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The short seller pointed out that Sebi’s notice conspicuously avoided naming Kotak Bank, despite its alleged involvement in offshore fund structures related to the Adani Group.

Hindenburg suggested that Sebi might be protecting powerful Indian businessmen from scrutiny.

The Sebi notice also disclosed connections between Hindenburg Research and New York hedge fund manager Mark Kingdon. It was revealed that Kingdon Capital, which held significant investments in Kotak Mahindra Investments Limited (KMIL), received an advance copy of Hindenburg’s Adani report.

This allowed the hedge fund to profit significantly by taking short positions in Adani Enterprises before the report’s release, yielding a profit of $22.25 million.

Kotak Mahindra Bank denied any involvement or knowledge of Kingdon’s activities, while Kingdon Capital defended its right to engage in research agreements that allow the use of reports before they are made public.

• DOI: 10.17072/2218-1067-2022-1-49-57
• Corpus ID: 249915637

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Trust in physicians and hospitals plummeted since the COVID pandemic, Northeastern research says

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A grateful public called doctors health care heroes and collected personal protective equipment and pizzas for them during the early, deadliest days of the COVID-19 pandemic.

But nearly four years later, public trust in physicians and hospitals plummeted, going from 71.5% in April 2020 to 40.1% in January 2024, according to a 50-state survey of U.S. adults led by Northeastern University’s distinguished professor of political science and computer sciences.

“It is obviously a very, very sizable decline,” says David Lazer , whose research was published in JAMA Open Access , a peer-reviewed medical journal.

And it’s one with public health repercussions, since individuals with lower levels of trust were less likely to get vaccinated against COVID or seasonal influenza, he says.

“It is striking that we saw distrust predicted future vaccination status,” Lazer says. “While we can’t be sure that this is a causal relationship, it is consistent with the possibility that distrust is a factor in lower vaccination rates.”

The study’s authors say “the pandemic may have represented a turning point in trust, with a profession previously seen as trustworthy increasingly subject to doubt.”

The distrust was distributed across all socio-economic groups in the 50-state survey borne of the COVID States Project, which has transformed into the Civic Health and Institutions Project , a 50 States Survey (CHIP50).

But it was particularly acute among people who had lower education and lower income, are Black, female or live in a rural area. The associations persisted even after controlling for partisanship, the report says.

The survey consisted of online interviews with 443,455 individuals 18 and older in all 50 states, with pains being taken to represent populations in terms of race, ethnicity, gender and age.

The wave of 24 surveys starting April 1, 2020, and ending Jan. 23, 2024, asked questions such as “How much do you trust the following people and organizations to do what is right” with possible answers ranging from “a lot, some, not too much or not at all.”

In waves prior to August 2022, researchers asked a variant of the question, querying respondents about  “How much do you trust the following people and organizations to do the right thing to handle the current coronavirus (COVID-19) outbreak?”

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 “We asked them if they were vaccinated, and about trust, and found that those two things were correlated,” Lazer says.

“We also looked at whether expression of distrust predicted future vaccine status, as measured by self report on the survey, and it did.”

The paper did not specifically ask about people’s opinions about masking and vaccination mandates, Lazer says, “but, yes, trust was strongly related to those things.”

In response to several open-ended questions, people with lower levels of trust commented that “doctors were just in it for the money” and communicated problems with billing issues, he says.

The levels of distrust may come as a surprise because doctors traditionally enjoy a great degree of public confidence.

Lazer and his co-authors say a 2022 survey reported that U.S. adults had “greater trust in physicians and nurses than in any other institution, including the Centers for Disease Control and Prevention.”

The early results may have represented an inflation of people’s esteem for the medical profession at a time when hospital emergency departments were besieged by COVID-19 cases, Lazer says.

The survey results are concerning to the researchers, who say most adults see a physician regularly and rely on their health care provider for information on everything from diet and exercise and smoking cessation to seatbelt use and firearm safety.

The politicization of the COVID-19 epidemic helped fracture the connection between the public and traditional sources of health information, Lazer says.

“If you don’t trust the establishment, if you don’t trust institutions, you’re more likely to go to Facebook groups who are making strange recommendations regarding health-related behaviors,” he says.

Some of the distrust has deeper roots, particularly among marginalized groups including women and people of color who may doubt the medical system is representing their interests, Lazer says.

“If people don’t see individuals like themselves in medicine, they may be less trusting of medicine,” he says.

In the short run, restoring trust in public health could mean working with trusted community partners to communicate health practices based on best evidence, including vaccination, Lazer says.

