5 ms·

Practice Fusion to pay $145M for taking kickbacks aimed at increasing opioid use

71 points by JshWright 7y ago

JshWright 7y ago
It's hard to put into words how angry I am about this. These sorts of things don't happen by accident. I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot...
- tempsy 7y ago
  These alerts were probably configured on some admin panel that was already built and didn’t require an engineer to be involved.
  - JshWright 7y ago
    That's certainly possible, but it's not likely (in my experience working with CDS features). These sorts of alerts are pulling data from all sorts of different places, and there's generally at least some engineering effort involved in setting up new "categories" of alerts like this.
    - tempsy 7y ago
      it doesn’t sound like it was a new category...just some new piece of logic that would trigger “prescribe opioids!” when the doctor typed something in why would you think these sham alerts rely on actual data that was “new”? these were probably as simple as some if statement that said “if patient over X age and in pain and lives in Y state then show alert”
      - hermitdev 7y ago
        The sad thibg about this whole opioid epidemic is that people such as myself, who actually suffer from chronic pain can't get relief. Not that opioids would help me, wrong kind of pain. I suffer from nerve pain which requires a whole other class of drugs, but the docs dont want to prescribe anything anymore, even non opioids. It fucking sucks, degrades my quality of life and ability to carry out day to day tasks.
      - JshWright 7y ago
        My guess is it's the "in pain" part that would require some engineering effort to expose as an option inside the CDS dashboard (assuming such a dashboard existed). Obviously none of us know how this was implemented, and it's possible PF had a slick CDS design tool that was super powerful and made these sorts of things easy. That's never been my experience though...
- bb611 7y ago
  Working in the Bay Area, I'm sure I've had more colleagues who would implement this than would not. That's even though I've specifically chosen to work at companies that emphasize the importance of social good in their business. Most people come to work for a paycheck, and the perceived cost to them of shaking up that paycheck (even just to get a new job) is very high.
  - toomuchtodo 7y ago
    How do you make the cost for them lower to make the right decision? Or make the amount of pain higher for making the immoral one?
- onetimemanytime 7y ago
  >>I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot... Shall we go down the list of horrible and unethical things engineers have built over millennia, so we settle this once in for all? If you quit, someone else will do it
  - firstplacelast 7y ago
    And this is why drug traffickers should not be punished. If they don't do it, someone else will. It is the people on the receiving ends, the ones that take the kickbacks and the ones that take the drugs, that should be punished.
  - sitkack 7y ago
    We don't know how many quit to get to the worker that implemented this. The thing is, it doesn't stop with the first person that quits, it goes forward with the first person that says "yes".
- astura 7y ago
  Because when an engineer gets a big list of the alerts he or she must implement some aren't labeled "*illegal kickback scheme to get doctors to prescribe medically unnecessary medication for profit," it looks like any other requirement. Making things look legit to others outside of the scheme is important to successfully pulling off the scheme. Even if an individual engineer suspected the opioid recommendation alerts were medically unnecessary, medically unnecessary tests and treatments are very common [1], so it wouldn't exactly stand out as "probaby an illegal kickback scheme." [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...
  - JumpCrisscross 7y ago
    > Because when an engineer gets a big list Let’s not be naive. The list is big. But elements are incriminating. If you implement them, you are morally—and eventually, legally—responsible.
