Ten individuals, groups, practices and organizations are recognized in the name of a "pharma bro" with the release of Lown Institute's Shkreli Awards.
The 8th Annual list contains the "most egregious examples of profiteering and dysfunction in healthcare," decided by a panel of 20 judges who are patient activists, clinicians, health policy experts and journalists. The awards are organized by Lown Institute, a nonpartisan think tank that measures hospitals' and health systems' social responsibility.
Martin Shkreli earned the nickname of pharma bro when, in 2015, his company, Turing Pharmaceuticals, acquired a 62-year-old drug called Daraprim and, overnight, increased the price from about $13.50 per pill to $750. In 2017, he was convicted in federal court on two counts of securities fraud and one count of conspiring to commit securities fraud, resulting in a 2018 sentence of seven years in prison. In 2022, a federal judge ordered Mr. Shkreli to repay $64 million for hiking the price of Daraprim and imposed a permanent ban on his executive roles in public companies and a lifetime ban from the pharmaceutical industry. He was released early from prison that same year.
Lown Institute's awardees were covered by local or national news outlets throughout 2023 and 2024. While most media coverage of the people, institutions, trends or allegations is dated in 2024, some of the actions in question date further back. The original news stories, all linked below, have more complete details.
Below are the recipients of the 2024 Shkreli Award, as decided by the Lown Institute.
1. Former Steward Health Care CEO Ralph de la Torre, MD. Lown Institute awarded Dr. de la Torre the top spot for bad behavior in 2024, which was the demise of Dallas-based Steward Health Care. The for-profit chain was on a buying spree in recent years. Four days into 2024, hospital landlord Medical Properties Trust reported Steward was $50 million behind on its rent. When The Boston Globe published local reporting on the state of affairs at Steward's Massachusetts hospitals, lawmakers and officials started to pay closer attention and the house of cards began falling apart. By May, Steward reported $9 billion in debt and put all of its hospitals up for sale. Dr. de la Torre resigned in September, days after the full Senate voted unanimously to hold him in contempt after he did not comply with a Senate subpoena.
2. UnitedHealthcare. UnitedHealth, the nation's largest Medicare Advantage provider, benefits from higher federal reimbursements when its patients are documented as having more health challenges. This practice may have enabled the company to secure tens of billions of dollars in additional taxpayer-funded payments over the past decade, according to STAT. UnitedHealth is currently facing a federal lawsuit over these practices, as well as an ongoing antitrust investigation. The company denies any wrongdoing.
3. Amgen. Amgen's cancer drug Lumakras, approved in 2021 at a 960 mg daily dose, showed in trials that a lower 240 mg dose offers similar efficacy with fewer side effects. Despite this, Amgen continues to market the higher dose and seeks final FDA approval at that level, potentially protecting $180,000 in annual revenue per patient. Pharmacologist Donald Harvey, PharmD, interviewed by KFF Health News, called Lumakras "a poster child for incredibly bad development." Amgen defends the 960 mg dose, citing FDA acceptance of it as the recommended level.
4. Thomas C. Weiner, MD, once celebrated as the highest-earning oncologist at St. Peter's Hospital in Helena, Mont., is now at the center of serious allegations. ProPublica reported in December that the physician administered unnecessary cancer treatments, including one case where a patient died from chemotherapy drugs despite having no signs of cancer. He is also accused of using barbiturates to hasten deaths, altering end-of-life plans without consent and overprescribing opioids. Fired in 2020, Dr. Weiner is appealing his wrongful termination suit in the Montana Supreme Court while facing a 2024 federal lawsuit over billing practices. He denies any wrongdoing and his attorneys have moved to dismiss the case.
5. Memorial Medical Center in Las Cruces, N.M., is accused of denying cancer treatment or demanding upfront payments, even from insured patients. Operated by Lifepoint Health under private equity firm Apollo Global Management, Memorial revised its financial assistance policy in 2023 to exclude cancer care. While the hospital denies turning patients away, NBC News reports suggest otherwise, citing patient testimonies and internal documents. Despite promotional claims of providing care regardless of ability to pay, some local cancer patients are forced to seek treatment hundreds of miles away.
