Cara Langsing Tanpa Obat, Diet Sehat, Kurus Cepat

CARA LANGSING TANPA OBAT, Diet plan SEHAT, KURUS CEPAT. Information Serta KONSULTASI HUBUNGI REKO HANDOYO 081389411679, 081932985325 JAKARTA.

Solusi anda untuk langsing tanpa obat obatan serta bisa kurus dengan sehat yaitu dengan nutrisi sehat. Nutrisi bukanlah obat bukan pula jamu tetapi nutrisi. Apa itu Nutrisi? Nutrisi dapat diartikan gizi yang diperlukan oleh tubuh untuk bisa berkembang serta melakukan regenerasi sel. Dengan nutrisi yang cukup makan tubuh kita akan bisa menyembuhkan diri sendiri serta membuang lemak yang tidak diperlukan oleh tubuh. Oleh karena itu jangan heran jika dengan Nutrisi berbagai keluhan penyakit seperti kolesterol, darah tinggi, maag serta asam lambung, bahkan asma, kanker tumor bisa diatasi serta berhasil.

Cara langsing tanpa obat, diet plan sehat serta kurus cepat hanya semudah menghitung 123. Kenapa? Karena sudah ada nutrisi sebagai pengganti makan pagi serta malam, ada natural yg terbuat dari rempah, sayuran serta buah, jadi kebutuhan nutrisi kita terpenuhi serta lemak terbakar dengan cepat.

Anda ganti makan pagi serta makan malam anda dengan shake formulation one herbalife, yaitu makanan diet plan sehat yang terbuat dari sayuran serta buah-buahan alami. Tambahkan fiber & Herbal treatments tablet, yaitu serat makanan yang befungsi melancarkan pembuangan anda serta menyehatkan badan. Jangan lupa gunakan pula penghancur lemak dari Herbalife bernama mobile u reduction serta peblokir lemak bernama lipo bond.

JIka anda ada maag serta sakit saluran pencernaan tambahan produk natural aloe focus yaitu natural aloe yang berfugsi untuk memperbaiki serta menyembuhkan sakit maag serta sakit seluran pencernaan dengan permanen. Jika anda menderita asma, vertigo atau sinus, tambahkan NRG Immediate tea untuk menyembuhkan asam serta vertigo anda.

Apakah aman buat siapa saja? Produk herbalife bisa dikonsumsi oleh siapa saja mulai dari anak usia bayi, balita, kakek nenek, penderita asma, penderita maag asam lambung, kolesterol serta bahkan ibu hamil serta menyusui.

Nah enak kan? Cara langsing tanpa obat, diet plan sehat serta kurus cepat aman serta menyehatkan. Gak ada deh yg design kayak gini di jagat ini, cumin Herbalife.

Ayo buruan konsultasi serta telp sekarang. CARA LANGSING TANPA OBAT, Diet plan SEHAT, KURUS CEPAT. Information Serta KONSULTASI HUBUNGI REKO HANDOYO 081389411679, 081932985325 JAKARTA.

Easy Tips Anybody Can Use When Coming To The Dentist

You need to go over this post for many tips presented here.

You must take at least two minutes when you’re brushing your teeth. You only aren’t going to reach all you need to arrive at. Be sure to give yourself adequate time every day and night to brush your teeth when you are able so that you don’t suffer from plaque that’s accumulating.

If you are concerned with obtaining a good dentist, research some of them ahead of time. Go online for reviews in the best dentists in the area. This can really have you feeling convenient throughout your cleaning along with other dental procedures.

Try brushing your teeth soon after eating once you can. Brushing within 15-thirty minutes of any meals can help you to lessen plaque damage. This smart practice may help help save from toothaches in the long term.

Can you get tartar problem? If this happens to you personally, you need effective anti-tarter products. Go to your dentist regularly to achieve the tartar.

You can only avoid problems once you maintain a dentist regularly. You will possess less anxiety when you visit your dentist. This relationship is going to be important if you want complex work ever arises.

