fine signals no immunity for multinationals
Chinaâ€™s decision to impose a record fine on GlaxoSmithKline Plc signals that
even the largest multinationals may not get off lightly in government
investigations in Asiaâ€™s largest economy.
China on Sept. 19 fined Glaxo almost $500 million after a bribery
investigation that had lasted almost 15 months and fueled declines in the
pharmaceutical companyâ€™s local sales.
The Glaxo ruling comes after a spate of Chinese antitrust investigations
into global companies have drawn protests from international trade groups,
who warned that the scrutiny could undermine the countryâ€™s appeal. The fine
is a setback for Glaxo in China and shows the need for multinationals to
ensure that business practices conform to the Chinese legal system, said
James Roy, associate principal at China Market Research Group in Shanghai.
The Intermediate Peopleâ€™s Court in the city of Changsha in Hunan Province
imposed the fine on Glaxo for bribing non-government personnel, the U.K.
drugmaker said in a statement. It published an apology to Chinaâ€™s government
and pledged to reform its practices.
China is widening graft investigations after President Xi Jinping warned
that corruption threatens the Communist Partyâ€™s six-decade hold on power.
Xiâ€™s anti-corruption campaign has snared thousands of party officials of all
levels. In July former security chief and politburo Standing Committee
member Zhou Yongkang was taken down and in June the campaign claimed Xu
Caihou, a former vice chairman of the Central Military Commission, the
countryâ€™s highest military body.
Foreign companies are still unlikely to be deterred from investing and will
focus on the potential to make profits in China when making their decisions,
While the Glaxo case will be a â€śfactorâ€ť in how multinationals view China,
their decisions to make investments in the country will be driven mainly by
the ability to make profits, he said. â€śYouâ€™re still seeing continued
investments from foreign companies -- itâ€™s dropping but the ones that are
successful here are continuing to invest and open up new facilities.â€ť
Visit Bloomberg for the full report.
after Sierra Leone shutdown ends
Streets in Sierra Leone's capital bustled again Monday after an
unprecedented nationwide shutdown during which officials said more than 1
million households were checked for Ebola patients and given information on
the deadly disease.
But it remained unclear if the three-day effort would help curb the spread
of a disease that is blamed for the deaths of more than 2,600 people in West
Africa. Authorities have not yet said how many new suspected cases were
discovered over the three days, but at least 71 bodies were buried during
Joe Amon, director of health and human rights for Human Rights Watch, said
there was little reason to believe the lockdown had been effective in ending
transmission since such measures are so hard to enforce.
Teams carrying soap and information about Ebola reached about 75 percent of
1.5 million households in this nation, the health ministry said. Some
residents complained of food shortages, as others sat out on verandas.
Rumors that the soap being distributed had been poisoned called into
question the education efforts.
More than 560 people are believed to have died from the dreaded disease in
Sierra Leone, a nation of 6 million people. Ebola has also spread rampantly
through Liberia and Guinea and a limited number of cases have been reported
in Nigeria and one in Senegal.
Treatment centers are overwhelmed with patients almost as soon as they're
built and health workers struggle to keep up with monitoring the contacts of
thousands of sick people. So the hardest hit countries have resorted to
extraordinary measures. Liberia has cordoned off entire towns or
neighborhoods, and Sierra Leone's nationwide shutdown was a first.
The World Health Organization has not said clearly whether it supports such
measures, saying they should only be undertaken if people's rights are
protected and the measures are proportionate and evidence-based. But so much
in this outbreak is new â€” from its large geographic spread to the number of
people infected to the government response â€” that evidence on the best way
to contain it is scarce.
The U.N. health agency has, however, repeatedly said that the border
closures and flight bans many countries have put in place to protect
themselves from Ebola are counterproductive. It reiterated on Monday that
such restrictions are hindering "relief and response efforts, risking
further international spread."
Later Monday, Sierra Leone officials are expected to announce how many cases
of Ebola were found during the three-day shutdown and how many dead were
discovered. The government has ordered tents for temporary treatment centers
to make room for any new cases discovered, said Abdulai Bayraytay, a
The scale of the outbreak â€” Ebola is believed to have infected more than
5,500 people â€” has strained the resources of countries with poor health
systems in the best of times. Liberia, which has been hardest hit by the
disease, opened its largest Ebola clinic to date on Sunday.
