Chemo Con

THE CHEMO CON

The very best con man might not fit your idea of what a con man looks and acts like.

For instance, some con men wear stethoscopes around their necks.

I’m not talking about doctors in general, I’m talking about a certain type of oncologist who knows how to work the system, tell his patients what they want to hear, and turn a nice profit.

If you or someone you know or love has cancer (and unfortunately, that covers just about all of us), you have to be on the lookout for one of the cruelest and most disturbing con jobs in medicine.

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Drugged and duped
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It starts with a practice known as “chemotherapy concession.” We’ll call it “Chemo Con.”

Here’s how it works…

An oncologist purchases chemotherapy drugs directly from drug companies, then bills the patient’s insurer.

But there’s a little wrinkle here that patients never hear about: Oncologists typically get a deep discount off the “sticker” price of the drugs. Then they bill insurers for the sticker price, which is sometimes more than 20 percent higher than the amount paid by the doctor.

Believe it or not, that’s not the con. In fact, this practice is completely legal and considered a “concession” to offset oncologists’ overhead costs. The con occurs when an oncologist uses a chemo drug that he knows will not be effective, or administers it to a patient he knows will get no benefit.

And as awful as that sounds, it happens. A LOT.

A few years ago, a researcher (who happened to be a practicing oncologist) examined the medical records of almost 8,000 cancer patients. He found that in cases where chemo was given in the final six months of life, ONE-THIRD of the patients had cancers that are known to be unresponsive to chemotherapy.

In other words, thousands of cancer patients and their families were duped, while chemo concessions were harvested.

But hold onto your hats. It gets even worse…

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Supreme sacrifice
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In 2005, the Medicare Modernization Act curbed chemo concession claims. Under the new plan, Medicare reimburses no more than 6 percent over the average amount doctors pay for any individual chemo drug. (Note that this act has no effect at all on billing of patients who are not covered by Medicare.)

At first, experts were concerned that the act would result in less care for cancer patients who relied on Medicare. I guess the thinking was that such a measly payout wouldn’t be enough to inspire oncologists to even show up and do their job.

But those experts didn’t imagine how creative some oncologists can be.

After the new rules took effect, the total number of Medicare claims for chemo treatments given within one month of diagnosis didn’t drop. In fact, they sharply increased. In addition, the use of less expensive chemo drugs declined, while the use of more expensive drugs increased.

Crank up the chemo mill and keep those coffers full!

But those profits come with a sacrifice–a sacrifice by patients, that is.

In a 2008 review of about 600 cases in which cancer patients died within 30 days of receiving chemo, 40 percent experienced “significant poisoning” from their treatment, and about one-in-four deaths were accelerated or actually caused by the treatment.

Every cancer patient and their family needs to be aware of this Chemo Con. So if you’re ever diagnosed with cancer, try to find a doctor who’s a caregiver, not a businessman.

And if a doctor prescribes chemo–especially in the very late stages–it’s time to start asking as many questions as possible to make sure the con isn’t on.


Sources:

“How Medicare’s Payment Cuts For Cancer Chemotherapy Drugs Changed Patterns Of Treatment” Health Affairs, Published online ahead of print 6/17/10, content.healthaffairs.org
“Medicare Cuts May Have Led Docs to Prescribe More Chemo” HealthDay News, 6/17/10, consumer.healthday.com
“Medicare Cuts Increase Cancer Treatments, Study Finds” David Cameron, Harvard press release, 6/17/10, hks.harvard.edu