“Then there are the longer-term solutions, which is to diversify medicine, diversify science,” he says. “It’s never too late.”

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How For-Profit Hospitals Billed More Aggressively Than Nonprofits For Medicare Outlier Payments: A Case Study From the Early 2000s

For-profits were also likelier to spend new revenue on executive pay and share buybacks, atul gupta, phd.

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American hospitals account for the largest nonprofit sector in the United States, but while most U.S. hospitals are nonprofit, a significant portion are for-profit. Policymakers and researchers long have questioned whether nonprofit hospitals behave differently than for-profit hospitals. In a recently released National Bureau of Economic Research working paper that examines this question, we made use of a now-resolved loophole in Medicare payment policy to understand how nonprofit and for-profit hospitals exploited this loophole, and what they did with the resulting financial windfall.

What was the loophole? Medicare used hospitals’ list prices (also called “charges”) to determine how much hospitals should get in “outlier payments” — which reimbursed hospitals beyond Medicare’s usual fixed-price contract for providing especially resource-intensive care. Because the Centers for Medicare and Medicaid Services could not observe the true costs of this treatment, they relied on those list prices, giving hospitals the opportunity to inflate them.

We used a novel approach to find hospitals that gamed the system with inflated charges for outlier payments during this time period and identified 180 such hospitals. The gain for these hospitals was substantial, resulting in a windfall of $3 billion in Medicare payments and $12 billion when including all insurers’ payments over this time period. (For perspective, consider that the total spending on the Women, Infants and Children’s (WIC) program in 2022 was $6 billion.)

Both for-profit and nonprofit hospitals took advantage of the loophole. But we found that the type of ownership was highly predictive of gaming, with the for-profit hospitals more likely to exploit the loophole than the nonprofit hospitals. The for-profit hospitals also were more likely to pocket the money rather than reinvesting it in patient care.

Hospitals That Gamed the System Derived Direct and Indirect Revenue Benefits

We found that weaknesses in government contracts can produce ripple or “spillover” effects that may far exceed in magnitude the direct revenue increases, based on our comparison of the revenue trends of the “gamer” hospitals versus those of a matched set of hospitals that did not inflate list prices for outlier payments. As our analysis showed, the impact of the loophole extended beyond the increased payments from Medicare to include increased payments from private insurance too.

This spillover — adding up to $12 billion — perhaps resulted from private insurers using similar payment designs and negotiating contracts based on list prices. The higher spending by private insurers, which then likely was passed on to employers in the form of higher insurance premiums, greater cost sharing for employees, and even salary decreases, highlights the importance of considering spillover effects when determining whether investments in oversight or enforcement actions are justified.    

Nonprofit Hospitals More Likely to Use Extra Money on Operating Costs

It is unclear exactly why the for-profit hospitals were more likely to take advantage of the Medicare outlier payment loophole. We hypothesize that managers of for-profit hospitals had more incentive to maximize revenue since they could distribute profits to themselves. We also hypothesize that managers who joined nonprofits versus for-profits differed in their financial motivation.      

What is clear, though, is that the nonprofit and for-profit gamers spent the extra revenue in different ways, consistent with predictions from organizational theory. Nonprofits directed about 75% of the gaming revenue to operating costs, with no increase in compensation for senior executives. We detected a modest but statistically significant improvement in the mortality rate at these nonprofit hospitals.

In contrast, for-profit hospitals transferred all of the excess revenue off their balance sheets, with no effect on patient care. For the largest and most important gamer, the Tenet Corporation, we showed that the excess revenue dramatically increased compensation for its highest-paid executives at the peak of gaming. Compensation more than doubled, from $6 million to $12 million and stock options ballooned to $92.5 million.

The system also engaged in stock buybacks, which resulted in nearly a billion dollars transferred to shareholders. In the case of for-profit hospital systems, this evidence strongly suggests that investing in more stringent oversight is likely to carry high social value.

Loopholes Will be Exploited and For-Profit Hospitals May Warrant Greater Scrutiny

Although the findings look back to a loophole closed two decades ago, they are particularly salient now. According to the US GAO, Medicaid and Medicare made more than $100 billion in improper payments in 2023.

The issue of improper payments has taken on additional policy significance in the aftermath of large payouts to hospitals for care related to the COVID-19 pandemic. Congress authorized nearly $200 billion in pandemic-related emergency assistance for healthcare providers.

There are concerns that some hospitals and other entities abused this and other COVID-era relief programs. The appropriate policy responses — in response to such “gaming” — depend on how the marginal dollar of excess revenue ends up being allocated.