Even if your teeth are certainly not natural, it’s still vital that you practice good dental hygiene. Brush your dentures just as you brush your real teeth.

Are you presently considering getting the tongue? You want to rethink that! Oral piercings can chip teeth and then leave you vulnerable to infection. In the event you don’t get this checked out immediately, a portion of your respective tongue may need to be removed.

Brush your teeth from your mouth.This eliminates food debris underneath the gums and clean them efficiently. You can scrub sideways, but ensure you perform the up and down scrubbing too.

Mouthwash is a vital element of your dental routine. Mouthwash will assist you to keep your mouth rinsed in areas you can’t reach along with your toothbrush cannot reach. Rinse after getting out of bed as soon as each night.

Milk products ought to be a vital if you would like healthy teeth.Eat yogurts, yogurts and drink a lot of milk. Take calcium supplement when you know you’re lactose intolerant. Your teeth is certain to get whiter and stronger.

In case you have a single tooth or several teeth knocked out, be sure to save the tooth. Rinse it lightly to take out any foreign debris. If you cannot place it from the socket, then put it in a small amount of milk and have in your dentist immediately.

It will help retain the beverage doesn’t touch your teeth. This can prevent your teeth from becoming stained. You will get large packages of straws quite cheaply at the supermarket.

Brush teeth three times daily for a couple of minutes each and every time. Brushing your teeth helps avoid cavities and gum disease. It can be less costly to care for your teeth regularly rather than to get dental problems in the future.

Teach children proper dental hygiene very early since you can. The earlier you begin good dental practices, the healthier their teeth will likely be each of their life. This can lead to better health overall along with lower dental bills than those that do not.

Go view your dentist twice a year whenever possible. Regular dental checkups will keep your teeth healthy and aid to avoid problems before they start. By way of example, in case you have a small cavity, they might possibly paint it over, but unless you catch it over time, you may need a filling.

Chewing sugarless gum is a terrific way to keep you teeth strong and in good health. Chewing gum creates more saliva inside your mouth produce more saliva.This may keep plaque from forming. It can also really helps to neutralize acids inside your mouth which could erode your teeth as time goes by.

With the tips presented here, you will be able to enhance your oral health and also have nicer looking teeth. After you use the tips stated previously, you may be well on your way towards an eye-catching smile. Take action to guard your teeth!

How To Coach The Little League San Francisco

By Marcia Marks

Coaching in the little league san francisco can be quite fun but it can also be quite a challenge for a lot of coaches because they will be handling a different type of crowd. Always remember that children have a different way of thinking as compared to adults which means that they have to be taught differently. It is a challenge to any coach to change his method to adapt to the situation.

Now when one teaches kids, he has to make sure he has clear rules. If kids would see that there are a clear set of rules to follow, then most likely they would listen to the one who made them. Kids respect authority if the coach would prove to the kids that he is someone who should be respected.

Now hitting is one of the most important aspects of baseball because the hit will determine whether a player can go to the next base or not. So it is very important for coaches to teach hitters the proper way of hitting the ball as well as the proper techniques. He should also teach them the proper stances in order to hit the ball properly.

Now one thing to take note when teaching batting would be that a lot of children are scared of getting hit. Now coaches would usually say that even if they do get hit, the pain will disappear once the player starts running. However, there actually is a proper stance to take when batting in order to avoid getting hit by the ball unless the throw of the pitcher is off.

Now when it comes to pitching, one has to make sure to pitch accurately. If one knows how to accurately pitch a ball toward the catcher, the other team will not be able to proceed. Now there are a lot of methods and techniques to pitch a ball which is what the coach should be teaching to his team.

Take note that it is actually possible for another team to steal a base. Now in the little league, there are stricter rules when it comes to leading off a base as compared to regular baseball. That is why the coach has to think of more creative ways in order to steal bases from the opponent.

Now as for some rules of the game, all players must be able to play in three innings. Another rule to observe would be to make sure that all players will bat at least once in the entire game. Also, coaches cannot use the same pitcher for all the pitches as pitchers only have limited number of times he can pitch.

