Other high-containment laboratories (HCL) that handle deadly, highly transmissible pathogens are typically government-run or university-affiliated. HCL labs have BSL-3 and BSL-4 levels and require rigorous adherence to protocols that ensure worker safety and prevent escape of dangerous pathogens.

Thus, the new report from Global Biolabs, which is critical of biorisk management protocols at existing and planned BSL-4 laboratories—especially given the increasing construction of new HCL labs worldwide—will be of interest to medical technologists, pathologists, and clinical scientists working with highly infectious diseases.

The biosafety experts who make up the Global Biolabs research team conduct risk-assessments and “provide key policy recommendations for strengthening biorisk management in BSL-4 labs,” according to the organization’s website.

Many countries did not fare well in Global Biolabs’ analysis of their policies. “The report urges the World Health Organization to strengthen guidance and individual countries to agree to audits by outside experts to ensure that their labs meet international standards,” Science reported in “Growing Number of High-Security Pathogen Labs Around World Raises Concerns.”

“The more labs and people working with dangerous pathogens, the risks go up,” biosecurity expert Filippa Lentzos, PhD (above), Associate Professor, Science and International Security, King’s College London, told Science magazine. Lentzos was part of the team that created the Global Biolabs mapping project two years ago. Clinical laboratory managers may want to review the findings in the Global Biolabs report. (Photo copyright: King’s College London.)

Only Seven Out of 27 Countries Get ‘Good’ Overall Score

“The boom in BSL-4 lab construction appears, so far, not to have been accompanied by strengthened biorisk management oversight,” according to the Global Biolabs 2023 report from the Global Biolabs Initiative. “Additionally, most planned BSL-4 labs will be in countries with relatively low scores for governance and stability,” the report’s authors wrote.

The report included a ranking of countries by total biorisk management score, the Daily Mail noted, adding:

  • Of 27 countries analyzed, seven ranked as good (above 70%) for biorisk policies,
  • 15 scored medium (above 30%),
  • five scored below.

Those with the best biorisk management scores (maximum 48):

  • Canada scored 46 (96%),
  • US scored 42 (88%),
  • Australia and the United Kingdom each scored 40 (83%).

Notably, China “scored zero on modifying pathogen rules.” According to the Daily Mail, “China’s overall management score (33) was in the middle of the pack, 69%.”

More Labs, More Danger

The Global Biolabs Initiative was launched in 2021 by Filippa Lentzos, PhD,

Associate Professor in Science and International Security, King’s College London, and Gregory Koblentz, PhD, Associate Professor and Director Biodefense Graduate Program, George Mason University, Fairfax, Virginia. The organization tracks maximum containment labs worldwide, noting trends that raise biosafety and biosecurity concerns.

According to the Daily Mail, Lentzos noted “that a particular worrying aspect of the BSL-4 boom was those countries looking to open their first lab were the bottom scorers in terms of good biorisk management.

“Many of the countries building new labs, some for the first time, score poorly on biorisk management. However, there is still time to strengthen national laws and regulations on biosafety, biosecurity, and dual-use research [biological research that could cause harm] to bring them up to international standards,” the Global Biolabs researchers wrote in their report.

Global Mapping of BSL-4 Labs

There are 51 BSL-4 labs operating worldwide, and 18 are planned or under construction, according to Global BioLab’s report. Here’s where they are located:

  • Europe: 24
  • North America: 12
  • Asia: 9
  • Oceania: 4
  • Africa: 2
  • South America: 0

Also, BSL-3+ labs total 55:

  • Europe: 21
  • North America: 18
  • Asia: 10
  • South America: 3
  • Africa: 2
  • Oceania: 1

The report also noted:

  • Of the 18 BSL-4 labs under construction, 11 are planned to open in Asia.
  • About half of BSL-4 labs are “less than the size of a tennis court.”

“Eighty percent (of BSL-4 labs) are located in urban areas, which heightens concerns about accidents at these facilities,” Koblentz told the Daily Mail.

