How to build a better health system: 8 expert essays

Glen 'Big Baby' Davis Sentenced To 40 Months In Prison For Defrauding NBA Health Care Plan

Former NBA player Glen "Big Baby" Davis was sentenced to 40 months in prison, plus three years' supervised release, by a federal judge on Thursday over his role in an alleged scheme to defraud the league's health care benefits plan.

Davis and more than 20 other people were sentenced for filing false medical claims with the NBA Players' Health and Benefit Welfare Plan in a scheme that lasted at least four years. Davis was found guilty of health care fraud, wire fraud, conspiracy to make false statements and conspiracy to commit health care and wire fraud in November and faced a maximum sentence of 20 years in prison.

In addition to prison time, Davis was ordered to pay $80,000 in restitution. He must also attend a financial management class and mandatory drug treatment as part of his supervised release.

Davis, 38, was named the SEC Player of the Year at LSU in 2006 and was drafted in the second round of the 2007 NBA Draft. He won the 2008 NBA Finals with the Boston Celtics and also spent time with the Orlando Magic and Los Angeles Clippers during his eight-year NBA career.

Former NBA player Terrence Williams was sentenced to 10 years in prison last August for his role in the scheme and Will Bynum, another ex-NBA player, received an 18-month prison sentence in April. Aamir Wahab, a California dentist who helped facilitate the fraud, was sentenced to three years in prison in December.

Davis' attorney, Sabrina Shroff, declined to comment to The Associated Press.

New CT Law Prohibits Health Care Providers From Reporting Medical Debt For Use In Credit Reports

A law that prohibits health care providers and hospitals in Connecticut from reporting a patient's medical debt to credit rating agencies for use in credit reports was signed by Gov. Ned Lamont.

"When medical debt is included in a person's credit report, creditors are making decisions based on a person's medical history that is not necessarily representative of their financial responsibility and household finances," Lamont said in statement. "By prohibiting medical debt from being reported to creditors, we are protecting patients who may have otherwise been apprehensive about seeking essential medical care."

Lamont said the law also voids any medical debt that is reported to credit rating agencies. It takes effect July 1, 2024.

State Sen. Matt Lesser, D-Middletown, co-chair of the Human Services Committee, pushed for the law.

"Medical debt is not the result of poor financial decisions – it is the result of a health care system where many families are just one accident or one bad diagnosis away from ruined credit and all that comes with it," Lesser said, in the statement.

"With Governor Lamont's signature, Connecticut now has some of the strongest consumer protections in the country. This was a priority for me this session and I am grateful to Governor Lamont and to Senate President Martin Looney for their strong support."

The Connecticut Hospital Association, the federal Consumer Financial Protection Bureau, and others submitted testimony to the legislature in support of the bill, records show.

Lamont also announced on Good Morning America in February that Connecticut would erase $1 billion in medical debt for eligible residents.

That relief, which would help an estimated 250,000 residents, will come from a $6.5 million fund from the COVID-era American Rescue Plan Act of 2021 that sought to cancel medical debt, he said at the time. The state will work with a nonprofit that buys medical debt at a reduced rate to eliminate the debt by June, according to the interview.

The credit rating legislation is Public Act 24-6, An Act Concerning the Reporting of Medical Debt. 

CT Lawmakers Criticize OHS For CT Health Care Reform Bill Failure

Legislative leaders took aim at the state's Office of Health Strategy and its director, Deidre Gifford, Wednesday morning as the midnight session deadline loomed and it became clear some hospital oversight reforms raised by the executive branch would not get a vote.

In particular, House leaders blamed OHS and Gifford for their inability to pass changes this year to the certificate of need program, a controversial process that came under intense scrutiny during Yale New Haven Health's attempt to buy Prospect Medical Holdings' hospitals in Connecticut.

They also criticized OHS for the lack of agreement on cost growth benchmarking — annual targets set by the state meant to limit the increasing cost of health care — and said negotiations around hospital-related bills should be "legislatively led" in the future, meaning lawmakers would spearhead the talks.

Senate Bill 9, a key hospital oversight measure that would have made changes to the certificate of need program and required more hospital reporting on finances, was introduced by the executive branch.

Hospital reforms "need to be legislatively led, because there's just a lack of trust right now in the executive branch from [the Connecticut Hospital Association] and the hospitals," House Speaker Matthew Ritter, D-Hartford, said. "Sometimes the executive branch has a good lead on an issue given expertise from different departments. But I think this [topic] has to be legislatively led.

