The Briar Patch

Our kids sometimes read the blog, mostly as an act of kindness to me, but sometimes for surveillance to make sure they are not getting slandered just to set up a good story.  I hope they are reading today because I am trying to atone for what has been reported as one of my major shortcomings.

Apparently, my wife and I failed – miserably – as parents because we did not sufficiently introduce our children to fairy tales, folklore and other similar stories.  Instead, we taught them theoretical physics (lie) and watched ‘Dumb and Dumber’ (how could we not?).


It is never to late.  Kids, go read ‘Br’er Rabbit and the Tar Baby.’

I am sure everyone else was raised by more capable parents and knows the story, but for my deprived children, the sly Br’er Fox, in attempt to catch Br’er Rabbit, constructs a doll from a lump of tar, which traps the rabbit.  But even more cunning, the rabbit manages to get the fox to throw him, tar baby and all, into the briar patch, where he uses the thorns to escape. Yes, my children, ‘Br’er’ is a derivative of ‘briar.’

We can process this tale as a family later (good lord).  Heck, we’ll read all of the Uncle Remus tales (that will teach you). But obviously this is a story about players using their wits to, pardon the pun, outfox the other guy.

I am not sure why this South African folktale came to mind as I read about the Trump administration inviting healthcare industry players to help rewrite the anti-kickback statues, but maybe it is because someone – the industry or the whistleblower lawyers – is about to get tricked and I am curious to know who gets it in the end.

We all know the current rules on kick-back payments.  Scratch that. Other than being sure that you can’t leave a bag of cash in a doctor’s car in exchange for her unnecessarily admitting a bunch of Medicare patients we have no friggin’ idea what constitutes fraud and abuse or a kickback.  Oh, and we know people get busted all the time. Everything else is fuzzy. 

The Trumpsters want to relax the rules so that everyone can cooperate more effectively to improve care and save money.  That seems a noble goal and consistent with how they have approached other regulatory morasses. 

The administration is reviewing proposals from industry for what they call a ‘regulatory sprint to coordinated care.’  ‘Regulatory sprint’ is our oxymoron for the day.

Of course, the fraud and abuse attorneys (and share in the bounty) are crying foul, characterizing this as allowing the very people who want to bribe providers to write their own ‘get out of jail free’ card.

While the objective makes sense, if you think about trying to get rules for this right – rules to allow for better cooperation and incentives without opening the door for rampant fraud – you know this will be a tar baby, indeed.


six + seventeen =


Tim Coan, ALN’s CEO, writes an insightful and witty blog once a week about a variety of topics relevant to independent physician practices.

Yes, I'd like to get Tim's blog.