According to Science, the number of BSL-4 labs has doubled since 2013. Growth in BLS-4 labs began around the time of the 2001 anthrax attacks and picked up speed in 2003 following the SARS outbreak, University World News reported.

Biosecurity and Biosafety Analyzed

Global Biolabs’ analysis included countries’ biosecurity and biosafety scores. Just 12 out of 27 countries with BSL-4 labs scored high on biosecurity, nine scored medium, and six scored low.

A high score for biosecurity—which US and France received—reflects laws for biosecurity, a national list of dangerous pathogens, and whistleblower protection.

Out of 27 countries, 21 with BSL-4 labs scored high on biosafety. However, two countries scored medium, and four scored low. The two countries that earned the highest scores for biosafety—Canada and Australia—have physical/engineering controls, occupational health, and transportation safety, among other areas reviewed.

Opportunities for Improvement

Global Biolabs made the following recommendations in their report:

  • Nations with BSL-4 and BSL-3 labs need to have in place biorisk management systems including comprehensive laws, regulations, and institutions that require safety and security risk assessments of proposed research.
  • Strengthening of biorisk management is called for by the World Health Organization and Biological Weapons Convention.
  • Labs, of all biosafety levels, are advised to aim toward safety, security, and responsible research. 

The effort by Global BioLabs to create a public record of how each BSL-4 and BSL-3 laboratory adheres to strict standards of safety and operations demonstrates that some degree of risk exists in the operation of these labs. Whether government and world health authorities make it a priority to address known deficiencies in those labs is a question yet to be answered.  

—Donna Marie Pocius

Related Information:

Global Biolabs Report 2023

Dangerous Labs Ranked, and China Scores Zero When It Comes to Safety in Handling “Risky” Experiments on World’s Most Dangerous Pathogens

Growing Number of High-Security Pathogen Labs Around World Raises Concerns

Lab Leak Most Likely Origin of COVID-19 Pandemic, Energy Department Now Says

China Rejects US Assertion that COVID-19 Originated from Lab Leak

It’s Boom Time for Biosafety Labs: Who is Keeping Tabs?

CDC: Biological Risk Assessment, General Considerations for Laboratories

Southern California Physician and Clinical Laboratory Owners Charged in Federal Crackdown on Pandemic-Related Billing Fraud

Federal prosecutors build the new healthcare-related fraud cases on previous nationwide enforcement actions from 2022

Federal charges have once again been brought against a number of physicians and clinical laboratory owners in what the US Department of Justice described as the “largest ever” coordinated nationwide law enforcement effort against COVID-19 pandemic-related healthcare fraud.

In total, the DOJ filed criminal charges against 18 defendants in five states plus the territory of Puerto Rico, according to an April 20 press release.

The highest dollar amount of these frauds involved ENT physician Anthony Hao Dinh, DO, who allegedly defrauded the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program for millions of dollars, and Lourdes Navarro, owner of Matias Clinical Laboratory, for allegedly “submitting over $358 million in false and fraudulent claims to Medicare, HRSA, and a private insurance company for laboratory testing” while performing “COVID-19 screening testing for nursing homes and other facilities with vulnerable elderly populations, as well as primary and secondary schools,” the press release states. Both court cases are being conducted in Southern California courtrooms.

The DOJ’s filing of charges came rather speedily, compared to other cases involving fraudulent clinical laboratory testing schemes pre-pandemic. The amount of money each defendant managed to generate in reimbursement from the fraud represents tens of thousands of patients. If feds were paying $100 per COVID-19 test, then the $153 million represents 153,000 patients, in just 18 to 24 months.

Assistant Attorney General Kenneth A. Polite, Jr.