No sooner had the ceremony to open the 150-bed center ended than ambulances
rushed there with patients. Because there are too few beds to treat patients
and too few ambulances to pick them up, people wait hours or even days
before being taken to hospitals. Ambulances are often packed with several
patients, said William Ross, a first responder in Monrovia, and many die on
the way to the hospital.
The outbreak has also suffered from a lack of doctors and nurses trained to
treat Ebola patients, numbers that have been further depleted by the
unprecedented number of infections in health workers. More than 300 have
been infected, and about half of those have died. A Spanish priest who
became infected while serving as a medical director for a hospital in Sierra
Leone was flown back to Spain on Monday. (Associated Press)
Visit the Houston Chronicle for the article.
advise against travel or trade bans on Ebola-hit Africa
Independent health advisers to the World Health Organization (WHO) have
assessed that there should be no general ban on travel or trade with
countries reeling from an Ebola epidemic in West Africa, the U.N. agency
said on Monday.
Some airlines have stopped flights to affected areas and WHO and other
agencies have said this has hampered aid efforts and the ability of experts
to reach victims of the world's worst ever outbreak of the hemorrhagic
In a statement issued after the Emergency Committee held its second meeting
last week, the WHO said Ebola had now killed at least 2,793 people in five
countries and remains a "public health emergency of international concern".
"Flight cancellations and other travel restrictions continue to isolate
affected countries, resulting in detrimental economic consequences, and
hinder relief and response efforts risking further international spread,"
the statement said. "The Committee strongly reiterated that there should be
no general ban on international travel or trade..."
The experts urged authorities in the affected countries - Guinea, Liberia,
Nigeria, Senegal and Sierra Leone - to work with the aviation and maritime
sectors to resolve differences and "develop a coordinated response" to
Quarantines may be deemed necessary in areas of intense and widespread
transmission of the deadly Ebola virus, the committee statement went on.
"States should ensure that they are proportionate and evidence-based and
that accurate information, essential services and commodities, including
food and water, are provided to the affected populations."
WHO advisers earlier recommended the screening of travellers departing
Ebola-affected countries from airports and ports.
The committee, composed of some 20 experts who advise WHO Director-General
Margaret Chan, declared on Aug. 8 that the epidemic constituted a public
health emergency of international concern. The medical charity Medecins Sans
Frontieres has warned since late March that the outbreak, which began in the
remote Gueckedou area of southeastern Guinea, is "unprecedented".
Sierra Leoneans on Sunday celebrated the end of a three-day lockdown meant
to stem Ebola's reach, with authorities saying the move had identified
dozens of new infections and located scores of bodies.
Separately on Monday, the WHO said two of the five affected countries -
Nigeria and Senegal - were managing to halt the spread of the disease.
Visit Reuters for the story.
Obama hits at
companies moving overseas to avoid taxes
The Obama administration took action Monday to discourage corporations from
moving their headquarters abroad to avoid U.S. taxes, announcing new rules
designed to make such transactions significantly less profitable. The rules,
which take effect immediately, will make it harder for U.S. firms to bring
cash earned abroad back to the United States tax-free and to take advantage
of other benefits of foreign relocation.
But the rules would not block the practice, known as tax â€śinversion,â€ť and
Treasury Secretary Jack Lew again called on Congress to enact more
â€śThese first, targeted steps make substantial progress in constraining the
creative techniques used to avoid U.S. taxes, both in terms of meaningfully
reducing the economic benefits of inversions after the fact, and when
possible, stopping them altogether,â€ť Lew said in a written statement.
Visit the Washington Post for the report.
surprise $117,000 medical bill from doctor he didnâ€™t know
Before his three-hour neck surgery for herniated disks in December, Peter
Drier, 37, signed a pile of consent forms. A bank technology manager who had
researched his insurance coverage, Drier was prepared when the bills started
arriving: $56,000 from Lenox Hill Hospital in Manhattan, $4,300 from the
anesthesiologist and even $133,000 from his orthopedist, who he knew would
accept a fraction of that fee.
He was blindsided, though, by a bill of about $117,000 from an â€śassistant
surgeon,â€ť a Queens-based neurosurgeon whom Drier did not recall meeting.
In operating rooms and on hospital wards across the country, physicians and
other health providers typically help one another in patient care. But in an
increasingly common practice that some medical experts call drive-by
doctoring, assistants, consultants and other hospital employees are charging
patients or their insurers hefty fees. They may be called in when the need
for them is questionable. And patients usually do not realize they have been
involved or are charging until the bill arrives.