So as one can see, coaching little league san francisco is pretty much the same as coaching the regular league but with a few differences. The major difference between the two would be the methods of teaching that the coach has to use. The coach has to be extra patient when teaching children because children do not understand things as fast as adults.

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Guidelines To Choosing The Best Personal Trainer In Highland Park IL

By Eloise Hewitt

If you need help achieving your fitness or health goals, hiring personal trainer can be the motivation boost you need. However, trainers never come cheap. This means that finding one you like is the key to realizing your fitness dream and getting the most for your investment and time. The motivation behind this article is to equip readers with tips that will enable them choose the best personal trainer in Highland Park IL. However, it is important to note that everyone has unique needs so it is important that you look for someone that fits your needs.

Your initial consideration should be experience and area of specialization. Ask your prospective instructor how long he/she has been in this business and whether they have areas of specialization of prefer to work with certain types of clients. It is always best to work with specialists for better results than working with trainers who pretend to know it all.

Cost is another factor. It is not necessarily true that good trainers must charge high fees and vice versa. In fact, there are very competent trainers in the market who are very affordable. Because of this, you should never settle on the first instructor who comes your way without window shopping.

Any fitness instructor who is worth his/her salt will not fail to have references. Ask them for their recent customers who share with you fitness or health goals. Do not just ask for these references for the sake of it, you need to contact them to find out if they were satisfied with him/her. Only contract the instructor if most of his/her past clients were happy with the services they received.

Before walking into any fitness center, it is also important to find out whether the instructor has professional liability insurance. This will become very important should you suffer any injuries in the process due to negligence on the instructors part. A good instructor should also take time to explain to you cancellation policy as well as billing procedures.

Your personality trainer is someone you will be interacting with a lot. This means that there must be cordial relationship between the two of you for the success of workouts. Otherwise, you will be forced to change instructors every now and then which will have negative impact on your workout.

You can also consider the trainers educational level. While accreditation certificate from a recognized body is just enough for one to be a fitness instructor, a university degree in exercise science or something related is definitely a plus. This is evidence that your instructor has solid educational foundation on what he/she is doing.

Ultimately, finding the right instructor is all about what works for you. It is like finding your hairdresser or doctor, there must be personal connection. So you should not feel that you are going to hurt the instructor if you decide to move on because you are not compatible with them.

About the Author:

Fair Oaks, CA Sciatica Issues Helped With Chiropractic Therapy

Sciatica exists in several different recognized forms, but all involve pain in the lower extremities generated by restricted or pinched nerves. The lower spinal vertebra may slip out of their proper position, weaken due to injury or activity, or undergo degeneration. A Fair Oaks chiropractor corrects sciatic symptoms without invasive surgery or additional drugs.

Pain may be constant, sharp and stabbing, or merely intermittent, and sometimes is accompanied by a tingling sensation and a decrease in mobility. Each unique case can require attention that goes beyond temporary pain relief. Many sufferers turn to chiropractic for solutions that do not involve surgery or long-term use of medications.

This holistic approach views the body as a unified and interconnected organism rather than a combination of independent systems having little interaction. It emphasizes the importance of properly aligned vertebra in the spine in relation to nerve activity, how positioning influences pain, and how those inter-related problems can be corrected.

Instead of masking painful episodes with ever-stronger medication, a chiropractor assesses the current spinal condition, and then begins to re-position any skeletal areas that may be creating restrictions. This is usually accomplished through a series of gentle adjustments designed to relieve pressure on nerves, ultimately decreasing pain and increasing mobility.

Chiropractors also reduce inflammation using ice or cold therapy, and often employ ultrasound to diminish the effects of muscle cramps, stiffness, or swelling. Electrical transcutaneous stimulation can be useful for controlling some types of intense pain, and can be administered in an office setting using special equipment.

Because sciatica is an indicator of other medical conditions, individual plans to correct those issues vary. In addition to clinical solutions, changes in weight and diet, exercise and general lifestyle are also explored. Many people respond well to this approach, and report an increase in spinal mobility as well as decreased incidence of pain.