  - kerkeslager 7y ago
    As a software engineer: a lot of what I do is understanding the context of what I'm doing. When I'm writing code, I'm trying to grok how the business users think about the business objects and business logic. I get a story that says, "As a user, when I press the H key I want a horn to play." And I go into the planning meeting and ask, "Is this like a bike horn?" And they say yeah! And I ask, okay, so when I press the key, do you want the horn to sound on key down, or key up? And they say, "How about it starts playing on key down, and stops playing on key up?" And then I say, "do you want different volumes, for let's say when they are on their bike and just want to politely let someone know they are there, versus when they're about to get hit by a truck?" And they say, "yes, eventually, but being able to play the horn at different notes is a higher priority." And then I ask, "wait, why is that useful for a bike horn?" And then they explain that they're going to be playing the horn as part of an orchestra. And then by the end of the conversation I realize the horn I'm implementing is a French horn midi keyboard, not a bicycle horn traffic signal, and the requirements are completely different. I don't really buy this idea that people are just writing single, isolated requirements out of context.
- W-Stool 7y ago
  Money. Most of the shady practices going on in the world today and a thousand years ago end up being about money. Even the software engineers who implemented this ghastly thing - they needed the job and the money the job pays so "OK, yeah, I'll do it".
- ummonk 7y ago
  How about A/B testing for increases in usage, ads-clicks, subscription signups, and lack of subscription cancellations? How about PR consisting pretty much of finding favorable journalists who will provide positive pre-vetted coverage of feature launches? How about VC-fueled price-dumping to squash competition and build a monopoly? How about paying phone manufacturers, browsers, etc. to become preloaded apps or default search engines? The impacts aren't nearly as harmful in tech as in pharmaceuticals, but there are a lot of practices in our industry which we all accept as normal procedure but would seem very ethically questionable to an outsider.
onetimemanytime 7y ago
>>"Practice Fusion’s conduct is abhorrent. During the height of the opioid crisis, the company took a million-dollar kickback to allow an opioid company to inject itself in the sacred doctor-patient relationship so that it could peddle even more of its highly addictive and dangerous opioids,” Christina Nolan, U.S. Attorney for the District of Vermont, said in a statement. So where is jail time for the entire decision-making team?
- tempsy 7y ago
  I can’t help but laugh at the cofounder’s LinkedIn page: https://www.linkedin.com/in/matthewcdouglass https://www.linkedin.com/in/matthewcdouglass Very first line: I dig: socially responsible company-building
  - shadow-banned 7y ago
    WOW. I almost sent him a DM... it won't accomplish anything.
- svskeptic 7y ago
  Don't forget the board. Its their responsibility to oversee the executive team. A deal this size/strategic was likely discussed at board level. All those VCs trying to change the world... for the better! /s
- jhhh 7y ago
  Likely nothing will happen to them. It's a combination of several factors: Courts removed DOJ's legal tools they used to go after individuals (Skilling). DOJ started allowing companies to hire law firms to investigate themselves for wrongdoing because it was easier than doing an investigation. Also, it created a revolving door between the white collar legal community. Culture change at DOJ after a pushback from said white collar legal community after flattening Arthur Anderson hilariously punctuated by the hiring in Obama's first term of Denis McInerney as the DOJ Chief of Fraud after he represented Arthur Anderson. Several high profile losses: Skilling (again), Bear Sterns execs, AIG execs. Everyone should just read Chickenshit Club.