The practice increases revenue for physicians and other healthcare workers
at a time when insurers are cutting down reimbursement for many services.
The surprise charges can be especially significant because, as in Drierâ€™s
case, they may involve out-of-network providers who bill 20 to 40 times the
usual local rates and often collect the full amount, or a substantial
â€śThe notion is you can make end runs around price controls by increasing the
number of things you do and bill for,â€ť said Dr. Darshak Sanghavi, a health
policy expert at the Brookings Institution until recently. This contributes
to the nationâ€™s $2.8 trillion in annual health costs.
Insurers, saying the surprise charges have proliferated, have filed lawsuits
challenging them. In recent years, unexpected out-of-network charges have
become the top complaint to the New York State agency that regulates
insurance companies. Multiple state health insurance commissioners have
tried to limit patientsâ€™ liability, but lobbying by the health care industry
sometimes stymies their efforts.
In Drierâ€™s case, the primary surgeon, Dr. Nathaniel L. Tindel, had said he
would accept a negotiated fee determined through Drierâ€™s insurance company,
which ended up being about $6,200. (Drier had to pay $3,000 of that to meet
his deductible.) But the assistant, Dr. Harrison T. Mu, was out of network
and sent the $117,000 bill. Insurance experts say surgeons and assistants
sometimes share proceeds from operations, but Dr. Tindelâ€™s office says he
and Dr. Mu do not.
The phenomenon can take many forms. In some instances, a patient may be
lying on a gurney in the emergency room or in a hospital bed, unaware that
all of the people in white coats or scrubs who turn up at the bedside will
charge for their services. At times, a fully trained physician is called in
when a resident or a nurse, who would not charge, would have sufficed.
Services that were once included in the daily hospital rate are now often
provided by contractors, and even many emergency rooms are staffed by
out-of-network physicians who bill separately.
When insurers intervene in a particular case, they say they have limited
ability to fight back. Insurance examiners â€śare not in the room on the day
of surgery to see the second surgeon walk into the room or why they were
needed,â€ť said Clare Krusing, a spokeswoman for Americaâ€™s Health Insurance
Plans, an industry group. And current laws do not require hospitals that
join an insurance network to provide in-network doctors, labs or X-rays, for
When out-of-network physicians perform hospital procedures, hefty charges
can be added to medical bills. Insurers often pay the full amount or large
portions, which provides an incentive for doctors to include out-of-network
So sometimes insurers just pay â€” to protect their customers, they say â€”
which encourages the practice. When Drier complained to his insurer, Anthem
Blue Cross Blue Shield, that he should not have to pay the out-of-network
assistant surgeon, Anthem agreed it was not his responsibility. Instead, the
company cut a check to Dr. Mu for $116,862, the full amount.
The rate of spinal surgery in the United States is about twice that in
Europe and Canada, and five times that in Britain, said Dr. Richard A. Deyo
of Oregon Health and Science University, who studies international
comparisons. Studies are limited but have generally concluded that after two
years, patients who have surgery for disk problems do no better than those
treated with painkillers and physical therapy â€” although the pain, which can
be debilitating, resolves far more rapidly with surgery.
The United States has more neurosurgeons per capita than almost any other
developed country, and they compete with orthopedists for spinal surgery. At
the same time, Medicare and private insurers have reduced payments to
surgeons. The average base salary for neurosurgeons decreased to $590,000 in
2014 from $630,000 in 2010, according to Merritt Hawkins, a physician
To counter that trend, some spinal surgeons have turned to consultants â€”
including a Long Island company called Business Dynamics RCM and a
subsidiary, the Business of Spine â€” that offer advice on how to increase
revenue through â€śinnovativeâ€ť coding, claim generation and collection
Some strategies used by surgeons, including billing large amounts for a
second surgeon in the room or declaring an operation an emergency, raise
serious questions. The indications for immediate spinal surgery, such as
loss of bladder function or rapidly progressive paralysis, are rare. But
insurers are more likely to reimburse a hospital or surgeon with whom they
do not have a contract if a case is labeled an emergency.
