Knowledge is Healing

Overuse of antibiotics is blamed for the growth of resistant organisms such as methicillin-resistant Staphylococcus aureus.

Several large grocery store chains with pharmacies have been marketing free 14-day prescriptions of generic versions of the most prescribed antibiotics as a way of helping parents in a flagging economy. Promotions typically run January through March, during the peak of cold and flu season.

The idea is not new. Walker, Mich.-based Meijer began offering free antibiotics -- including amoxicillin and penicillin -- in 2006. But the concept has picked up steam as the economy grows weaker, with more grocery chains jumping on board this winter. Among then are Lakeland, Fla.-based Publix; Giant Food, based in Landover, Md.; Rochester, N.Y.-based Wegmans; and Stop & Shop, based in Quincy, Mass.

Store executives are clear that it's an enticement to draw more customers. But they also say it's a service to families who might otherwise not fill a prescription or see a doctor because of cost concerns.

Parents are already pressuring physicians to give their children antibiotics, even though viruses cause the most common childhood infections, said Wayne Snodgrass, MD, PhD, chair of the committee on drugs for the American Academy of Pediatrics and professor of pediatrics and pharmacology at University of Texas Medical Branch at Galveston. Offers of free medication will probably even more pressure.

While the programs have the potential to place physicians in the unwitting position of law enforcement officials, several physician organizations, including the American Medical Association, have expressed support for them. They feel the programs could be a tool for physicians to identify patients in need of help.

According to Sherry Green, executive director of the National Alliance for Model State Drug Laws, there are 38 states with laws authorizing monitoring programs and 32 that have a program up and running. The number of states with monitoring programs has more than doubled since 2002 when the U.S. Dept. of Justice made grants available to create programs.

Under the programs, states create Web sites on which pharmacists report controlled substance prescriptions that are filled. Physicians can gain access to the site to identify possible doctor shoppers or addicts, or even those who might be involved in illegal drug diversion.

Jeanine Freeman, senior vice president of legal affairs for the Iowa Medical Society, said when Iowa received a grant to create a drug monitoring program two years ago the medical society's initial concern was that the program would be established under grant only with no statutory requirement.

A former billing clerk at Cedars-Sinai Medical Center in Los Angeles was arrested in November 2008 and charged with stealing patient records and using the identities to steal from insurers.

James Allen Wilson, whose job authorized him to access to the hospital's electronic medical record system, allegedly set up a fake lab company then used stolen information from patient files to bill insurers. Investigators say the scheme netted Wilson at least $69,000, an amount expected to grow as the investigation continues.

Jane Robison, spokeswoman for the Los Angeles County District Attorney's office, said an insurer brought the alleged violations to the attention of investigators, who then alerted the hospital.

Investigators visited Wilson's home and found the records of more than 1,000 patients and actual workers' compensation claims, police said. The hospital sent letters to all patients involved alerting them to the scheme and advising them that it did not appear the stolen information was being used for anything besides the insurance fraud.

The investigation looked into charges the company awarded stock options with a strike price that was tied to the date of its lowest 52-week share price -- rather than to the price on a specified single date -- and did not tell investors of this arrangement.

The SEC said that practice allowed United executives to have stock options worth far more than they would have been otherwise.

The SEC cited United's "extraordinary cooperation in the commission's investigation, as well as its extensive remedial measures" as reasons the company was not charged with fraud, and why it could settle for nothing on charges it violated the reporting, books and records, and internal controls provisions of the federal securities laws. United did not admit or deny guilt.

United, the SEC said, had recouped nearly $1.8 billion in cash and stock-option value through litigation, annulment of options and other means. The company also shared details of its own backdating investigation with the SEC, the agency said.

United instituted controls to ensure backdating would not occur again, the SEC said. Also, United removed senior executives and board members who were deemed complicit, the agency said.

After three years of lobbying, debate and discussion, the National Conference of Insurance Legislators at its annual meeting on Nov. 23, 2008, adopted a model law governing network rentals. It was supported by the American Medical Association.

Susan Nolan, NCOIL executive director, said many states are set to consider network rental rules in 2009. "We felt like we really provided a model when folks needed it."

Jordan Estey, NCOIL director of legislative affairs & education, said five states -- Connecticut, Colorado, Florida, Indiana and Ohio -- over the past two years have passed laws governing third-party network access that are similar to the model adopted by NCOIL.

The model requires that insurers disclose to doctors accurate information when a contract is accessed by a third party and bars unauthorized use of network discounts.

Under the model law, the third party renting a network must abide by the terms of the original contract, and physicians have a right to deny discounts to insurers who don't follow those rules. That means that a third-party insurer who gets access to a network discount for a physician must also direct patients to the physician as if he or she were in-network and generally grant him the benefits of a network physician.

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