
Practice Fusion to pay $145M for taking kickbacks aimed at increasing opioid use - JshWright
https://www.fiercehealthcare.com/tech/allscripts-practice-fusion-to-pay-145m-settlement-doj-opioid-case
======
kerkeslager
> In separate civil settlements, Practice Fusion has agreed to pay
> approximately $118.6 million to the federal government and states to resolve
> allegations that it accepted kickbacks from the opioid company and other
> pharmaceutical companies and also caused its users to submit false claims
> for federal incentive payments by misrepresenting the capabilities of its
> EHR software.

> Of that $118.6 million, $113.4 million will be paid to the federal
> government and up to $5.2 million to states that opt to participate in
> separate state agreements.

So, nothing was taken from the personal bank accounts of the people who made
these decisions, and nobody went to jail. That is to say, nothing was done
about this.

The takeaway here is that you can murder people for money and as long as you
do it behind the paperwork of a large corporation, you can get away with it.

The only people who pay the consequences are shareholders. Sure this
incentivizes shareholders to try not to invest in sociopathic execs, but I'm
not sure how possible that even is.

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JshWright
It's hard to put into words how angry I am about this. These sorts of things
don't happen by accident. I don't understand how someone gets asked to build
this "feature" and they don't just quit on the spot...

~~~
astura
Because when an engineer gets a big list of the alerts he or she must
implement some aren't labeled "*illegal kickback scheme to get doctors to
prescribe medically unnecessary medication for profit," it looks like any
other requirement. Making things look legit to others outside of the scheme is
important to successfully pulling off the scheme.

Even if an individual engineer suspected the opioid recommendation alerts were
medically unnecessary, medically unnecessary tests and treatments are very
common [1], so it wouldn't exactly stand out as "probaby an illegal kickback
scheme."

[1] [https://www.propublica.org/article/unnecessary-medical-
care-...](https://www.propublica.org/article/unnecessary-medical-care-is-more-
common-than-you-think)

~~~
kerkeslager
As a software engineer: a lot of what I do is understanding the context of
what I'm doing. When I'm writing code, I'm trying to grok how the business
users think about the business objects and business logic.

I get a story that says, "As a user, when I press the H key I want a horn to
play." And I go into the planning meeting and ask, "Is this like a bike horn?"
And they say yeah! And I ask, okay, so when I press the key, do you want the
horn to sound on key down, or key up? And they say, "How about it starts
playing on key down, and stops playing on key up?" And then I say, "do you
want different volumes, for let's say when they are on their bike and just
want to politely let someone know they are there, versus when they're about to
get hit by a truck?" And they say, "yes, eventually, but being able to play
the horn at different notes is a higher priority." And then I ask, "wait, why
is that useful for a bike horn?" And then they explain that they're going to
be playing the horn as part of an orchestra. And then by the end of the
conversation I realize the horn I'm implementing is a French horn midi
keyboard, not a bicycle horn traffic signal, and the requirements are
completely different.

I don't really buy this idea that people are just writing single, isolated
requirements out of context.

~~~
astura
Well, first off it's not a "single, isolated requirements out of context."

From TFA

>in exchange for implementing clinical decision support (CDS) alerts in its
EHR software designed to increase prescriptions for their drug products.

When and how the software would display the CDS alerts would be discussed in a
planning meeting; the logic of each individual CDS alerts would not, those
would be handed down from somewhere else. Software engineers are in no
position to be suggesting or discussing individual clinical decisions.
Software engineers aren't going into a planning meeting saying "hey, what
about suggesting scheduling a pap test if the patient is a female between 21
and 60 and there's no record of a recent test?" That's not in the software
engineer's purview.

So there's very little doubt in my mind that the "suggest opioids if XYZ" CDS
alert came down in a list of other innocent CDS alerts like "suggest pap test
if XYZ" or "suggest mammogram if XYZ" or "possible drug interaction detected"
or "tetanus vaccine due."

Of course there's also the possibility that the system was engineered so that
the person configuring the software builds all the CDS alerts themselves with
a drag-and-drop interface.

But anyway, sometimes you, as an engineer implementing the system, don't get
to personally participate in requirements gathering, planning meetings, or
interfacing with the end users. Depending on a lot of factors, sometimes
that's done by pointy haired bosses at a much higher level. Especially if
you're just a contractor or a subcontractor. I once worked on a project as a
short term subcontractor (around six months), I was literally handed detailed
requirements, including mockups of all the screens, and told "implement this."
Of course, everyone had their own opinion on how it should work, but it was
not open for discussion.

So I have absolutely no reason to believe that the programmers of this
software knew about this nefarious kickback scheme but I have reason to
believe that they probably didn't.