Drierâ€™s concern about extra charges began even during his preoperative
physical. The hospital sent his blood tests to an out-of-network lab and
required him to have an echocardiogram (eventually billed for $950), even
though he had no cardiac history. His worries escalated as he lay prepped
for the operating room on the morning of his surgery. A technician from a
company called Intraoperative Monitoring Service L.L.C. asked him to sign a
financial consent form, noting that the company did not accept Blue Cross
Blue Shield plans, so he would be required to pay the bill himself. The
monitoring had been ordered by his surgeon and is considered essential for
the type of neurosurgery he was having, to make sure delicate nerves are not
damaged as they are manipulated.
In the operating room, he underwent a procedure called spinal fusion, in
which the surgeons removed two herniated disks that were impinging on
nerves, and inserted some bone graft as well as plates and screws to
stabilize the spine. On his hospital bill, Mr. Drier noted charges for three
implants, a total of about $10,400, as well as for two surgical screws
billed at $2,470 and $3,990 â€” expensive for hardware, he thought, but his
insurer paid the full amount.
The biggest surprise was the bill from Dr. Mu, the assistant surgeon.
Fusions generally require a second trained pair of hands, but those can be
provided by a resident or a neurosurgical nurse or physician assistant
employed by the hospital, for whom there is no additional charge. The
operative record for Drierâ€™s surgery states that no qualified resident was
In Drierâ€™s case, each surgeon billed for each step of the procedure. Dr.
Tindel billed $74,000 for removing two disks and an additional $50,000 for
placing the hardware that stabilized Drierâ€™s spine. Dr. Mu billed $67,000
and $50,000 for those tasks.
If the surgery had been for a Medicare patient, the assistant would have
been permitted to bill only 16 percent of the primary surgeonâ€™s fee. With
current Medicare rates, that would have been about $800, less than 1 percent
of what Dr. Mu was paid.
Unexpected fees are routinely generated outside the operating room as well.
On the wards, a dermatologist may be called in to examine a rash and perform
an expensive biopsy. The person in scrubs who walks a patient to a bathroom
for the first time after hip surgery may turn out to be a physical therapist
Dr. Abeel A. Mangi, a Yale cardiac surgeon, said hospitals often encouraged
extra visits for both billing and legal reasons. He said he was required to
request a physical therapy consult before each discharge, for example, even
if he felt there was no need.
Drier tried to negotiate with the surgeons to divvy up the $117,000 payment
in a way he believed was more fair; he liked Dr. Tindel and felt he was
being underpaid. Drierâ€™s idea, he wrote in an email, was to settle on â€śa
reasonable fee for both the surgeon and assistant and return the rest of the
check to the insurance company/employeesâ€ť of his company. But in July, he
received a threatening letter from Dr. Muâ€™s lawyer noting that he had failed
to forward the $117,000 check. So he sent it along, with regret.
Visit the New York Times for the story.
Jeffrey L. Deal from TRU-D, to participate in Center for Global Health and
Diplomacy Panel discussing Ebola
On Sept. 23, Dr. Jeffrey L. Deal, inventor of TRU-D SmartUVC, an automated
room decontamination device used to eliminate pathogens in health care
settings, will participate as a panelist in a special session on "Mobilizing
a United Corporate and Communications Response to Contain Ebola" as part of
the Center for Global Health and Diplomacy's (GHD) Conference on Creating a
Post-2015 Infrastructure for Development: Challenges, Successes and
Suggestion for the Future. The purpose of the session is to discuss
innovative strategies for the containment of the Ebola virus outbreak in
Deal recently returned from a 10-day mission in Monrovia, Liberia, where he
installed two TRU-D robots, donated by TRU-D SmartUVC LLC, in the Ebola
Treatment Units at JFK and ELWA Hospitals. As a part of the Ebola Task
Force, which also included teams from WHO, the CDC, Doctors Without Borders,
UNICEF and the World Food Programme, Deal worked with many others involved
in the international aid effort while in Liberia. He will join principals
from the CDC Foundation, the UN Foundation and other global health and
political organizations on the CGHD conference panel to share his
experiences in the debate on the international community's current ability
to control the epidemic.
His Excellency Alpha Conde, President of the Republic of Guinea, will lead
the session with a keynote address. After the session concludes, Deal, along
with representatives from TRU-D SmartUVC LLC and other session attendees
will be a part of the NASDAQ closing bell ceremony, where every dollar
donated during that time will be given to the CDC Foundation to support
national and international organizations working to contain Ebola.