6. Seven suppliers responsible for $2 billion of suspicious catheter charges. In 2023, Medicare saw an 800% surge in billing for urinary catheters, with 450,000 beneficiaries affected and $2 billion in suspicious charges tied to just seven suppliers. One supplier, "Pretty in Pink Boutique," turned out to have no medical business at its listed address and a phone number connecting to an auto body shop, The New York Times reported in February. Investigators Looking into $2B Catheter Fraud Involving Medicare Patients
Seven companies allegedly operating out of Connecticut, Florida, Kentucky, New York and Texas are the target of a $2 billion Medicare fraud investigation – one of the largest in the program’s history.
According to published reports, in this catheter fraud scheme, the companies were billing for urinary catheters. The National Association of ACOs (NAACOS), a resource for Accountable Care Organizations, uncovered the scheme. The organization says its members began notifying them in December about suspicious amounts being billed for catheters.
7. A $100,000 air ambulance bill uncovered by Cigna. When Sara England's infant son Amari needed an emergency air ambulance transfer after heart surgery, Cigna denied coverage for the 86-mile flight, deeming it "not medically necessary." Despite protections under the 2022 No Surprises Act, insurers can still deny claims over medical necessity, leaving Ms. England with a $97,599 bill. Appeals failed, forcing the family to bear the cost, KFF Health News reported in March.
8. Zynex Medical, a maker of nerve stimulation devices for pain management, is under scrutiny for questionable billing practices, STAT News reported in June. Patients often receive devices believing insurance will cover the costs, only to be sent unsolicited supplies like batteries and electrode pads, sometimes in excessive quantities and at inflated prices. Insurers often pay, but patients can end up with surprise bills. In 2023, nearly 70% of Zynex's $184 million revenue came from these supplies. The company declined to comment.
9. Tongue-tie cutting. Despite limited evidence of effectiveness, baby tongue-tie cutting involves cutting tissue under the tongue and is being promoted as a remedy for issues like breastfeeding difficulties, sleep apnea and even constipation, reports The New York Times. While complications are rare, some babies experience severe pain, refuse to eat and require hospitalization. Typically not covered by insurance, the $900 procedure is often paid for out of pocket, with some physicians performing up to 100 per week.
10. The University of North Texas Health Science Center in Fort Worth dissected and sold unclaimed bodies without proper consent, an NBC News investigation found in September. Body parts were supplied to medical students and companies despite failures to contact easily reachable family members. One veteran entitled to military burial honors had body parts sold to entities in an experience his family described as deeply violating. In response, UNTHSC suspended its body donation program, fired responsible officials and launched reviews to address the ethical violations.
It is very common for health insurance companies to undercut recommended by highly experienced physicians. Denials are frequent;y due to the wording, or lack thereof regarding clinical documentation even when submitted after the denial of services (DOS).
Providers are aware of the “Deny, Delay, and Defeat practices of insurance ompanies to maximize prorfit at the insistence of investors. United Health Care is the focus of an assasination of their CEO (Brian Thompson). Despite his in public murder in front of the hotel where an investor meeting was held in in whic he was the keynote speaker, the meeting was held shortly after his murder. This supports the opinons that insurance companies are callous cold-hearted even toward their own employees.
Optum owns the following California Knox-Keene licensed plans: PrimeCare Medical Network, Inc., Monarch Health Plan, Inc., U.S. Behavioral Health Plan of California, ACN Group of California, Inc. Optum owns or is affiliated with many medical clinics, including:
CareMount Medical: Part of Optum Medical Care in the New York and New Jersey region
ProHEALTH New York: Part of Optum Medical Care in the New York and New Jersey region
Riverside Medical Group: Part of Optum Medical Care in the New York and New Jersey region
HealthCare Partners: Acquired by Optum in 2020, and is now transitioning to the Optum network
Pharmacy Benefit Management
UnitedHealthcare's pharmacy benefit manager (PBM) is Optum Rx:
How many physicians does Optum own?
90,000 physicians
Optum is a technology-enabled healthcare services company that is part of UnitedHealth Group. Optum has over 2,200 locations in 25 states, including California, Texas, Florida, New York, and Pennsylvania. Optum also owns several medical networks, including the Inland Empire and Southern California networks.
These vevents are causing outrage amongst providers and patients. Some of these denials are egregious, and callous.
Does the FTC have jurisdiction over insurance companies?
The McCarran-Ferguson Act does not exempt insurance companies from the FTC's jurisdiction, but rather exempts only those activities that constitute "the business of insurance," regardless of who performs them, and then only to the extent that such activities are regulated by state law.
