Tag: health care

Man indicted for allegedly committing almost a quarter of all Arizona ACCCHS fraud

Multiple Arizona residents are among the more than 300 people charged in a nationwide “takedown” of health care schemes, including one accused of being responsible for billing the state for 22% of all AHCCCS “sober living” fraud. 

Farukh Jara Ali is accused of submitting about $650 million in “false and fraudulent claims” to the Arizona Health Care Cost Containment System and personally receiving $24.5 million as part of the alleged fraud.

Ali is the owner of a company called ProMD Solutions, which 12News has previously covered in connection with the AHCCCS “sober living” fraud scandal.

ProMD Solutions is listed as the statutory agent for multiple businesses accused of fraud. 

In 2023, a man identifying himself as Mark Stanley, a Vice President with the company, told 12News via Zoom that ProMD Solutions was a billing company that also provided turnkey solutions for behavioral health businesses. He denied any billing fraud on ProMD’s part. 

ProMD Solutions’ website lists an address in Irvine, CA. But a search of the address reveals it to be a strip mall with a third-party mailbox store. In reality, prosecutors say Ali was running the business from Pakistan. 

In court documents, prosecutors state that Ali had contracted with 38 purported healthcare providers to bill the state for $650 million, of which AHCCCS paid $564 million.

According to the indictment, other behavioral healthcare businesses began a scheme to offer bribes and kickbacks to sober living homes, allegedly offering higher amounts for patients who could use the American Indian Health Plan.

Native Americans were widely targeted by the sober living scheme.  In many cases, they were promised drug and alcohol rehab that they never received. 

The bribes were allegedly in exchange for sending the sober living residents to these behavioral health providers. Prosecutors allege Ali and the business owners conspired to falsify treatment notes to justify billing for services that were never rendered. 

According to the indictment, ProMD Solutions was the company responsible for doing the actual billing, with Ali taking 5% off the top. Prosecutors say he made just under $25 million. Prosecutors believe he bought a $3 million golf course home in Dubai using at least some of that money. 

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‘Sky-High’ Levels of Alzheimer’s Protein Found in Newborns

A protein long blamed for the brain damage seen in Alzheimer’s disease has now been found in astonishingly high levels in healthy newborn babies, challenging decades of medical dogma.

The discovery could transform our understanding of both brain development and Alzheimer’s disease itself. The protein, called p-tau217, has been viewed as a hallmark of neurodegeneration – yet a new study reveals it’s even more abundant in the brains of healthy infants.

Rather than being toxic, p-tau217 may be essential for building the brain during early development.

To understand why this matters, it helps to know what tau normally does. In healthy brains, tau is a protein that helps keep brain cells stable and allows them to communicate – essential functions for memory and overall brain function. Think of it like the beams inside a building, supporting brain cells so they can function properly.

But in Alzheimer’s disease, tau gets chemically changed into a different form called p-tau217. Instead of doing its normal job, this altered protein builds up and clumps together inside brain cells, forming tangles that impair cell function and lead to memory loss typical of the disease.

For years, scientists have assumed high levels of p-tau217 always spell trouble. The new research suggests they’ve been wrong.

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Justice Department charges 324 defendants in major nationwide health care fraud operation

The Justice Department (DOJ) on Monday charged at least 324 people with health care fraud charges in connection to its massive 2025 National Health Care Fraud Takedown operation, including 96 doctors and medical professionals.

The charges come from a joint operation between the DOJ, FBI, the Health and Human Services (HHS) Department and the Drug Enforcement Administration (DEA). The charges accounted for more than $14.6 billion in intended loss. 

The defendants range from licensed medical professionals, to business owners, to alleged members of transnational criminal organizations, according to the DOJ. 

“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” Attorney General Pamela Bondi said in a statement. “Make no mistake – this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”

The charges include allegations of fraudulent “wound care,” which refers to allegedly providing patients with treatment that they did not need, prescription opioid trafficking such as fentanyl, and telemedicine and genetic testing fraud schemes, among others. 