TRU-D, short for Total Room Ultraviolet Disinfector, was the first automated
room decontamination system to be used in Africa, and the two devices are
still aiding in the battle against the Ebola virus outbreak. The device
works by using UV-C light energy â€“ generated during a single cycle from a
single, central location in the room â€“ to modify the DNA structure of
pathogens in the room, like Ebola, so that they cannot reproduce. Viruses,
bacteria and spores that cannot reproduce cannot colonize and harm patients.
Both TRU-D units in Liberia were previously released from a 28-month-long
CDC-funded study conducted by the Duke University Prevention Epicenter
Program, the most comprehensive evaluation of the real-world application of
UV-C disinfection to date.
Deal currently serves as director of health studies for Water Missions
International, a nonprofit Christian engineering organization providing
sustainable safe water and sanitation solutions for people in developing
countries and disaster areas. deal holds an anthropology degree, medical
degree, board certifications and three post-doctoral fellowships and has had
a long and distinguished medical career including 30 years as a clinical
instructor at MUSC. His passion for tropical medicine led him to spend time
establishing and working in medical facilities in locations around the world
such as South Sudan, Darfur and finally Tanzania.
For information and links to independent studies on TRU-D, visit
Space Act Agreement with NASA and Jet Propulsion Laboratory
AlloSource, one of the nationâ€™s largest providers of skin, bone and soft
tissue allografts for use in surgical procedures, and the worldâ€™s largest
processor of cellular bone allografts, signed a Space Act Agreement with
National Aeronautics and Space Administration (NASA) and the Jet Propulsion
Laboratory (JPL) to collaborate on microbial research.
AlloSource will leverage technologies developed by NASA/JPL for assembly and
launch operations of various Mars missions --specifically, rapid molecular
microbial burden measurement and genetic inventory cataloging -- to advance
microbial research in tissue processing.
Manufacturerâ€™s Edge, formerly the Colorado Association for Manufacturing and
Technology (CAMT), and NASA are partners on a technology matching and
product development assistance program to help Colorado companies use NASA
resources to spur innovation for new products and processes. AlloSourceâ€™s
participation in the Manufacturerâ€™s Edge program led to this unique
collaboration. JPL, a division of the California Institute of Technology, is
the NASA center that manages the Curiosity Rover mission, which focuses on
assessing a local region on Marsâ€™ surface as a potential habitat for past
The molecular microbial detection technology used in the rigorous pre- and
post-mission testing of the Mars mission spacecraft components provides an
opportunity for AlloSource to evolve microbial testing on donated tissue. In
order for tissue to be safe and suitable for transplant, an array of
intense, specialized scientific testing is required. Tissue is subjected to
microbiological testing at recovery and must be free of specific
microorganisms and contaminants that would preclude tissue from processing
Additional post-processing testing is also required before the tissue is
transplantable. NASA, JPL and AlloSource will share ideas and processes
related to microbiological testing methods and will look for new ways to
rapidly detect the presence of microorganisms.
Visit Allosource for the release.
Medicaid pricing probe by the Justice Department
Manufacturing woes are not the only issue plaguing Ranbaxy Laboratories. The
generic drug maker has been asked by the U.S. Department of Justice to
provide documents on pricing data provided to Medicaid, according to a
filing with the Bombay Stock Exchange.
Specifically, the filing says the feds sent a civil investigative demand,
which Ranbaxy was quick to note is not an allegation of wrongdoing or demand
for compensation. In any event, the drug maker indicated it would â€śfully
cooperate with the civil investigation.â€ť
The disclosure comes amid ongoing difficulties Ranbaxy faces with U.S.
authorities. Last year, the drug maker paid a $500 million fine to U.S.
authorities as part of a settlement that included pleading guilty to two
charges of violating drug safety laws. Meanwhile, a consent decree
stipulating manufacturing requirements remains in effect and the FDA has
banned imports from four plants in India.
Meanwhile, Ranbaxy faces litigation in Texas, where the state attorney
general two years ago filed a lawsuit charging the drug maker with violating
the state Medicaid Fraud Prevention Act. The lawsuit alleges that Ranbaxy
reported false or inflated prices and failed to disclose, or concealed
discounts to the state Medicaid program.
Last month, Ranbaxy set aside about $40 million for an unspecified charge,
although The Economic Times reported that set aside may have pertained to
the Texas litigation, and that the settlement would cover both Medicaid and
manufacturing disputes with the government. A spokesman for the Texas
attorney general says the case is ongoing but declined further comment.
Visit the Wall Street Journal for the report.