ENTA Thumbs Nose At FBI; Self-Refers Anyway

Sources close to those involved have reported that ENTA (Ear Nose Throat and Allergy), a DMH OWNED OFFICE,has been at it once again.

Read the whole story at BlogDecatur in the NEWS section.

New Law Would Block Hospitalists

There is a new bill (House Bill 5339) in the Illinois General Assembly that has already passed the House and now is on the floor of the Illinois Senate.

Evidently, some insurance plans were REQUIRING PATIENTS TO USE HOSPITALISTS INSTEAD OF THEIR OWN FAMILY DOCTOR.

This bill when passed will outlaw this practice.

What I find curious is that Consociate Health Plans, which covers many patients in the Decatur area including anyone working for DMH, is run by people who answer to Ken Smithmier.

Anyone wish to venture a guess as to whether Ken Smithmier wants to see this bill passed? Perhaps this was the plan all along for his "hospitalist" scheme: to force patients with Consociate insurance to use his hospitalists to scam even more money and put it in the DMH system.

If it was, Ken, you are soon to be even more SOL.

DMH must really be hurting for cash. Employees no longer have their wellness benefit, they no longer get a reward for recruiting other employees. Sounds like Ken is really scraping the bottom of the barrel to attempt to keep things afloat.

Spend spend spend, and eventually you run out of money.

Robert Pittenger Weighs In On The DMH Scandal

The following is a comment taken from the 2-9-06 post. I thought it important enough to repeat in a separate post (it's also on blogDecatur.) The anonymous poster signed himself as Robert Pittenger, former federal investigator who was in charge of the DMH investigation.


For some time I followed this blog while employed as an Investigator with the United States Attorney, Central District of Illinois. Having some time on my hands since retirement, I decided to see what has been said on the blog. After reading the last entry regarding Hospitalist, there may be something not yet talked about or thought of.

That being said...I'm certain that there are many GOOD reasons to use a hospitalist.

When a Medicare patient is seen by their doctor and the doctor determines they are sick enough to be admitted. There is an admitting diagnosis.

From there, the patient is treated appropriately and normally there are tests done to further diagnose the problem and then treat disease or illness causing the admission. A normal family practioner will go through that [or similar]process and once the patient is well enough to be discharged, the doctor will discharge the patient and at the time of discharge, the doctor will identify a final diagnosis.

That final diagnosis is the key element that triggers what Medicare [YOU and I] pay for that hospital stay.

Medicare is set up so that the hospital is paid what Medicare determines to be an appropiriate amount for the particular illness or disease. To do that Medicare came up with the DRG system. That is Diagnostic Related Groups. So each final diagnosis is assigned to a DRG. Each DRG pays a flat rate.

As example, here in Central Illinois [the cost varies throughout the United States] a hospital will be paid a flat rate of approximately $4,000 for what is termed a simple case of pneumonia.

That amount is suppose to cover the hospital's cost and yield a slight profit. Unfortunately for hospitals that is not always the case.

Goverment studies have shown that a patient with simple pneumonia will be in the hospital 3-5 [apx]. If the patient is discharged sooner, the hospital makes money, if they stay longer, the hospital loses money. It is expected to balance out, whether that is the case or not is another topic.

A small percentage ( about 5% )of "all" pneumonia patients are found to have complex types of pneumonia. Those are more difficult and expensive to treat and cause a longer hospital stay. Because of that, the Medicare system pays a higher rate of reimbursement to the hospital for a patient who has been discharged as having a complex pneumonia.

Goverment studies have shown that a complex pneumonia will cause a hospital stay of about 6-8 days, thus Medicare will pay the higher reimbursement, somewhere around $6,000 to $7,000 [apx].

Keep in mind that a hospital could make a larger profit by having a patient discharged after 1-2 days when they are diagnosed with simple pneumonia.

EVEN BETTER...

What if...a hospital administrator could get that primary care physician to change his final diagnosis to complex pneumonia.