shadow-banned 7y ago
I wonder, and I am not trying to be a smart-ass here, if this is the first case of a growth hack (some sort of push notification/alert) that actually lead to someone's death.
cortesoft 7y ago
Are they going after the opioid companies, too?
- gameshot911 7y ago
  Yes - https://www.npr.org/2020/01/23/798973304/pharmaceutical-executive-john-kapoor-sentenced-to-66-months-in-prison-in-opioid https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec...
throw03172019 7y ago
Didn’t they get bought for $100M just a year ago? I wonder what kind of holdback they had? This is a big payment unless AllScripts knew it was coming.
- acct_toss_away 7y ago
  I was employed there during the acquisition. It was certainly expected and priced in. Management successfully managed to unload a hot potato while getting a nice carve out for themselves.
breck 7y ago
One of the research projects I am working on is an open source medical records system for patient owned medical records. I hadn’t considered deeply how the design of any EHR system will always include biases of some sort that will influence the behavior of patients and providers. This is a sad event but definitely will be a good learning experience for those in the EHR design world.
sbr464 7y ago
Stuff gets deep quickly. Like movies like “The Hurt Locker”? Well say hello to Sackler family opioid money. It’s interesting to see how deep in pop society opioid money made it.
simonw 7y ago
Someone's been editing Wikipedia: https://en.wikipedia.org/w/index.php?title=Practice_Fusion&type=revision&diff=937934215&oldid=922185266 https://en.wikipedia.org/w/index.php?title=Practice_Fusion&t...
Iv 7y ago
When is someone going to jail over this kind of things?
olliej 7y ago
Are they going after the companies that were paying the kickbacks? They’re just as, if not more, culpable
trhway 7y ago
>in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products. in near future they will start to use AI and nobody would be able to tell where the specific opioid bias crawled in from, and even if the lineage of the biased decisions is successfully established it would be from some innocent facts/rules/data.
anticodon 7y ago
Since US invasion in Afghanistan, opium production had grown multiple times in Afghanistan. Of course, there will be never an investigation or any evidence dug up (just like there're no investigation of US war crimes), but I sense that these two events are tightly related and the root of all this is very very deep. So deep that noone ever will be ever dig up the truth.
- iknowalot 7y ago
  We invaded Afghanistan only a few months after the Taliban made opium illegal to produce (due to some religious reasoning)...very suspicious when you look at our history of peddling opioids as a nation.
kerkeslager 7y ago
> In separate civil settlements, Practice Fusion has agreed to pay approximately $118.6 million to the federal government and states to resolve allegations that it accepted kickbacks from the opioid company and other pharmaceutical companies and also caused its users to submit false claims for federal incentive payments by misrepresenting the capabilities of its EHR software. > Of that $118.6 million, $113.4 million will be paid to the federal government and up to $5.2 million to states that opt to participate in separate state agreements. So, nothing was taken from the personal bank accounts of the people who made these decisions, and nobody went to jail. That is to say, nothing was done about this. The takeaway here is that you can murder people for money and as long as you do it behind the paperwork of a large corporation, you can get away with it. The only people who pay the consequences are shareholders. Sure this incentivizes shareholders to try not to invest in sociopathic execs, but I'm not sure how possible that even is.
moltar 7y ago
There was a great series on opioid epidemic on Freakonomics podcast recently, if you are interested.

