Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
'Lien Doctors' Gamble on Personal Injury Cases
Some doctors will treat accident victims on the condition that they only get paid after a lawsuit wraps up, the .
Most are unaware that these so-called "lien doctors" exist until they hire a personal injury lawyer. They can be found via online directories such as Doctors on Liens, Power Liens, or Global Lien Doctors.
A ruling in the case of David Pebley helped the practice flourish in California. In 2011, Pebley was parked on the side of the highway when a big truck slammed into his motor home. He sued the driver and his employer, but instead of using his health insurance for treatment, Pebley enlisted lien doctors.
The strategy paid off, with a jury awarding $3.6 million in damages, including $644,000 in past and future medical costs.
"It is so lucrative to provide lien care," Henry Lubow, MD, a California doctor who has been a medical billing expert in more than 5,000 personal injury cases, told the Journal, adding that lien charges can be as much as 25 times what insurance will pay. Spine surgeon Gerald Alexander, MD, who treated Pebley, said about 10% of his practice is litigation-related.
Patients who sign up with lien doctors are usually barred from submitting claims to their insurance, and they're held responsible for the full bill no matter the outcome of their lawsuit -- though doctors and lawyers say liens are negotiated down if a case fails.
Hidden Clinical Trial Data
Sponsors aren't keeping up with mandatory clinical trial reporting, an .
Among more than 4,700 trials that should have results posted to ClinicalTrials.gov, sponsors violated the reporting law more than 55% of the time.
Among 184 sponsors with at least five trials that were due in late September, 30 failed to meet all deadlines, Science found. For two-thirds of their trials, these "habitual violators" reported nothing at all.
These offenders included Boston Children's Hospital, the University of Minnesota, and Baylor College of Medicine, according to the investigation.
Deborah Zarin, MD, the head of ClinicalTrials.gov from 2005 to 2018, told Science the problem persists because reporting is seen as an "annoying administrative and perhaps legal burden, not a scientific imperative. Human nature being what it is, people follow the requirements when forced to do so."
The reporting rule dates back to 1997, when ClinicalTrials.gov was created. Initially, reporting was required only for trials of treatments for serious or life-threatening diseases. But in 2007, the law was expanded to require reporting for a much broader range of trials within 21 days of enrolling the first patient, and for posting summary results, adverse events, and other data within a year.
A final rule issued by the NIH and FDA in 2017 clarified the law's expectations and penalties -- which can be more than $12,000 per day for late filing -- but enforcement is still lacking.
Big Returns on Healthcare IPOs
Last year was a pretty good one for investors in healthcare companies with initial public offerings, , with two-thirds trading above their opening prices by year-end.
Investing equally in all 68 companies would have yielded a 47% return; for 16 companies, their stock prices doubled.
Many of the companies are biotechs, and several of them benefitted from promising but very early clinical trial data, Axios reported.
Check out the to see the 24 companies that lost value and the 44 that rose.
Google Nabs More Medical Records
Over the past few years, Google has scored access to tens of millions of patient health records in at least three-quarters of U.S. states, and in some cases the company can access personally identifiable health information without the knowledge of patients or doctors, a .
The newspaper previously broke a story about Google's "Project Nightingale," a partnership with Ascension, the Catholic chain of 2,600 hospitals and doctors' offices that offered up information on 50 million patient records.
That story sparked outcry that led to a federal inquiry and objections from patients. Now, the Journal reports that Utah's Intermountain Healthcare signed an agreement to give Google access to patient health records, though an Intermountain spokesperson said the hospital didn't share data that identified patients.
And Mayo Clinic said patient data would remain private and stripped of personal identifiable information when it announced a partnership with Google in September. But neither company disclosed at the time that the contract allows Mayo to share personally identifiable health data in the future, according to the Journal.
David Feinberg, MD, the head of Google Health, insisted the company is motivated by the greater good, not profit: "Google is so good at being helpful," he told the newspaper. "We want to be helpful with knowledge, success, health, and happiness."