“Today’s announcement marks the largest-ever coordinated law enforcement action in the United States targeting healthcare fraud schemes that exploit the COVID-19 pandemic,” said Assistant Attorney General Kenneth A. Polite, Jr. (above), in an April 20 DOJ press release. “The Criminal Division’s Health Care Fraud Unit and our partners are committed to rooting out pandemic-related fraud and holding accountable anyone seeking to profit from a public health emergency.” Clinical laboratory managers may want to pay close attention to the DOJ’s prosecution of these newest cases of alleged COVID-19 fraud. (Photo copyright: Department of Justice.)

Matias Clinical Laboratory, Inc.

The DOJ first brought fraud charges against Lourdes Navarro, owner of Matias Clinical Laboratory (Matias) in Baldwin Park, California, in April 2022. The Dark Daily covered that federal crackdown in “California Clinical Laboratory Owners among 21 Defendants Indicted or Criminally Charged for COVID-19 Test Fraud and Other Schemes Totaling $214 Million.

Then, in April of 2023, the DOJ filed expanded charges against the 18 defendants, including the owners of Matias which provided COVID-19 screening for schools, rehab facilities, and eldercare facilities, according to a United States Attorney’s Office, Central District of California press release.

Prosecutors allege that Navarro and her husband, Imran Shams, who operated Matias—also known as Health Care Providers Laboratory—perpetrated a scheme to perform medically unnecessary respiratory pathogen panel (RPP) tests on specimens collected for COVID-19 testing, even though physicians had not ordered the RPP tests and the specimens were collected from asymptomatic individuals.

In some cases, the indictment alleges, Navarro and Shams paid kickbacks and bribes to obtain the samples.

The indictment notes that reimbursement for RPP and other respiratory pathogen tests is generally “several times higher” than reimbursement for COVID-19 testing. Claims for the tests were submitted to Medicare and an unidentified private insurer, as well as the HRSA COVID-19 Uninsured Program, which provided support for COVID-19 testing and treatment for uninsured patients.

Claims to the HRSA falsely represented that “the tested individuals had been diagnosed with COVID-19, when in truth and in fact, the individuals had not been diagnosed with COVID-19 and the tests were for screening purposes only,” the First Superseding Indictment states.

The indictment further states that both Navarro and Shams had previously been barred from participating in Medicare and other federal healthcare programs due to past fraud convictions. Navarro, the indictment alleges, was reinstated in December 2018 after submitting a “false and fraudulent” application to the HHS Office of Inspector General.

It also alleges that Navarro and Shams concealed their ownership role in Matias so the lab could maintain billing privileges.

More Alleged Abuse of HRSA Uninsured Program

In a separate case, Federal prosecutors alleged that Anthony Hao Dinh, DO, an ear, nose, and throat physician in Orange County, California, engaged in a scheme to defraud the HRSA COVID-19 Uninsured Program as well.

Dinh, prosecutors allege, “submitted fraudulent claims for treatment of patients who were insured, billed for services that were not rendered, and billed for services that were not medically necessary.”

The criminal complaint, filed on April 10, alleges that Dinh submitted claims for approximately $230 million, enough to make him the program’s second-highest biller. He was paid more than $153 million, prosecutors allege, and “used fraud proceeds for high-risk options trading, losing over $100 million from November 2020 through February 2022,” states the US Attorney’s Office, Central District of California press release.

Dinh was also charged for allegedly attempting to defraud the federal Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) program. He faces a maximum sentence of 50 years in federal prison, the press release states.

Dinh’s sister, Hang Trinh Dinh, 64, of Lake Forest, California, and Matthew Hoang Ho, 65, of Melbourne, Florida, are also charged in the complaint, the Los Angeles Times reported.

Both of these cases are notable because of the size of the fraud each defendant pulled off involving COVID-19 lab testing. Clinical laboratory managers may want to review the original court indictments. The documents show the brazenness of these fraudsters and detail how they may have induced other doctors to refer them testing specimens.

Stephen Beale

Related Information:

Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat COVID-19 Health Care Fraud

DOJ Announces Nationwide Coordinated Law Enforcement Action to Combat Health Care Fraud Related to COVID-19—Summary of Criminal Charges

Criminal Complaint: US v. Dinh, et al.