71 points by JshWright 7y ago

It's hard to put into words how angry I am about this. These sorts of things don't happen by accident. I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot...

tempsy 7y ago
These alerts were probably configured on some admin panel that was already built and didn’t require an engineer to be involved.
- JshWright 7y ago
  That's certainly possible, but it's not likely (in my experience working with CDS features). These sorts of alerts are pulling data from all sorts of different places, and there's generally at least some engineering effort involved in setting up new "categories" of alerts like this.
  - tempsy 7y ago
    it doesn’t sound like it was a new category...just some new piece of logic that would trigger “prescribe opioids!” when the doctor typed something in why would you think these sham alerts rely on actual data that was “new”? these were probably as simple as some if statement that said “if patient over X age and in pain and lives in Y state then show alert”
    - hermitdev 7y ago
      The sad thibg about this whole opioid epidemic is that people such as myself, who actually suffer from chronic pain can't get relief. Not that opioids would help me, wrong kind of pain. I suffer from nerve pain which requires a whole other class of drugs, but the docs dont want to prescribe anything anymore, even non opioids. It fucking sucks, degrades my quality of life and ability to carry out day to day tasks.
    - JshWright 7y ago
      My guess is it's the "in pain" part that would require some engineering effort to expose as an option inside the CDS dashboard (assuming such a dashboard existed). Obviously none of us know how this was implemented, and it's possible PF had a slick CDS design tool that was super powerful and made these sorts of things easy. That's never been my experience though...
bb611 7y ago
Working in the Bay Area, I'm sure I've had more colleagues who would implement this than would not. That's even though I've specifically chosen to work at companies that emphasize the importance of social good in their business. Most people come to work for a paycheck, and the perceived cost to them of shaking up that paycheck (even just to get a new job) is very high.
- toomuchtodo 7y ago
  How do you make the cost for them lower to make the right decision? Or make the amount of pain higher for making the immoral one?
onetimemanytime 7y ago
>>I don't understand how someone gets asked to build this "feature" and they don't just quit on the spot... Shall we go down the list of horrible and unethical things engineers have built over millennia, so we settle this once in for all? If you quit, someone else will do it
- firstplacelast 7y ago
  And this is why drug traffickers should not be punished. If they don't do it, someone else will. It is the people on the receiving ends, the ones that take the kickbacks and the ones that take the drugs, that should be punished.
- sitkack 7y ago
  We don't know how many quit to get to the worker that implemented this. The thing is, it doesn't stop with the first person that quits, it goes forward with the first person that says "yes".
astura 7y ago
Because when an engineer gets a big list of the alerts he or she must implement some aren't labeled "*illegal kickback scheme to get doctors to prescribe medically unnecessary medication for profit," it looks like any other requirement. Making things look legit to others outside of the scheme is important to successfully pulling off the scheme. Even if an individual engineer suspected the opioid recommendation alerts were medically unnecessary, medically unnecessary tests and treatments are very common [1], so it wouldn't exactly stand out as "probaby an illegal kickback scheme." [1] https://www.propublica.org/article/unnecessary-medical-care-is-more-common-than-you-think https://www.propublica.org/article/unnecessary-medical-care-...
- JumpCrisscross 7y ago
  > Because when an engineer gets a big list Let’s not be naive. The list is big. But elements are incriminating. If you implement them, you are morally—and eventually, legally—responsible.
- kerkeslager 7y ago
  As a software engineer: a lot of what I do is understanding the context of what I'm doing. When I'm writing code, I'm trying to grok how the business users think about the business objects and business logic. I get a story that says, "As a user, when I press the H key I want a horn to play." And I go into the planning meeting and ask, "Is this like a bike horn?" And they say yeah! And I ask, okay, so when I press the key, do you want the horn to sound on key down, or key up? And they say, "How about it starts playing on key down, and stops playing on key up?" And then I say, "do you want different volumes, for let's say when they are on their bike and just want to politely let someone know they are there, versus when they're about to get hit by a truck?" And they say, "yes, eventually, but being able to play the horn at different notes is a higher priority." And then I ask, "wait, why is that useful for a bike horn?" And then they explain that they're going to be playing the horn as part of an orchestra. And then by the end of the conversation I realize the horn I'm implementing is a French horn midi keyboard, not a bicycle horn traffic signal, and the requirements are completely different. I don't really buy this idea that people are just writing single, isolated requirements out of context.
W-Stool 7y ago
Money. Most of the shady practices going on in the world today and a thousand years ago end up being about money. Even the software engineers who implemented this ghastly thing - they needed the job and the money the job pays so "OK, yeah, I'll do it".
ummonk 7y ago
How about A/B testing for increases in usage, ads-clicks, subscription signups, and lack of subscription cancellations? How about PR consisting pretty much of finding favorable journalists who will provide positive pre-vetted coverage of feature launches? How about VC-fueled price-dumping to squash competition and build a monopoly? How about paying phone manufacturers, browsers, etc. to become preloaded apps or default search engines? The impacts aren't nearly as harmful in tech as in pharmaceuticals, but there are a lot of practices in our industry which we all accept as normal procedure but would seem very ethically questionable to an outsider.

onetimemanytime 7y ago

>>"Practice Fusion’s conduct is abhorrent. During the height of the opioid crisis, the company took a million-dollar kickback to allow an opioid company to inject itself in the sacred doctor-patient relationship so that it could peddle even more of its highly addictive and dangerous opioids,” Christina Nolan, U.S. Attorney for the District of Vermont, said in a statement. So where is jail time for the entire decision-making team?