Homemade remedies for pelvic illnesses in women

Homemade remedies for pelvic illnesses illness in ladies and air pockets in urinary bladder can be caused with If you’ve experienced urination acne, then you know why it is greatly connected with crying. It brings about issues and difficulties in urinating and when you do basically urinate, it burns causing a lot of pain. It also leave you quite sad twenty four seven.

This acne might be due to swelling of the urethra which brings about significant discomfort. If you are suffering pelvic illnesses there are some homemade remedies for pelvic illnesses and steps to alleviate the agony.

This looming health crisis can be averted, but it will need a ton of money. In a welcome initial step, President Barack Obama suggested in February to set aside $1.2 bn. to stop the spread and to make new drugs. As budget talks heat up in Washington, legislators from both parties must put their differences aside to support the fight against the superbugs and start saving American lives.

The centers for disease control and prevention guesstimates 2 million americans get infected in infirmaries each year due to exposure to antibiotic resistant bacteria. Some 23,000 die. According to the CDC, fighting these bacteria with costs the health care system about $20 bn. a year.

First off, you need to drink plenty of water. This might not sound like the cure that’s most surprising, but it is really important that you take it into account. The great quantity of water taken in helps your body to flush out the unpleasant bacteria and can also give you volumes to bump out when you are urinating.

Another factors you can utilize is taking cranberry juice or any kind of cranberry additions. The cranberry juice also provides help in flushing out the bacteria and making certain that it doesn’t stick to the wall of the bladder. This decreases the case of inflammation of the bladder and makes urinating easier and less painful.

You should however make sure that you use unsweetened cranberry juice as the surplus sugar will just add Calories to your system. You can decide to use heat to ease the agony. The irritation and swelling brings about pressure, burning and agony in your pubic area. Nonetheless by applying a heating pad, you can sooth the area and scale back the pain.

Finally, you want to chop irritations out of your diet. Things like alcohol, spicy food, caffeine, synthesised sweeteners and carbonated drinks can cause irritation to your bladder and delay the recovery process with home made cures for pelvic diseases in women. Your focus should be on sensible food like healthy fats and carbs containing high fiber content.

Presto Chango – UPMC Tries to Make its Employees All Disappear

This story is just in time for Halloween. 

The Lawsuit Challenging the Non-Profit Status of UPMC

Back in March, 2013, we discussed a lawsuit initiated by the then Mayor of Pittsburgh that challenged the tax-exempt, non-profit status of giant hospital system UPMC.  The suit charged that UPMC functions more like a for-profit corporation based on its large surplus (recently $1 billion), larger reserves ($3 billion), minimal commitment to charitable care, and generous executive pay (recently $5.9 million  to CEO Jeffrey Romoff, 19 executives paid more than $1 million, and ownership of a jet aircraft).  By the way, Romoff’s latest total compensation was said to be $6.1 million (look here), and UPMC just bought an even fancier corporate jet, a Bombardier Global Express worth $51 million (look here).

The Employees Vanish

The Pittsburgh Post-Gazette just described UPMC’s remarkable response to the lawsuit.

 For purposes of the city’s payroll taxes, [an attorney representing UPMC] Mr. [William] Pietragallo explained,
UPMC’s subsidiaries — like UPMC Shadyside and Western Psychiatric
Institute and Clinic — file separate forms. Employees work for those
legal subsidiaries. But UPMC itself?

We don’t have employees,’ Mr. Pietragallo said.

The question is central to the city’s suit to strip UPMC of its
status as a purely public charity. UPMC argues the city can’t challenge
its exemption from payroll taxes because it technically has no
employees. It’s a case where the legal reality may differ significantly
from the one that UPMC, which on its website claims to have 55,000
employees, markets on a regular basis.

‘You can’t pay employment taxes unless you have employees,’ Mr. Pietragallo said.