"I can just tell you that every meeting I have with a hospital … it starts with, 'We disagree with OHS.' Then you meet with OHS and they say, 'It's not a big deal.' It's been like this the last two years."

Spokespeople for the Office of Health Strategy and Gov. Ned Lamont's office declined to comment Wednesday.

House Minority Leader Vincent Candelora, R-North Branford, also expressed frustration with OHS.

"What we're seeing is, bills are coming out, and there's a complete disconnect between the [health care] industry, the legislature and the Office of Health Strategy," he said. "We tried to get [the certificate of need program] revised and it all fell apart. There are a lot of problems with that agency.

"It's pretty sad when the only success coming out of OHS is they reformed the agency to make the director the commissioner now. It doesn't change the fact that they are an obstacle for appropriate reform in our health care industry."

Ritter and House Majority Leader Jason Rojas, D-East Hartford, said OHS and the hospitals couldn't agree on reporting data that inform cost growth benchmarking efforts.

"They can't even agree on reporting requirements," Ritter said.

Rojas added: "Data collection is a big issue when we're talking about the health care benchmarks."

The failure of the General Assembly to make substantive changes in how Connecticut regulates and oversees hospitals, a sensitive issue given the precarious finances of the three Prospect Medical-owned hospitals, prompted legislative leaders Wednesday to question whether the Lamont administration was adequately engaged.

The session will end at midnight Wednesday without the passage of Senate Bill 9, an administration bill that would have mandated greater financial oversight of hospitals and revised the state's much-maligned program for assessing health care needs, the certificate of need program.

The legislature had also considered three other bills that would have made various changes to the CON program, including reducing the timeframes for a decision on an application. In the waning weeks of the session, elements of those proposals were going to be included in Senate Bill 9, legislators have said.

The bond package includes one provision on hospital financial reporting.

The Democratic co-chairs and ranking Republicans on the legislature's Public Health Committee said the failure was frustrating, coming on the heels of Yale New Haven Hospital suing to get out of a deal to purchase the three hospitals, but not solely the fault of the administration.

They disagreed with suggestions by legislative leadership that the failure was due to a lack of effort or engagement by the administration's Office of Health Strategy.

"It's the last day of session, and everyone's frustrated because a lot of things that people try to do and want to do to help protect access to health care, costs of health care, and safety of patients aren't going to happen today," said Rep. Cristin McCarthy Vahey, D-Fairfield, co-chair of the Public Health Committee.

She attributed the failure to its ambition, complexity and lingering mistrust by the hospitals toward state government due to a protracted fight over taxation by the previous administration of Gov. Dannel P. Malloy.

"There's plenty of blame to go around," said Rep. Nicole Klarides-Ditria, R-Seymour, the ranking House Republican. "Everybody wants what they want. OHS wants theirs. CHA wants theirs. Everybody thinks what they want is best. So, it's our job as legislators to literally pick and choose the things that we think are best. That's our job."

Sen. Saud Anwar, D-South Windsor, co-chair of the Public Health Committee, said the failure to reach a deal is set against "the backdrop of a historically poor relationship between the Office of Health Strategy and [the hospital association] for a long, long time.

"We have a completely new team at the Office of Health Strategy that is about a year and a half old. So what may have happened five years ago, two years ago, three years ago, is not the actual situation."

Paul Kidwell, senior vice president for policy at the Connecticut Hospital Association, did not comment directly on the remarks made Wednesday, but said the association continues to work with lawmakers and Lamont's administration.

"Connecticut hospitals and health systems are committed to exceptional patient care, preserving and expanding access, improving affordability, helping our communities, and advancing world-class healthcare here in Connecticut," he said. "We work with our communities, legislative partners, and the governor and his administration to advance these goals. This work does not end at the close of the legislative session, and we look forward to continuing to collaborate for the benefit of patients across the state."

Sen. Heather Somers, R-Groton, said OHS was engaged, if inflexible at times.

"There was some compromise, but not to a point that we would have buy-in from the legislators to be able to get that passed," she said. "And it was a complex bill. It's hard to explain. It's in the weeds. You almost need a PhD in CON."

Of course, she added, there was no consensus on how to fix CON, since some lawmakers want it eliminated.

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