Of course that does not happen too often because most physicians are honorable people. But there have been many cases where this very thing took place. NOT IN DECATUR!!

But you should understand it can be a bad thing for us taxpayers when a physician can be influenced or no longer can make independant judgement.

Most doctors that I know are honorable and would not allow a hospital's administration to pressure them to change their diagnosis, but the fact is that has happened in other cities and towns.

So while there are probably very good reasons and good arguements in support of hospitalist, there is a potential dark [ $$MONEY$$ ] side.

One thing is a fact...every Medicare patient has [cited in the social security act] the freedom to choose who provides their health care...end of story. If someone prevents that from happening, eventually we will all lose, if we have not already. Keep in mind that choice can be influenced by disparaging remarks.

Robert A. Pittenger

2/16/2006 04:07:32 PM

Mr. Pittenger, I have a couple of follow-up questions, if you don't mind:
___________________________

Any idea when we should expect a decision on this investigation?

What is the normal process for an investigation of this type?

Where/How will a decision on this investigation be announced?

Thanks for giving us a little more information than the local "media."

Lance Armstrong Gives Research Money to Scandal-ridden DMH

The DMH H&R strikes again. (ARTICLE)

While federal and state investigators continue to solidify their case in their joint investigation of Decatur Memorial Hospital and their administrative staff, DMH has somehow snagged cancer research money away from the Lance Armstrong Foundation.

Research for cancer is a good thing, and it's nice that a Decatur hospital was selected to receive such an honor. But PLEASE!! Does Lance Armstrong know that his foundation has handed over $450,000 to a "non-profit" organization that is in the middle of a LARGE FEDERAL INVESTIGATION FOR MEDICARE/MEDICAID FRAUD AND STARK ANTI-TRUST LAW VIOLATIONS?!?!?! Does Lance know that the administration of this hospital will be going to prison in the next year?!?!? Lance Armstrong does NOT like scandal...his "juicing" allegations by the French did not sit well with him...I wonder what he'll do when he finds out the hospital his foundation is giving money to is being investigated for cheating the US and State government out of hundreds of thousands of dollars and that the hospital's administration, and maybe a few docs, are going to jail soon!!!!

And since when did "Cancer Care Specialists" located on Monroe Ave. become the "Cancer Care Institute" at DMH? I guess Dr. Wade has been bought by the DMH lie machine as well. Any takers on how long it will be before Smithmier forbids him or any of his fellow cancer docs from seeing patients at St. Mary's?

To all DMH lackeys: The river of money is going to dry up. Plain and simple. The federal investigation is still ongoing and when the indictments are handed out, it will be best NOT to be snuggled up too close to Ken Smithmier!!

And what is this "Decatur Community Partnership"? Are St. Mary's Hospital personnel or independent (non-DMH aligned) physicians involved in this group? Or is this just another front organization for Ken Smithmier to attempt to gain control over all the healthcare in Decatur?

The bottomline question: When Ken Smithmier and the rest of the DMH administration goes to jail, and when all of DMH's entanglements into Decatur businesses fall into ruin, what will healthcare in Decatur be like?

St. Mary's Revitalization Program ought to be preparing for just this contingency.

Watcher's DMH-BS Ad of the Week 2-9-06

The DMH H&R has been strangely silent with ads. Maybe they made Smithmier mad and he's punishing them again.

This weeks BS Ad is the new series of billboards that the propaganda machine has put up all over town. Breast cancer, prostate cancer, etc. All good topics in general, however, none of these topics has anything to do with a hospital! They have to do with physicians! A cancer doctor sees these patients once a primary care physician has diagnosed them!

These topics have everything to do with a primary care physician, but DMH has nothing to do with primary care physicians! They've kicked them out of the hospital and have installed their "hospitalists." To make the assumed statement that DMH is somehow responsible for patients to survive their cancer is ridiculous! Physicians, and for the most part, primary care physicians are the ones who need to be congratulated for diagnosing these patients early. DMH, however, does not support primary care docs, so Smithmier just takes the credit instead. Absurd.