This is not the first time UPMC has made this claim in response to a legal action,

Earlier this year, when UPMC faced 80 complaints of unfair labor
practices, it argued that it was only a holding company and did not
technically employ those in the complaints.
The complaints alleged,
among other things, that UPMC employees were being punished for
attempting to unionize. UPMC ultimately settled.

Obvious Contradictions

These claims of invisible employees appear to be contradicted by UPMC’s own public relations,

 UPMC touts it large workforce. Its 2012 annual report, for example: ‘The economic impact of UPMC is more substantial than most people
realize. The organization is the largest nongovernmental employer in the
Commonwealth of Pennsylvania, and more than $6.2 billion in total labor
income
can be attributed directly or indirectly to UPMC.’

UPMC’s website and media releases say the hospital giant employs in
the range of 55,000 people.
And when UPMC made the top rankings of U.S.
News & World Report’s Best Hospitals, it did so as a conglomeration
of several facilities attorneys are now arguing are separate
subsidiaries.

Also,

[An attorney representing the city of Pittsburgh, Ronald]   Barber argued that even for tax purposes, UPMC has documented having
employees. In a Form 990 filed for the ‘UPMC Group,’ the hospital
network said it employed around 52,000 people.

A few days later, the Post-Gazette reported that the city responded to these UPMC claims in matter-of-fact way,

 On its website, in its annual report and in some tax filings, UPMC
purports to have employees — sometimes tens of thousands of them, the
city of Pittsburgh’s attorneys said in a court filing.

Furthermore,

 The city also argued that those working for subsidiaries are UPMC
employees as well, pointing to UPMC’s 2012 Annual Report and website,
which tout the hospital system as one of the state’s largest employers.
Attorneys also pointed to a lawsuit in which UPMC claimed to ‘extend
offers of employment.’

How Complexity Benefits Bureaucrats and Managers

It is Halloween coming up, not April Fool’s Day, and the claims made on behalf of UPMC do not appear to be jokes.  Instead, I believe they underline two serious problems with how large health care organizations are currently lead.

The first is that health care organizations often have exceedingly complex structures for reasons that have nothing to do with fulfilling their health care mission.  One reason may be that the complexity creates options for plausible deniability.  In particular, when such organizations are accused of bad behavior, as they now often are, subsidiaries may be set up to “take the rap.”  For example, we discussed how Pfizer Inc has been using the bankruptcy filing of its Quigley subsidiary made as if that subsidiary were independent to delay resolution of claims that the subsidiary sold hazardous asbestos products.   

This tactic of having the subsidiary take the rap may be particularly useful when taking the rap may lead to a severe penalty for the organization, such as disbarring it from being paid by the government.  A disbarred subsidiary may simply be dissolved and its work transferred to other parts of the organization.  For example, in May, 2013 we discussed a settlement in which Baush and Lomb subsidiary Ista Pharmaceutical would be disbarred from participation in government programs.  However, Baush and Lomb itself would not be disbarred, and would be able to “wind down” Ista’s operations and transfer its products to other parts of the larger company. 

The current example appears to be a more creative use of subsidiaries to claim deniability, although whether the arguments about disappearing employess above are even plausible is open to question.

Complex organizations also offer many opportunities to employ and enrich administrators, bureaucrats and managers, and to justify ever larger compensation for the top executives who purport to run the whole thing.  That such proliferation of management and management compensation may detract from the mission does not appear to be a big concern of the sorts of people who now run health care.

Contempt for Truth

The second problem is that the leadership of large organizations seem to have little use for the truth.  Instead, they may put lots of faith in their marketers, public relations people, and legal staff to obfuscate the truth in pursuit of ever more revenue and executive enrichment.  As management becomes less and less reality-based, however, it may be less likely to be able to respond to the very reality-based needs of patients and the public.