For example, if hospitals direct excess revenue to patient care, policymakers may have less to fear from loopholes. However, if the excess revenue has limited benefits for patients and workers, it would support devoting greater resources to contract design and payment oversight.

The working paper, “Turbocharging Profits? Contract Gaming and Revenue Allocation in Healthcare,” was published June 2024 by the National Bureau of Economic Research and authored by Atul Gupta , Ambar La Forgia, and Adam Sacarny.

Assistant Professor, Health Care Management, Wharton School

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Large Animal Lover at Heart

Where are you from? I spent my childhood and teenage years in the Capital of Belgium, Brussels.

Share your academic journey to becoming a veterinarian .  I started my Bachelor's in Brussels before doing my Master's in Veterinary Medicine at the University of Liège, Belgium. I graduated in 2016, worked first in Belgium, then traveled to gain more experience by learning at the highest level possible.

How did you come to Cummings School of Veterinary Medicine?    The Invisible Hand of the Residency Match was decided, and I'm happy with the result. New England is quite close to my home country in terms of culture and patience, but it also has the added benefit of seeing the sun much more regularly!

What has surprised you during your tenure here ?  Patience. We have incredible mentors who are incredibly patient with sometimes reluctant horses. They take their time to explain procedures in detail to both owners while making the students part of the caregiving team at each step.

What do you hope to do after completing your time at Cummings School ?  Go on saving large animals with the high level of care that Tufts thrives to apply.

Share an experience from your time at Cummings School that stands out to you?  Our incredible nurses (besides being the best support we could hope for) always strive to go above and beyond. They consistently remind us that we don't need to take ourselves seriously while doing serious work. Our patients are their canvas, and bandages are an excuse for creativity. Sometimes, bringing old kids' clothing, you can't help laughing at an obese goat in a cartoon pajama.

What brings you joy professionally?  Solving a lameness that has been a mystery for months. Working with multiple teams. Planning a surgery after visualizing a fracture with a radiologist ultrasonographer and then discussing the pain relief plan with the anesthesiologist. Giving the first hand full of grass to a post-op colic. Seeing the excitement and fear in a student's eyes when you guide them through a procedure and the happiness when it is a success.

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'Something big soon India,' Hindenburg hints at another major revelation after Adani disclosure

Hindenburg Research, the US-based short seller, hinted at another major disclosure related to India on Saturday. On Saturday, the firm posted on X stating, "Something big soon India." This comes after their explosive report last January, which scrutinised the Adani Group just before a planned share sale by Adani Enterprises.

The release of Hindenburg's report led to a sharp decline in Adani Enterprises Ltd's (AEL) stock price, which plummeted by 59% within a month. The January 2023 report had a profound impact, wiping out $86 billion from the market value of Adani Group stocks and sparking a substantial sell-off of its overseas bonds.

Hindenburg accused the conglomerate of engaging in what it termed "the largest con in corporate history," leading to a steep decline in the value of Adani's listed companies.

Something big soon India — Hindenburg Research (@HindenburgRes) August 10, 2024

Mewanwhile, the Securities and Exchange Board of India (SEBI) recently unveiled new details in the ongoing Adani-Hindenburg saga, particularly concerning Hindenburg's ties with New York hedge fund manager Mark Kingdon.

According to SEBI, Hindenburg provided Kingdon with an advance copy of its report on Adani nearly two months before its public release, enabling Kingdon to profit from strategic trades. In a comprehensive 46-page show cause notice, SEBI outlined a "Research Agreement" between Hindenburg and Kingdon Capital Management, established in May 2021.

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Health | Hoag recruits top doctor in hospital’s push…

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Health | hoag recruits top doctor in hospital’s push to become research leader, the health care provider is investing $1 billion in its irvine campus and will soon open a new digestive health and cancer center..

Short of all sorts of supplies, he recalls using fishnets for sutures, fishhooks for needles and, generally, rigging up a whole menagerie of equipment with whatever his team had on hand.

When he returned to Brown University to finish medical school, his Ivy League colleagues thought he was mad, he said. “I was willing to experiment with materials that most of my peers wouldn’t touch.”

Some 40 years later, Chang’s patents are used in medical offices around the world to treat patients for gastrointestinal health and improve pre-cancer diagnosis and therapy.

After a distinguished career at UC Irvine where he launched the university’s comprehensive digestive disease center and was chief of the medical school’s division of gastroenterology, Chang accepted a new challenge this summer at Hoag.