Criminal Complaint: US v. Navarro

Newport Coast Physician Faces Federal Charges in Healthcare Fraud Cases

COVID Fraud Takedowns: Feds Charge 18 People, Including Doctors, with Raking in Nearly $500M from Scams

California Clinical Laboratory Owners among 21 Defendants Indicted or Criminally Charged for COVID-19 Test Fraud and Other Schemes Totaling $214 Million

British Junior Doctors Stage Four-Day Walkout Demanding Increased Pay and Better Working Conditions

More than 10,000 doctors walked out for the second time in two months, further burdening an already overwhelmed NHS

On April 11, tens of thousands of junior doctors (similar to medical residents in the US) left their posts in British hospitals commencing a four-day walkout. The strike resulted in the cancellation of thousands of operations and appointments, as well as cancelling or delaying thousands of clinical laboratory tests and anatomic pathology readings associated with those healthcare visits and surgical procedures.

The walkout was spurred by pay concerns and working conditions and comes on the heels of a three-day strike last month. That strike had already weakened the UK’s frail National Health System (NHS), which has become inundated with appointment backlogs that predate the COVID-19 pandemic, and which has led to longer wait times to see a doctor, ABC News reported.

This latest strike was more perilous since the senior doctors who covered for their juniors during last month’s strike were previously on leave for a holiday weekend, United Press International (UPI) reported.

Matthew Taylor

“These strikes are going to have a catastrophic impact on the capacity of the NHS to recover,” Matthew Taylor (above), Chief Executive of the NHS Confederation, told Sky News. “The health service has to meet high levels of demand at the same time as making inroads into that huge backlog … That’s a tough thing to do at the best of times—it’s impossible to do when strikes are continuing.” (Photo copyright: Wikimedia Commons.)

Junior Docs Cite Injustice

Junior doctors who walked out are calling for a 35% pay raise to right the wrongs of 15 years of below-inflation raises, but the government continues to argue it cannot afford to increase pay, UPI noted.

“There is nothing ‘junior’ about the work I have done as a doctor. For an hour of work that I might save a life, I can be paid 19£ [$23.65],” said Jennifer Barclay, MD, a surgical junior doctor in the UK’s North West electoral zone, in a British Medical Association (BMA) press release.

“My dad, an electrician, tells me to quit and retrain in his footsteps. I’d be earning more, have less stress, less responsibility, better hours, and a better work-life balance after three years,” she added. “Surely, this life, this training, responsibility, debt, and crushing workload is worth more than 19£ per hour? I’ll be on the picket line this week because doctors believe that it is.”

According to the BMA, newly qualified junior doctors earn just over 14£ ($17.43) per hour, ABC News reported, which added, “The doctors’ union has asked for a 35% pay rise to bring junior doctor pay back to 2008 levels.”

However, their pay demands come in the midst of a cost-of-living crisis in the UK. Inflation has risen above 10%. Paired with increases in heating costs and food prices mean that decreased wages leave many struggling to pay bills, ABC news reports.

A hard-hitting BMA advertising campaign designed to shine light on these disparities depicts three junior doctors (with one-, seven-, and 10-years’ experience) removing an appendix. The video shows that the total the three would be paid for the hour-long operation would be 66.55£ ($82.84):

  • Doctor with one year experience: 14.09£ ($17.54).
  • Doctor with two years’ experience: 24.46£ ($30.45).
  • Doctor with three years’ experience: 28£ ($34.85).

And this for performing a potentially life-saving procedure, the BMA stated.

In the press release, BMA Junior Doctors Committee co-chairs Robert Laurenson and Vivek Trivedi said, “It is appalling that this government feels that paying three junior doctors as little as 66.55£ between them for work of this value is justified. This is highly skilled work requiring years of study and intensive training in a high-pressure environment where the job can be a matter of life or death.”