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Doctors Group Launches Campaign Empowering More Healthcare Professionals To Join Drug Decriminalization Movement

A group of doctors who support drug policy reform is launching a new campaign aimed at equipping physicians and healthcare professionals with skills to play a greater role in advocating for the decriminalization of drugs. Organizers say there’s a need for more voices from the medical community to take part in ongoing discussions around cannabis, psychedelics and harm reduction issues.

Doctors for Drug Policy Reform (D4DPR) says it’s spent the past year developing its new advocacy toolkit intended for healthcare professionals and scientists on “Transitioning from a Criminal Justice Model of Drug Use to a Health-focused Approach.” It includes guides to help would-be activists craft opinion pieces and engage with lawmakers and the media in order to “educate on the failures and lasting harms of the War on Drugs” and “confidently reframe drug use through a compassionate public health lens.”

“We’re assembling a core group of ‘on-call’ health professionals who are willing to lend their voice when timely advocacy opportunities arise,” says a recent D4DPR email about the effort, funded through a grant from the Drug Policy Alliance (DPA). “Now more than ever, we need healthcare professionals like you to speak up—especially when critical legislation is being debated.”

Bryon Adinoff, D4DPR’s president, told Marijuana Moment that it’s “imperative” that healthcare professionals take part.

“We want to health them speak up and learn how to do it in the right way,” he said.

Among the topics D4DPR is prioritizing with the new initiative are cannabis regulation, the decriminalization and therapeutic use of psychedelics as well as overdose prevention centers. By and large, Adinoff said, other medical professionals and organizations have “not been sufficiently active in this area.”

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RFK Jr. Announces “Health Insurance Breakthrough” That Affects Nearly 260 Million Americans

In a press conference on Monday, HHS Secretary Robert F. Kennedy Jr. and CMS Administrator Dr. Mehmet Oz announced a landmark agreement with the nation’s largest health insurers to tackle the number one healthcare problem plaguing hundreds of millions of Americans: prior authorization.

Prior authorization is the requirement for doctors and patients to get advance approval from insurance companies BEFORE certain treatments, tests, or procedures are covered. It was meant to control costs, but for 85% of Americans, it’s become a serious barrier to care.

“Doctors like myself are continually struggling with this issue,” Dr. Oz said, explaining how the bureaucratic process not only delays treatment but deeply frustrates both providers and patients.

In 2023 alone, Medicare Advantage (which covers about 32 million people) initially denied 3.2 million prior authorization requests. Dr. Oz made clear these are not just numbers: they represent “individuals who often, in the most vulnerable time in their lives, needed something done and it was denied.”

The burden also falls heavily on physicians. On average, doctors spend 12 hours per week on paperwork, handling about 40 prior authorization cases weekly. Dr. Oz said it contributes to burnout, slows down care, and “erodes public trust in the health care system.”

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Ivy League Researchers Scaremonger About GOP Health Policy But Say Nothing About Similar Democrat Plans

Ivy League faculty members have a leftist bias — would you believe it?

That sarcastic conclusion comes from the latest example of rhetorical scaremongering over the budget reconciliation bill being considered by Congress. When Republican lawmakers decide to scale back health care benefits, the professoriate loudly proclaims that people in their legions will die. But when Democrat lawmakers do the same thing, these same commentators decide to join the Witness Protection Program.

Deaths Metric

On June 3, a series of researchers affiliated with the University of Pennsylvania’s Leonard Davis Institute of Health Economics and the Yale School of Public Health released a letter regarding the House-passed budget reconciliation bill. In it, they claimed that several specific provisions in the bill “would result in more than 42,500 deaths annually.” They further claimed that allowing enhanced Obamacare subsidies to expire at year’s end, as they are scheduled to do under current law, “will cause an additional 8,811 deaths,” meaning that “altogether, we project that these changes will result in over 51,000 preventable deaths.”