~~~
JshWright
> Software engineers are in no position to be suggesting or discussing
> individual clinical decisions.

Boy am I glad I work for an EHR that doesn't agree with you... If I was asked
to implement a CDS rule that wasn't based on some reasonable clinical
guideline (CMS quality measures, etc) you'd better believe I'd push back on it
and want to understand where it was coming from.

Healthcare isn't some dark art that engineers couldn't possibly understand.
These rules should be based on publicly available and widely agreed upon
standards of care.

~~~
pbreit
The Practice Fusion ones almost certainly would fit your crieria. Ie “after
[x] type of surgery, fentanyl and oxycontin are reasonable painkillers”. (Both
entirely legal and widely prescribed today)

~~~
JshWright
No one should be getting extend release opioids after a surgery...

------
throw03172019
Didn’t they get bought for $100M just a year ago? I wonder what kind of
holdback they had? This is a big payment unless AllScripts knew it was coming.

~~~
acct_toss_away
I was employed there during the acquisition. It was certainly expected and
priced in. Management successfully managed to unload a hot potato while
getting a nice carve out for themselves.

------
simonw
Someone's been editing Wikipedia:
[https://en.wikipedia.org/w/index.php?title=Practice_Fusion&t...](https://en.wikipedia.org/w/index.php?title=Practice_Fusion&type=revision&diff=937934215&oldid=922185266)

------
Iv
When is someone going to jail over this kind of things?

------
anticodon
Since US invasion in Afghanistan, opium production had grown multiple times in
Afghanistan. Of course, there will be never an investigation or any evidence
dug up (just like there're no investigation of US war crimes), but I sense
that these two events are tightly related and the root of all this is very
very deep. So deep that noone ever will be ever dig up the truth.

~~~
iknowalot
We invaded Afghanistan only a few months after the Taliban made opium illegal
to produce (due to some religious reasoning)...very suspicious when you look
at our history of peddling opioids as a nation.

------
breck
One of the research projects I am working on is an open source medical records
system for patient owned medical records. I hadn’t considered deeply how the
design of any EHR system will always include biases of some sort that will
influence the behavior of patients and providers.

This is a sad event but definitely will be a good learning experience for
those in the EHR design world.

------
sbr464
Stuff gets deep quickly. Like movies like “The Hurt Locker”? Well say hello to
Sackler family opioid money. It’s interesting to see how deep in pop society
opioid money made it.

------
cortesoft
Are they going after the opioid companies, too?

~~~
gameshot911
Yes - [https://www.npr.org/2020/01/23/798973304/pharmaceutical-
exec...](https://www.npr.org/2020/01/23/798973304/pharmaceutical-executive-
john-kapoor-sentenced-to-66-months-in-prison-in-opioid)

------
trhway
>in exchange for implementing clinical decision support (CDS) alerts in its
EHR software designed to increase prescriptions for their drug products.

in near future they will start to use AI and nobody would be able to tell
where the specific opioid bias crawled in from, and even if the lineage of the
biased decisions is successfully established it would be from some innocent
facts/rules/data.

------
olliej
Are they going after the companies that were paying the kickbacks? They’re
just as, if not more, culpable

------
moltar
There was a great series on opioid epidemic on Freakonomics podcast recently,
if you are interested.

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shadow-banned
I wonder, and I am not trying to be a smart-ass here, if this is the first
case of a growth hack (some sort of push notification/alert) that actually
lead to someone's death.

------
onetimemanytime
>> _" Practice Fusion’s conduct is abhorrent. During the height of the opioid
crisis, the company took a million-dollar kickback to allow an opioid company
to inject itself in the sacred doctor-patient relationship so that it could
peddle even more of its highly addictive and dangerous opioids,” Christina
Nolan, U.S. Attorney for the District of Vermont, said in a statement._

So where is jail time for the entire decision-making team?

~~~
tempsy
I can’t help but laugh at the cofounder’s LinkedIn page:
[https://www.linkedin.com/in/matthewcdouglass](https://www.linkedin.com/in/matthewcdouglass)

Very first line: _I dig: socially responsible company-building_

~~~
shadow-banned
WOW. I almost sent him a DM... it won't accomplish anything.