Patient Care is Affected

Lower salaries also affect patient care levels and have led to recruitment issues, with many doctors leaving the profession, the BBC reported. “This is not a situation where we are fixed in our position. We’re looking for negotiations and Steve Barclay (UK’s Secretary of State for Health and Social Care) isn’t even willing to talk to us. He hasn’t put any offer at all on the table … there has to be two sides in the discussion,” Emma Runswick, MD, a junior doctor and deputy chairwoman of the BMA, told the BBC.

But while the junior doctors battle for wages, the government’s initial focus has been on patient wellbeing. “There will be risks to patient safety, risks to patient dignity, as we are not able to provide the kind of care we want to,” NHS Confederation Chief Executive Matthew Taylor told UPI prior to the walkout.

The timing of the walkout also caused consternation with the NHS. “Not only will walkouts risk patient safety, but they have been timed to maximize disruption after the Easter break,” Health Secretary Barclay told UPI as the walkout was announced.

Barclay also claimed the amount sought by doctors was “unreasonable” and would cause raises above $25,000 per year, UPI reported. “If the BMA is willing to move significantly from this position and cancel strikes, we can resume confidential talks and find a way forward as we have done with other unions,” he stated.

It is important to note that doctors would be pulled from picket lines if immediate danger were present due to trade union laws that say life-and-limb coverage must be provided, the BMA told the BBC.

—Kristin Althea O’Connor

Related Information:

Junior Doctors’ Strike: Patient Care ‘On a Knife Edge’ as Up to 350,000 Appointments Could Be Cancelled During Four-Day Walkout

British Doctors Walk Out of Hospitals at Start of Crippling Four-Day Strike

Tens of Thousands of Doctors in Britain to Participate in 4-Day Walkout

Three Junior Doctors Would Earn Just 66£ Between Them for Taking Out Your Appendix, says BMA in New Advertising Campaign

English Docs Strike Could be Catastrophic, Officials Say”

Junior Doctors’ Strike Puts Patients at More Risk-Barclay

HSN Explains What a Junior Doctor Is

NHS System Explained

Why Is Britain’s Health Service, a Much-Loved National Treasure, Falling Apart?

Former Theranos CEO Elizabeth Holmes Fights Prison Sentence While Claiming She Was ‘Not Being Authentic’ with Public Image

Founder of now defunct clinical laboratory testing company was supposed to report to prison April 27, but a last-minute legal challenge has delayed that judge’s order

Anatomic pathologists and clinical laboratory leaders who are following the continuing saga of Theranos and Elizabeth Holmes may be interested to learn that the former CEO’s attorneys are making last-minute legal moves to delay her prison sentence while she appeals her guilty verdict. At the same time, Holmes appears to be on a mission to revamp her public image.

Apparently, the twists and turns in Holmes’ never-ending story are not yet over when it comes to Theranos, its maligned clinical laboratory technology, and the company’s convicted founder.

On May 7, The New York Times (NYT) profiled Holmes in a massive, 5,000-word story that attempted to portray her as a flawed businessperson who now prefers a simpler life with her partner and two young children.

Elizabeth Holmes

“I made so many mistakes and there was so much I didn’t know and understand, and I feel like when you do it wrong, it’s like you really internalize it in a deep way,” disgraced Theranos founder Elizabeth Holmes recently told The New York Times. Anatomic pathologists and clinical laboratory directors impacted by the revelation that Theranos hide the fact that its blood testing technology was faulty may not sympathize with Holmes’ position. (Photo copyright: Stuart Isett/Fortune Global Forum.)

Legal Team Secures Last-Minute Delay in Holmes’ Surrender

Holmes admitted to the news outlet that the deep voice she used in public, along with her black turtleneck sweaters, were part of a character she created.

“I believed it would be how I would be good at business and taken seriously and not taken as a little girl or a girl who didn’t have good technical ideas,” Holmes told the NYT. “Maybe people picked up on that not being authentic, since it wasn’t.”