tempsy 7y ago
I can’t help but laugh at the cofounder’s LinkedIn page: https://www.linkedin.com/in/matthewcdouglass https://www.linkedin.com/in/matthewcdouglass Very first line: I dig: socially responsible company-building
- shadow-banned 7y ago
  WOW. I almost sent him a DM... it won't accomplish anything.
svskeptic 7y ago
Don't forget the board. Its their responsibility to oversee the executive team. A deal this size/strategic was likely discussed at board level. All those VCs trying to change the world... for the better! /s
jhhh 7y ago
Likely nothing will happen to them. It's a combination of several factors: Courts removed DOJ's legal tools they used to go after individuals (Skilling). DOJ started allowing companies to hire law firms to investigate themselves for wrongdoing because it was easier than doing an investigation. Also, it created a revolving door between the white collar legal community. Culture change at DOJ after a pushback from said white collar legal community after flattening Arthur Anderson hilariously punctuated by the hiring in Obama's first term of Denis McInerney as the DOJ Chief of Fraud after he represented Arthur Anderson. Several high profile losses: Skilling (again), Bear Sterns execs, AIG execs. Everyone should just read Chickenshit Club.

shadow-banned 7y ago

I wonder, and I am not trying to be a smart-ass here, if this is the first case of a growth hack (some sort of push notification/alert) that actually lead to someone's death.

cortesoft 7y ago

Are they going after the opioid companies, too?

gameshot911 7y ago
Yes - https://www.npr.org/2020/01/23/798973304/pharmaceutical-executive-john-kapoor-sentenced-to-66-months-in-prison-in-opioid https://www.npr.org/2020/01/23/798973304/pharmaceutical-exec...

throw03172019 7y ago

Didn’t they get bought for $100M just a year ago? I wonder what kind of holdback they had? This is a big payment unless AllScripts knew it was coming.

acct_toss_away 7y ago
I was employed there during the acquisition. It was certainly expected and priced in. Management successfully managed to unload a hot potato while getting a nice carve out for themselves.

breck 7y ago

One of the research projects I am working on is an open source medical records system for patient owned medical records. I hadn’t considered deeply how the design of any EHR system will always include biases of some sort that will influence the behavior of patients and providers. This is a sad event but definitely will be a good learning experience for those in the EHR design world.

sbr464 7y ago

Stuff gets deep quickly. Like movies like “The Hurt Locker”? Well say hello to Sackler family opioid money. It’s interesting to see how deep in pop society opioid money made it.

simonw 7y ago

Someone's been editing Wikipedia: https://en.wikipedia.org/w/index.php?title=Practice_Fusion&type=revision&diff=937934215&oldid=922185266 https://en.wikipedia.org/w/index.php?title=Practice_Fusion&t...

Iv 7y ago

When is someone going to jail over this kind of things?

olliej 7y ago

Are they going after the companies that were paying the kickbacks? They’re just as, if not more, culpable

trhway 7y ago

>in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products. in near future they will start to use AI and nobody would be able to tell where the specific opioid bias crawled in from, and even if the lineage of the biased decisions is successfully established it would be from some innocent facts/rules/data.

anticodon 7y ago

Since US invasion in Afghanistan, opium production had grown multiple times in Afghanistan. Of course, there will be never an investigation or any evidence dug up (just like there're no investigation of US war crimes), but I sense that these two events are tightly related and the root of all this is very very deep. So deep that noone ever will be ever dig up the truth.

iknowalot 7y ago
We invaded Afghanistan only a few months after the Taliban made opium illegal to produce (due to some religious reasoning)...very suspicious when you look at our history of peddling opioids as a nation.

kerkeslager 7y ago

> In separate civil settlements, Practice Fusion has agreed to pay approximately $118.6 million to the federal government and states to resolve allegations that it accepted kickbacks from the opioid company and other pharmaceutical companies and also caused its users to submit false claims for federal incentive payments by misrepresenting the capabilities of its EHR software. > Of that $118.6 million, $113.4 million will be paid to the federal government and up to $5.2 million to states that opt to participate in separate state agreements. So, nothing was taken from the personal bank accounts of the people who made these decisions, and nobody went to jail. That is to say, nothing was done about this. The takeaway here is that you can murder people for money and as long as you do it behind the paperwork of a large corporation, you can get away with it. The only people who pay the consequences are shareholders. Sure this incentivizes shareholders to try not to invest in sociopathic execs, but I'm not sure how possible that even is.

moltar 7y ago

There was a great series on opioid epidemic on Freakonomics podcast recently, if you are interested.