The letter leaves much to unpack. For starters, the idea that anyone can know with any level of certainty the precise number of deaths attributable to a specific policy — not 8,810 or 8,812, mind you, but exactly 8,811 — is absurd on its face. If the researchers know the specific number of people who will die due to one policy change, then why not tell us the names of said individuals, and where, when, and how those people will die, while they’re at it?

Second, the expiration of the enhanced subsidies at year’s end comes because of Democrats, not Republicans. When they controlled Congress and the presidency, Democrats passed provisions letting these subsidies expire. Democrats fully expected future Congresses to extend them but wanted to try to disguise their true cost, just like they tried to hide the full $5 trillion cost of the failed Build Back Bankrupt legislation. They should neither complain nor blame Republicans for not wanting to fix or extend Democrats’ bad law. (The same applies to Republicans when it comes to tax gimmicks they might include in reconciliation.)

Ideological Bias

But the real “tell” regarding this letter comes in the form of a question the researchers didn’t answer. I emailed the lead authors, Rachel Werner at Penn and Alison Galvani from Yale, with a simple question: “Do you plan on conducting similar analyses on the number of deaths associated with Gov. [Gavin] Newsom’s proposal to freeze enrollment of undocumented immigrants in MediCal, and charge existing undocumented enrollees a $100 monthly premium? Why or why not?”

Astute readers may not be surprised to learn that, even after following up, I received nary an acknowledgement, let alone a reply. The researchers might claim they never received my message or that they only published their letter in response to a request from Sens. Ron Wyden, D-Ore., and Bernie Sanders, I-Vt., for an analysis of the effects of the reconciliation bill. (Any Republican lawmakers in California reading this should please — please — ask the researchers for the type of analysis I requested, if only to highlight their hypocrisy.)

But it doesn’t take a Ph.D. in economics to recognize the real reason for the disparate treatment. The letter was a headline — “Republican bill will kill X people per year!” — in search of a story and a justification. That’s why Wyden and Sanders requested it, and that’s why the researchers gladly complied. But when it comes to attacking Newsom, or Democrat Govs. J.B. Pritzker of Illinois or Tim Walz of Minnesota, all of whom have proposed scaling back taxpayer-funded coverage of illegal immigrants — not because they believe such benefits should go only to citizens, mind you, but because of skyrocketing costs — they suddenly become mute.

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Witness Alleges Hospital’s ‘Egregious’ Breaches of Standard of Care Killed Teen

Witness testimony continued this week in the wrongful death trial of Grace Schara, a 19-year-old with Down syndrome who died in a Wisconsin hospital days after being admitted for a COVID-19 infection. Grace’s sister and expert witnesses testified that doctors violated the standard of care and principles of informed consent.

Grace’s family sued Ascension St. Elizabeth Hospital in April 2023 and filed an amended complaint in July 2023, alleging the hospital’s COVID-19 treatment protocols directly resulted in Grace’s death in October 2021, a week after admission.

The trial began last week at the State of Wisconsin Circuit Court for Outagamie County. The lawsuit names several defendants, including some Ascension doctors and nurses and the Wisconsin Injured Patients and Family Compensation Fund.

Grace’s older sister, Jessica Vander Heiden, testified Tuesday that she was unaware that the hospital had placed a “do not resuscitate” (DNR) order in Grace’s chart until shortly before her death and that, in Grace’s final moments, hospital staff refused to intervene and did not honor her family’s repeated requests to revoke the DNR.

Expert witnesses for the plaintiffs testified that there were multiple violations of the standard of care by Ascension doctors and nurses.

Dr. Gilbert Berdine, an associate professor of medicine at Texas Tech University Health Sciences Center, said that this was the first malpractice case where he testified as an expert witness for plaintiffs and explained why he chose to do so.

“The breaches of the standard of care were egregious, and I could not live with myself without answering the call to review and give advice on this case,” Berdine said.

