Doc Blows Whistle on Cigna

https://www.medpagetoday.com/special-reports/features/109910

Cigna increased efforts to speed up claims denials using new software and performance measures that pressured medical directors to close cases without a full review, according to a ProPublica investigationopens in a new tab or window.

The insurance company reportedly pressured medical directors who fell behind in reviewing cases, and even threatened to fire them if they failed to work faster, according to Debby Day, MD, a medical director who worked at Cigna for more than 15 years.

Often, the company encouraged doctors to “cut and paste the denial language that the nurse had prepared and quickly move on to the next case,” according to Day. This practice became so common that Cigna employees took to calling the approach “click and close.”

The company reportedly measured the pace and total number of cases that each medical director closed, which involved a productivity dashboard that tracked performance. Day told ProPublica the only way to keep up with expectations was to “deny, deny, deny.”

But Day told ProPublica that she believed her work was too important to speed through. Medical directors at Cigna were given the responsibility to approve or reject payment requests for critical care such as complex surgeries. And while the insurance company was pressuring doctors to work faster, Day said the work of the nurses “was getting sloppy,” which made reviewing claims harder and more meticulous.

Cigna told ProPublica that medical directors are not permitted to “rubber stamp” nurse denials and the company expects case reviewers to “perform thorough, objective, independent, and accurate reviews in accordance with our coverage policies.”

Longevity Scientist Faces Blowback

A Harvard geneticist who became the face of the longevity movement has drawn increasingly harsh criticism for claiming his products can reverse aging, according to the Wall Street Journalopens in a new tab or window.

Last year, David Sinclair, PhD, faced backlash for posting on social media that a gene therapy invented in his lab and developed by his company, Life Biosciences, had successfully reversed aging in monkeys. He also claimed the therapy had restored vision in the monkeys.

Earlier this year, Sinclair reportedly said another company he co-founded had developed a supplement that had reversed aging in dogs, according to WSJ.

However, other longevity science experts called this an empty promise. There isn’t an accepted standard for measuring aging, let alone a definition of what it means to “reverse” it, they said. The criticism was paired with the resignations of scientists from the Academy for Health and Lifespan Research, a group that Sinclair co-founded and led. Of the roughly 60 members who resigned, one posted on social media that Sinclair was a “snake oil salesman.”

The Academy’s remaining board members called for Sinclair to step down as president, which he eventually agreed to do.

Sinclair made a name for himself by promoting scientific claims about his work that garnered interest from top-tier scientific journals as well as praise in the news and on social media. But he has increasingly drawn criticism for hyping his own research or promoting unproven products, especially when he stood to benefit financially.

“The data is not good, you’re calling it the wrong thing, and then you’re selling it,” Nir Barzilai, MD, the new president of the Academy and the director of the Institute for Aging Research at Albert Einstein College of Medicine in New York, told WSJ. “The selling is a step too far.”

Fertility Clinic Accidents

The growing fertility industry has been plagued by an opaque system that frequently hides major errors and accidents, according to a Washington Post investigationopens in a new tab or window.

Many fertility centers are not required to report errors or accidents, including lost or damaged embryos, to any government or professional oversight organization, the report found. The industry relies largely on self-policing, which means patients are rarely informed immediately after something has gone wrong.

The Post highlighted two accidents that resulted in the loss of thousands of eggs and embryos belonging to hundreds of individuals and couples. One accident in San Francisco involved the implosion of a cryopreservation tank that contained 4,000 eggs and embryos. Another incident in Cleveland resulted in the loss of 4,000 eggs and embryos after a similar storage tank failed.

Both incidents occurred over the same weekend in March 2018, the Post reported.

Industry representatives insisted that error rates are low, and experts told the Post that fertility practitioners are regulated similar to other medical disciplines. Patients are also able to use the courts to address mismanagement of genetic material, experts said.

In fact, the Alabama Supreme Court ruling that frozen embryos are children came during a dispute over the mishandling of human embryos. But experts claim that most lawsuits end in settlements with nondisclosure provisions reinforcing the secrecy around the fertility industry.

Still, Adam Wolf, a prominent attorney for fertility plaintiffs, told the Post that the “vast, vast supermajority of mistakes in fertility clinics, the public doesn’t even know about.”

Filed under: General Problems