Conclusion

I hope that the outlandish claims now being sanctioned by UPMC leadership may raise awareness of what is going wrong with the leadership of health care organizations in general.  As we have been saying for years, health care leadership that puts its self-interest ahead of patients and the public, and which disregards the truth in service of self-interest may be the biggest cause for ever increasing health care costs, and ever declining access and regard for the health of patients and the public.  True health care reform would encourage leadership that puts the mission ahead of self-interest, and values honesty more than personal profit. It would promote regulation that holds top leadership of organizations accountable for their organizations’ actions and not allow the leadership to hide behind complex organizational structures.   

Another Month, Another Set of Legal Settlements, Deferred Prosecution Agreements, and Jury Findings Adverse to Large Health Care Corporations

Another month, another series of adverse legal rulings suggesting misbehavior by large health care organizations.  In alphabetical order,…

Baxter, McKesson, Teva Pay Punitive Damages

As reported by Bloomberg,

A jury said Teva Pharmaceutical Industries Ltd. unit and two other drugmakers must pay $162.5 million in punitive damages for selling the anesthetic Propofol in a way that led three colonoscopy patients to develop Hepatitis C.

Jurors in state court Las Vegas ordered Teva Parenteral Medicines Inc., Baxter Healthcare Corp. and McKesson Corp. to pay so-called punishment damages over sales of the anesthetic in vials large enough to be reused by doctors. Anne Arnold, Richard Sacks and Anthony Devito contend they contracted Hepatitis C from reused vials during colonoscopy procedures. They had sought more than $700 million in damages.

It’s the second punitive award against Baxter and the unit of Petach Tikva, Israel-based Teva over a 2008 hepatitis outbreak in Nevada tied to Propofol. The first case resulted in a punitive verdict of more than $500 million against the drugmakers. Teva has agreed to cover all damage awards arising from the Nevada cases on behalf of Baxter and McKesson.

In particular,

The patients’ lawyers allege Teva intentionally sold Propofol in jumbo-sized vials to encourage doctors to reuse them, even with the risk of spreading blood-borne diseases such as hepatitis, an incurable liver disease.

So the allegations are that the company intentionally put financial gain ahead of the safety of patients.

Boston Scientific Settles Over-Billing Allegations

Again per Bloomberg:

Boston Scientific Corp.’s Guidant LLC unit will pay $9.25 million to settle a whistleblower’s claim that the company over-billed the U.S. and private hospitals for heart pacemakers and defibrillators.

The details:

Guidant allegedly reneged on credits owed to the U.S. Department of Veterans Affairs for replacement of units still under warranty and is accused of over-charging hospitals for the devices, causing them to over-bill Medicare, according to an e-mailed statement from the Justice Department.

Note that we have quite a extensive files on Boston Scientific, and on Guidant, now its subsidiary.

Hil-Rom Settles Fraud Allegations

Reported by the Knoxville News-Sentinel:

Federal prosecutors announced Tuesday a $41.8 million civil fraud settlement in a ‘whistle-blower’ lawsuit against international medical equipment supply company, Hill-Rom Company Inc.

The results also were that

As part of the settlement, Hill-Rom has entered into a five-year ‘corporate integrity agreement,’ in which the firm will face close scrutiny by federal officials, Killian said.

The allegations were:

‘Hill-Rom submitted false claims for medical equipment for patients who did not qualify for the equipment, including patients who had died, were no longer using the equipment or had been moved to nursing homes,’ [US Attorney Bill] Killian said.

In particular,

The lawsuit alleged the firm was ripping off Medicare with its faulty billing practices. According to the lawsuit, unsealed Tuesday, Hill-Rom offered its sales representatives $200 gift certificates and 42-inch televisions as reward for boosting billings and, in 2001, laid off the lion’s share of staff dedicated to ensuring compliance with Medicare rules.

Note that this suggests a pattern of providing incentives to employees who “make their numbers,” no matter how they do so. We have seen how making the financial numbers seems to take precedence over all else, including patients’ well-being, in many contemporary health care organizations.

Maxim Healthcare Settles Fraud Allegations

In a story in the Baltimore Sun,

A Columbia-based health care firm has agreed to a $150 million settlement with the federal government and 43 states to resolve criminal and civil charges that it submitted claims for millions of dollars of work that it did not perform and operated offices that were not properly licensed, officials said Monday.