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UK Turning Into ‘National Health State’, Says Think Tank

The UK is turning into a “National Health State,” the Resolution Foundation has said, after Chancellor Rachel Reeves announced a £29 billion annual increase in NHS funding.

The think tank’s analysis of Reeves’s Spending Review estimates that by the end of financial year 2028–29, the health service will account for half (49 percent) of all day-to-day public services spending, up from 34 percent in 2009–10.

On Wednesday, the chancellor announced a record £29 billion funding injection, which the Treasury said will deliver on the government’s promise to cut waiting lists, improve patient care, and modernise services.

Resolution Foundation Chief Executive Ruth Curtice said in a statement, “Health accounted for 90 per cent of the extra public service spending, continuing a trend that is seeing the British state morph into a National Health State, with half of public service spending set to be on health by the end of the decade.”

The Institute for Fiscal Studies (IFS) noted in its initial response to the Spending Review that the funding increase for the NHS was substantial, but questioned whether it will be enough to get the health service back to meeting its 18-week target for hospital waiting times within this Parliament, something which the think tank said was “enormously ambitious.”

£6 Billion to Speed up Tests and Treatments

After the Spending Review, Reeves announced that £6 billion of the allocated funds will be used to deliver up to four million additional NHS tests, scans, and procedures over the next five years.

This will be spent on ambulances, new scanners, increasing diagnostic centre capacity, and more Urgent Treatment Centres.

The government will also invest £30 billion in day-to-day maintenance and repair of the NHS estate, with over £5 billion allocated for critical repairs over the next five years.

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The Statin Wars

We shouldn’t have been surprised that the Covid experience was so marred by financial conflicts where pharmaceutical industry interests called the shots—too often to the detriment of our health.

Some of us weren’t surprised.

For decades, I’ve been unearthing unthinkable scandals inside our medical establishment. They are stories that I wouldn’t have believed myself had I not spoken to first hand sources and whistleblowers, and seen the proof in hard data and documents.

The Statin Wars is one such example.

I began covering issues regarding cholesterol-lowering statins and conflicts of interest around 2004 when I was an investigative reporter for CBS News.

I continued covering these issues on my independent Sunday television program “Full Measure.”

The statin controversy began when a panel of government advisers decided our cholesterol levels should be lower than we thought. It turns out nearly every one of the “experts” — was paid by statin makers. Yet none of them initially disclosed this financial conflict of interest!

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Los Angeles Children’s Hospital Shutting Down ‘Transgender’ Youth Clinic Amid Federal Pressure

The Children’s Hospital Los Angeles (CHLA) has announced that it will shut down the Transyouth Health and Development program by the end of July.

The move comes amid mounting federal pressure to stop mutilating and sterilizing children in the name of “gender science.”

There have been reports that CHLA is under investigation by the Department of Health and Human Services (HHS) for potential violations of new federal guidelines issued by the Trump administration regarding sex changes for minors.

The hospital is one of the few in the nation that will provide sex change surgeries and hormones to kids under 18 who receive taxpayer-funded healthcare.

“Federal agencies, including the Department of Justice, Health and Human Services, and the Centers for Medicare and Medicaid Services, have made it clear there will be consequences, potentially civil and criminal, for entities pushing irreversible procedures on vulnerable minors,” the hospital wrote to staff.

“The threats are no longer theoretical,” the hospital asserted.

“CHLA has a responsibility to navigate this complex and uncertain regulatory environment in a way that allows us to remain open as much as possible for as many as possible,” the email continued. “This painful and difficult decision was driven by the need to safeguard CHLA’s ability to operate amid significant external pressures beyond our control.”

The Post Millennial reports, “CHLA is more dependent on public funding than any other pediatric center in California, making it especially vulnerable to changes in federal policy. Around 40 percent of all pediatric beds in Los Angeles are housed at CHLA, and executives say preserving access to care for the largest number of children, particularly low-income and chronically ill kids, must come first.”

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