Trina Health Centers Scam Could be Collapsing With Arrest of Owner
This from Medpage today on April 3, 2018:
The California-based owner of a national network of insulin infusion centers for people with diabetes was arrested Monday on federal public corruption charges, including bribery, racketeering, healthcare fraud, and wire fraud.
A federal grand jury in Alabama indicted G. Ford Gilbert, CEO of Sacramento-based Trina Health, as well as an Alabama legislator and a lobbyist, for their roles in an alleged scheme to win insurance coverage for the chain’s unique brand of diabetes treatment.
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The indictment said Gilbert “came up with a plan to push a bill through the Alabama Legislature’s 2016 session that would require Blue Cross Blue Shield of Alabama to cover the treatments.” The insurance company in 2015 had denied reimbursement for Trina Health’s three Alabama clinics, which had operated in 2014 and 2015 in Fairhope, Foley, and Birmingham.
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The charges said Gilbert made payments to Alabama House Majority leader Micky Hammon, a Republican who had agreed to lobby for the bill. Hammon pleaded guilty in federal court on mail fraud charges in an unrelated case and is serving a three-month prison sentence. Because of that conviction, he was not included in Monday’s indictment.
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U.S. Attorney Louis V. Franklin said the other defendants, both in Alabama, are state Rep. Jack D. Williams, 60, of Vestavia Hills, and lobbyist Martin J. “Marty” Connors, 61, of Alabaster.
Franklin’s news release said Gilbert hired Connors — former chairman of the Alabama Republic Party — to lobby on behalf of the bill, and Connors recruited Williams, who chaired the Commerce and Small Business Committee of the Alabama House of Representatives. Connors asked Williams to hold a public hearing on the bill. The bill failed.
“Williams also knew of the payments to Hammon and acted in part to help Hammon, who as everyone in the scheme knew, was experiencing grave financial problems,” according to the news release.
[a comment:]
The CPT Code based reimbursement, or the “fee for service” model is fundamentally based and fraudulent. The decision to cover a procedure or a test is not based on the clinical and scientific merits, but based on how to best protect the status quo. For example, the high false positive rates of stress imaging tests, CTAs have been proven by major studies of nearly 1,000,000 real world patients. They generate 60+% false positive and at least 10% false negative cases sending millions of patients to unnecessary interventional procedures such as coronary angiograms and stunting. What does the industry do, they continue protect and reimburse these useless tests.
[another comment:]
— mark vanhusen, md
dr mcg….all great points. here is what I have found though locally. pt comes in great story and strong FH of CAD and very obese and stress echo refused by insurance co. frustrating so I refer to cardiology pronto and test gets ordered. these insurance co decisions are pathetic. and just added to healthcare costs and am I going to get on the phone to plead for this test…nope refer and let the insurance pay for even more care. cant wait to retire to get away from this stuff.
Further exploration (visiting the Trina Health web site) reveals that “insulin microburst treatment” is a new form of insulin infusion– intravenously, over a period of an hour, repeated three times in one day; treatments are repeated from once a week to once a month. The web site states that the initial treatment may be repeated twice over two days. The site claims that complications of diabetes are reversed and the patient’s sense of “well being” is restored after a few treatments. The site further claims that the treatment is covered by Medicare and private insurance… which is where we came in.
Apparently, from the web site materials, Mr. Gilbert had a daughter who developed type I (insulin-dependent) diabetes at age 2; she had what is known as “brittle” diabetes, in which wide swings in blood glucose and frequent episodes of severe hyperglycemia occur. Such patients are usually treated with an “insulin pump”, which is a device worn in a pouch with a connection to a subcutaneous needle, through which insulin is infused on a schedule; newer insulin pumps respond to changes in blood glucose with increases and decreases in insulin dose.
The clinic treatment, (“Artificial pancreas treatment”) however, uses insulin given intravenously, which produces an immediate response (the liver is insulin’s first target organ) “within four seconds”– the liver releases enzymes and absorbs glucose from the blood, converting the glucose to glycogen for storage. Peripheral tissues (individual cells, particularly in muscle) respond to insulin by absorbing more glucose and using the mitochondria to metabolize glucose and produce adenosine triphosphate (ATP), the compound that is used throughout the body directly for energy to run metabolic processes.
The Trina web site claims that its intravenous insulin treatments heal the “sick” mitochondria and that the effect of a few hours of intravenous insulin delivery is maintained for a week to four weeks (the interval between clinic treatments.) The treatments would appear to take at least half a day, suggesting that only well-to-do and/or unemployed persons could conveniently make use of them.
These treatments are apparently FDA-approved, although this may be a loophole.
The whole thing smells like a scam, including (on the Trina web site) testimonials and a glowing report about the developer, Mr. Gilbert, who has now been arrested for bribing an Alabama state legislator.
(photo courtesy of pixabay.com and Alexas_Fotos)
Conrad Theodore Seitz 
— MCG Doc