His vision, backed by a substantial investment from the healthcare provider, is to launch Orange County’s largest digestive health institute in the the next two years, transform the community hospital into a research leader and — eventually — eradicate Orange County of esophageal and colon cancer.

Within the next two years, t hanks to a recent $1 billion investment , Hoag will greatly expand its Irvine medical center with six new buildings, including new centers for women’s health and surgical innovation and Chang’s institute for digestive health and cancer treatment.

Looking at the construction underway, Chang and Hoag President and CEO Robert Braithwaite said the revitalization of the medical center will push the community healthcare system to become more like a research institute that also provides top-notch care.

Braithwaite said he aims to shape Hoag in the model of the Mayo Clinic — not itself a university, but still a renowned medical leader in training fellows and conducting cutting-edge research.

Following this round of construction, for example, Braithwaite plans to construct another Irvine campus building where corporate biotech innovators will work hand-in-hand with Hoag doctors to put new technology on the fast track from the research bench to the operating room, he said.

Hoag’s determination to grow in Irvine spurred from community need, Braithwaite said. Around 2017, Hoag’s Irvine hospital was frequently reaching 100% capacity. It was a clear sign they needed to expand.

But Hoag wanted to “grow different,” he said, beckoning a phrase that harnesses the community hospital’s Apple-sized ambitions.

Hoag hired 10 architectural firms to come up with designs for a remodeled Irvine medical campus, which originally opened as a traditional hospital tower under another operator in the 1980s and changed hands a couple of times before Hoag moved in about 15 years ago.

“I told the architects we want you to use your best thinking and best research in healthcare to bring us a new design,” Braithwaite said.

Two of the firms came up with what Hoag’s calling an “institute model.”

Gone are the days of cardiology on floor 4, pulmonary on floor 5, GI on floor 6, and so on, Braithwaite said.

The new model is about synergy, not separation.

“We want to create a flow of clinicians and experts in one area,” he said. “This is not a general approach, but it’s about giving people what they want and deserve: expertise and quality.”

His idea is that the physical design of the buildings will, like a university, encourage innovation between physicians, endoscopists and others as they pass each other in the halls.

Hoag’s Dr. Elizabeth Raskin, left, CEO Robert Braithwaite, Dr. Allyson Brooks and Dr. Burt Eisenberg hold an artist’s rendering of the health center’s expansion plans in Irvine in 2022. The expansion will include six new buildings, with specialized institutes in women’s health, cancer and digestive illnesses.(Photo by Mindy Schauer, Orange County Register/SCNG)

A rendering of what the Women’s Health Institute will look like on Hoag’s new Irvine campus. It and two other medical institutes are expected to open by 2025. (Rendering courtesy of Hoag Hospital)

Dr. Kenneth Chang, Executive Medical Director of the Digestive Health Institute, speaks about his role at Hoag Hospital in Irvine, CA on Wednesday, July 31, 2024. (Photo by Paul Bersebach, Orange County Register/SCNG)

That’s where Chang comes in. With his 30 years of experience at UCI, Braithwaite believes Chang is the leader who can shepherd Hoag into a new era of cancer research and care.

One way Chang says he plans to tackle cancer is by putting Hoag at the forefront of using novel, less invasive technologies. Soon, someone with inflammatory bowel disease, for example, might be screened with an endoscopic ultrasound instead of a colonoscopy, he said.

“Our goal is to treat life-altering conditions with less and less invasive techniques,” Chang said. “We’re miniaturizing the whole approach to cancer.”

The traditional approach to treating cancer, especially at the dawn of oncology in the 20th century, was notoriously invasive — think rounds and rounds of chemotherapy and life-threatening organ removals.

Chang wants to “miniaturize” everything about the cancer paradigm — the consequences, the risks, the procedures, the incidence.

“When we talk about cancer, where do things go awry? It’s at the cell level,” he said. The smallest common denominator of life. “Right now, when it comes to treatment, we wait for a cell to multiply a gazillion times and then it becomes a cancer,” he said. “If you have bad plumbing, you don’t wait for your house to flood. You fix the leak.”

But, he and Braithwaite say Hoag’s vision is not just about innovation. It’s about people.

“One of my guiding statements in my career is innovation fueled by compassion,” Chang said.

“There’s innovation fueled by money, prestige and power,” he added. “None of that is sustainable for me. But when you have innovation for a patient in critical condition in front of you, you’ll not accept ‘no’ for an answer. You’ll search your heart and soul for a solution.”

He reflects back on his missionary work 40 years ago. “If we didn’t have what we needed,” he said, “we would make it.”

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