乌鸦传媒

Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

Optum Physician Exodus

Patients at Oregon Medical Group are being told that their doctor has left the practice and there's no other doctor who can take them on. That's because no one is being hired to replace them -- and patients are left scrambling, according .

Some 32 physicians have left Oregon Medical Group in the last 2 years alone, and some doctors in the same system treat as many as 2,800 patients annually, according to the report.

Oregon Medical Group is owned by Optum Inc., whose parent company is UnitedHealth Group. Some physicians have expressed concern that Optum and UnitedHealth Group are focused on profit and expansion at the expense of vulnerable patients, according to the report.

One patient, Tim Christie of Eugene, Oregon, had been going to his doctor for two decades when he got dumped by Oregon Medical Group.

"The gist of the message was, 'Thanks for being a patient, but you're fired,'" Christie told OregonLive. "I was dumbfounded."

It's unclear how many patients, like Christie, were left without care. Rep. Nancy Nathanson (D-Ore.), has tried to get answers from Optum, to no avail.

"The bottom line is that when our local medical community is expressing alarm, and the number of patients without doctors now could be in the thousands, we have a growing crisis in access to basic healthcare," Nathanson told The Oregonian.

Cosmetic Surgery's 'Wild West'

In many states, doctors can practice cosmetic surgery regardless of their training, according to an investigation by .

Most patients don't know that doctors can perform cosmetic procedures without surgical training, which can be even more confusing when doctors offering these services advertise themselves as "board-certified" but don't specify in what specialty, the report stated.

In California, for instance, a 28-year-old patient died during liposuction. Her physician, Mohamad Yaghi, MD, of Los Angeles, was trained in pediatrics, according to the report.

Her family sued Yaghi for malpractice and reportedly reached a settlement last year. A state investigation into the case faulted Yaghi for alleged violations, "such as proceeding with surgery that involved sedation when he knew -- or should have known -- that the patient had recently consumed food or water, which increases the risk of food getting into the lungs," the Los Angeles Times reported.

The state investigation also found that in 2018, Yaghi had given intravenous sedation in a facility without proper accreditation to yet another woman, who ended up in the ICU as a result.

Yaghi surrendered his medical license earlier this year, according to the report.

"You can do whatever you want until you kill somebody," Debra Johnson, MD, the former president of the American Society of Plastic Surgeons, told the Los Angeles Times.

Surprise Health Plan Switches

Some patients with health coverage through the Affordable Care Act (ACA) are finding out that someone else has switched their health plan -- without their permission or knowledge, according to .

This "unauthorized enrollment or plan-switching" is rampant in some parts of the U.S., the report found. The new plans might not offer the same coverage, which means that patients can show up for appointments or procedures only to find out the care isn't covered or that they'll have to pay more.

Agents told KFF that Texas, Georgia, and Florida are "switching hotbeds," and states that have their own marketplace are more successful because state ACA markets often require more information. But otherwise, rogue agents only need a person's name, date of birth, and state to access a person's health coverage.

Take for instance Florida resident Michael Debriae, who canceled his ACA plan when he got insurance through a new job. A broker in Florida signed him up for another plan without his knowledge, and Debriae may be on the hook for the $2,445 in tax credits paid to the insurer on his behalf, according to the report.

Adam Bercowicz, a licensed independent broker in Fort Lauderdale, Florida, told KFF that he has literally watched his dashboard of clients and seen some being switched to different plans in real-time. He's lost 300 to 400 clients this way.

"If I saw one of my clients was stolen from me at, let's say, 11:57 p.m., I put myself back on," Bercowicz said. "And by 11:58 -- a minute later -- they were already switched back."

As of last June, brokers are supposed to be required to record policyholders' consent before making changes, but that's rarely enforced, experts told KFF and NPR.

A CMS representative didn't answer KFF's specific questions, such as if protection like two-factor authentication would be added to the site.

Comment