A five-year federal investigation found that Maxim Healthcare Services Inc., one of the country’s largest providers of home healthcare services, submitted $61 million in false claims for services to the federal government’s Medicaid and Veterans Affairs health programs over an 11-year period from 1998 to 2009.

Investigators said managers and workers at Maxim repeatedly modified time sheets and documents to cover up the fraud, creating a culture in which submitting false claims became ‘common practice.’

The settlement was of criminal as well as civil charges:

The settlement includes a $20 million criminal fine and $130 million in civil settlements.

It will also involve a deferred prosecution or corporate integrity agreement:

In addition to the fines, Maxim also has been charged criminally with conspiracy to commit health care fraud. But the company could avoid conviction if it meets requirements outlined in the settlement.

Unlike many such cases, this one involved criminal charges for and guilty pleas by some people involved in the wrong-doing, in this case, middle managers:

Several regional account managers, a home health aid and a clinical services director also pleaded guilty to criminal charges, government officials said. They could face as much as $250,000 in fines and jail time for their roles in the fraud.

Another atypical result was that the CEO who presided over the misbehavior actually suffered some consequences, although he did not have to pay fines for face criminal charges,

Maxim officials said they take full responsibility for the violations. The company said it hired a new CEO in 2009 and changed its business practices to protect against a repeat.

ProPublica published an article at the same time which noted that Maxim’s practices had come into question before,

A different set of problems involving Maxim came up during a ProPublica investigation into the oversight of registered nurses in 2009. We identified several nurses who were hired by the Maryland-based company despite having a record of problems.

Although that previous article did not mention the company’s name:

The articles focused on how regulators across the country did little to scrutinize troubled nurses who crossed state lines to continue working. Our earlier stories did not identify Maxim by name.

We have noted that organizations which misbehave once are likely to misbehave again. This may stem from an organizational culture that puts revenue ahead of ethics and patients’ and the public’s health, and the lack of negative consequences that people who respond to the resulting positive financial incentives are likely to suffer.

Medicis Settles Shareholder Class-Action Lawsuit

Noted by the Arizona Republic,

Medicis Pharmaceutical Corp. and its auditing firm, Ernst & Young, have agreed to pay $18 million to settle a shareholder class-action lawsuit stemming from the pharmaceutical company’s financial statements.

The shareholders alleged that Medicis was not honest about its financial affairs:

The shareholders’ lawsuit stems from Medicis’ announcement in September 2008 that it would restate earnings from 2003 through the first half of 2008.

Shareholders alleged that Medicis offered its wholesale customers generous return policies for prescription drugs as part of an effort to inflate the company’s revenue. Medicis would accept returned products that were expired or about to expire at either no cost or substantial discounts to the wholesale customers, according to the lawsuit.

Summary

The constant march of legal settlements by, jury verdicts against, and in some cases criminal convictions of or guilty pleas by large health care corporations indicate how common misbehavior by such organizations has become. Since it is likely that much misbehavior does not lead to publicly announced legal actions, what is published can only provide a floor for an estimate of how common it is. The march, which we have been documenting since starting Health Care Renewal, shows how sleazy and often corrupt health care has become, and how that sleaziness and corruption is prevalent not just among small players, but among the biggest and richest health care organizations, and their top leaders.

One reason the situation continues to be so bad is that while the unethical behavior does sometimes result in pontificating by the civil authorities, and fines that may only be costs of doing business, it rarely leads to meaningful negative consequences for those who authorized, directed or implemented it. This was noted in the reporting of the Maxim Healthcare case above. For example, in the Baltimore Sun article we found,

One watchdog group called the penalty a drop in the bucket for a company that had $2 billion in reimbursements from 2003 to 2009.

‘That is hardly crippling,’ said Joe Newman, a spokesman for the Project on Government Oversight, which tracks government contractors. ‘It is certainly something that stings Maxim’s pocketbook, but they will be fine after that.’

