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Tuesday, 04 October, 2016

Healthy Debate: Wells Fargo and CMS

Recent headlines and Congressional attention has focused on Wells Fargo and the use of incentives to promote the sales of accounts. Staff opened accounts in many customers names and then proceeded to charge those customers fees for these accounts - accounts that the customers didn’t want or know about.


Now Congress is investigating Wells Fargo and folks want the bank’s leaders to be punished. They want the Board of Directors and senior management to be held responsible and “own” the misbehavior of the employees because while they did not perform the actions nor did they tell the employees to act dishonestly, the higher ups are still responsible.


In heath care we have the same thing minus headlines and Congressional investigations. The Medicare program embodied in the Centers for Medicare and Medicaid Services (CMS) imposes policy changes often times with short notice and mandates Medicare patients participate in experiments and other endeavors.  Providers have very strong and often inappropriate incentives to participate in these experiments.


The agency often ignores valid public comment and criticism implementing policy changes anyway. In addition, many of the provisions the agency is implementing now are precluded from administrative or judicial review.  Simply put, there’s no way to correct a wrong. When we have an agency such as the CMS that ignores public comment, particularly when there is no appeal right, the agency must “own” the effects of the incentives of its policies. Accordingly, it is the agency that bears some responsibility for the effects of its policies – yet there is no oversight or remedy since there is no appeal.



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