Holmes was scheduled to report to a federal prison in Texas on April 27 after several unsuccessful motions were filed to delay the start of her sentence for the fraud convictions. Dark Daily covered Holmes’ conviction in “Disgraced Theranos Founder Elizabeth Holmes to Serve 11 Years, Three Months in Prison, Ending the Latest Chapter in the Story of the Failed Clinical Laboratory Company.”

However, on April 26, the 9th Circuit Court of Appeals stayed her surrender date until that court rules on Holmes’ latest bid to stay free while she appeals her conviction, The Washington Post reported.

Just days earlier on April 10, a district court judge ruled that Holmes would not stay free while her appeal progresses. The 9th Circuit announcement curtailed the district court ruling. It is not known when the 9th Circuit will issue a decision in the matter.

In “Theranos Ex-CEO Elizabeth Holmes Convicted on Three Counts of Wire Fraud and One Count of Conspiracy to Commit Fraud after Seven Days of Jury Deliberations,” Dark Daily reported that Holmes was convicted in January 2022 of defrauding Theranos investors out of $121 million. Theranos marketed a blood-testing machine called Edison, although it was later uncovered that results attributable to the technology were actually produced on traditional clinical laboratory analyzers.

New York Times Reports on Holmes’ Change in Personality

The somewhat odd New York Times profile of Holmes varied between reflections on her past crimes and on her current personal life, where she is known as “Liz.”

“In case you’re wondering, Holmes speaks in a soft, slightly low, but totally unremarkable voice—no hint of the throaty contralto she used while running her blood-testing startup Theranos, now defunct,” the NYT reported.

Holmes still lives in California with her partner, Billy Evans (whose parents own a luxury hotel chain), and their two children: a son who is almost two years old and a daughter born in February. She works at home for a rape-crisis hotline.

Balwani’s Role in Theranos Again Publicly Debated

In the NYT interview, Holmes talked about being raped while a student at Stanford University and about alleged abuse from her Theranos business partner and former lover, Ramesh “Sunny” Balwani.

Balwani, Theranos’ former President and Chief Operating Officer, began his 12-year, 11-month prison sentence on April 20 in a Southern California facility for his role in defrauding Theranos investors, KTVU TV reported. Balwani has also appealed his conviction on the 12 fraud charges.

Holmes reiterated to the NYT past statements she made in court that Balwani allegedly exerted social and sexual control over her when they both worked at Theranos and were in a romantic relationship.

“She lived by entrepreneurial tenets that she said Balwani told her she needed to follow in order to succeed,” the NYT reported. “These included not sleeping for more than five hours, going vegan, getting to the office daily by 5 a.m., no alcohol.”

“[I] deferred to [Balwani] in the areas he oversaw because I believed he knew better than I did,” including on clinical lab activities at Theranos, Holmes said.

Balwani’s attorneys dismissed Holmes’ allegations, as they have in the past.

Clinical laboratory professionals can reasonably make two broad observations from the continuing saga of Theranos and Elizabeth Holmes:

  • Justice for healthcare crimes is often deferred for those who have influence and money.
  • Holmes’ image overhaul may be a last-ditch effort to sway public opinion about her, in the event that she receives a new jury trial as a result of her appeal.

Dark Daily will continue to keep you updated on further developments in this case.

Scott Wallask

Related Information:

Liz Holmes Wants You to Forget about Elizabeth

Hot Startup Theranos Has Struggled with Its Blood-Test Technology

Theranos Ex-CEO Elizabeth Holmes Convicted on Three Counts of Wire Fraud and One Count of Conspiracy to Commit Fraud after Seven Days of Jury Deliberations

Holmes, Balwani Get Lengthy Prison Terms for Theranos Fraud

Disgraced Theranos Founder Elizabeth Holmes to Serve 11 Years, Three Months in Prison, Ending the Latest Chapter in the Story of the Failed Clinical Laboratory Company

Federal Prosecutors Seek $878 Million Restitution from Former Theranos Founder/CEO Elizabeth Holmes