‘They won’t be barred from the Medicaid program. That would hurt them.’

Also, Sun columnist Jay Hancock wrote:

Corporations are happy to be treated as people under the law, as we know from recent court decisions. They can own property. They can seek redress in Congress and the courts. They can make huge political contributions.

But when it comes to being penalized for cheating the government, corporations quickly abandon their personhood and go back to being abstract blobs.

‘I don’t know about you, but if I hired a contractor to work on my house and he charged me a ton of extra money for work he didn’t do, I wouldn’t use that contractor again,’ Minnesota Sen. Al Franken said in Congress a few months ago. ‘And I would make sure my friends knew not to use them either. It seems like the same should be true of government contractors.’

But that is often not the case. For years, government agencies have not vigorously enforced the law when doing so might inconvenience big corporations and their well-paid executives. Maybe this lenience stems from the loony philosophy of former Chairman of the Federal Reserve Alan Greenspan, who was once regarded as some sort of economic genius, who seemed to think that fraud cannot occur in his idealized idea of a free market, because somehow all bad actors would become widely known and therefore all counter-parties would avoid them. In an article in Stanford Magazine,

The influential Greenspan was an ardent proponent of unfettered markets. Born was a powerful Washington lawyer with a track record for activist causes. Over lunch, in his private dining room at the stately headquarters of the Fed in Washington, Greenspan probed their differences.

‘Well, Brooksley, I guess you and I will never agree about fraud,’ Born, in a recent interview, remembers Greenspan saying.

‘What is there not to agree on?’ Born says she replied.

‘Well, you probably will always believe there should be laws against fraud, and I don’t think there is any need for a law against fraud,’ she recalls. Greenspan, Born says, believed the market would take care of itself.

For the incoming regulator, the meeting was a wake-up call. ‘That underscored to me how absolutist Alan was in his opposition to any regulation,’ she said in the interview.

It is a measure of the insanity of recent years that one of the chief leaders of government economic policy did not believe there was any need for laws against fraud.

It appears that this daft idea has carried over to and still influences how many in government and out deal with health care. However, as we have ddiscussed, health care is not and probably cannot ever be an ideal free market. Also, in health care, most of the bad actions remain anechoic, and in many cases it may be hard for counter-parties to avoid bad actors because they may dominate the market. Also, it may be those that make decisions about whether to deal with particular organizations may be executives, and sometimes health care professionals who have become indifferent to the ethical issues.

As I have said again and again, pervasive bad behavior by large health care organizations has got to be a major cause of our ongoing health care dysfunction.

So, to really deter bad behavior, those who authorized, directed or implemented bad behavior must be held accountable. As long as they are not, expect the bad behavior to continue.

Assisted Living Residence Providers and Stakeholders

You are invited to attend our next Assisted Living Advisory Committee meeting on Thursday, December 8, 2016, from 12:00-3:00 PM in the Sabin-Cleere, located on the first floor of Building A on our Cherry Creek Campus. 

For meeting agendas, handouts, etc. please go to: https://drive.google.com/folderview?id=0ByqZDBabyNVSR3pNejg2X2J0V2c&usp=sharing%20
Click on the folder labeled “12/8/16 meeting.” We recommend that you return to this site on the day of the meeting to check for additional or revised meeting materials. 

Telephone and web conferencing is available. 

To participate via Web: 

Step 1: Go to: https://cdphe.adobeconnect.com/alac/ 
The Adobe Connect screen will appear entitled “Assisted Living Advisory Committee Meeting” 
Step 2: Click “OK” option after you have read the text box message
Step 3: You will now be in the Virtual Meeting Room

Directions on how to participate once you have entered the room are in the “Meeting agendas, handouts, reports and minutes” link above.

If you have never attended an Adobe Connect meeting before:
Test your connection: https://cdphe.adobeconnect.com/common/help/en/support/meeting_test.htm<>
Get a quick overview: http://www.adobe.com/go/connectpro_overview

To participate by telephone:
Step 1: Dial 1-712-432-3066 
1-877-820-7831>