LEWISTON — Central Maine Healthcare officials are requiring at least 1,000 workers and their adult family members to either sign up with a private Kentucky company to monitor their health or pay more for their health insurance.

One of those same Central Maine Healthcare officials founded the private company and runs it with his wife.

Hospital leaders say the man — Richard Goldstein, president of the Central Maine Medical Group — did not participate in the health system’s discussions with the company, Edumedics, and Goldstein’s relationship with the company was “thoroughly transparent” to health system leaders.

However, Goldstein’s tie to Edumedics has not been so transparent to workers. In a letter to employees from the health system’s four top leaders, Goldstein used only his hospital title. In a human resources video touting the new partnership, he is referred to only as president of Central Maine Medical Group. He is not mentioned in an online “frequently asked questions” page set up for employees, even though one of the questions is, “Who is Edumedics?”

A national expert in medical ethics called the situation an “overt” and “serious” conflict of interest.

“There’s obviously a serious conflict of interest in requiring them to have their health taken care of by an organization for which the president will undoubtedly benefit financially. To me, it’s an overt conflict of interest and should be widely criticized,” said Jerome Kassirer, a doctor who served as editor-in-chief of the New England Journal of Medicine in the 1990s and has written extensively about financial conflicts of interest in medicine, including a 2004 book on the subject.

Goldstein co-founded Edumedics in 2010. The Kentucky-based company helps businesses lower health insurance costs by monitoring employees who have chronic diseases and helping them manage their conditions.

Goldstein joined Lewiston’s Central Maine Healthcare in January 2013 as president of Central Maine Medical Group, the arm of the health system that handles doctors’ offices and medical practices. As president, Goldstein oversees more than 350 health care providers at four hospitals and nearly 80 sites, according to his biography on Edumedics’ website.

Central Maine Healthcare includes Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital, as well as the Maine College of Health Professions, a family medicine residency program and dozens of medical practices throughout central Maine.

Central Maine Healthcare officials refused to disclose how much Goldstein earns as president. He is not listed on the health system’s most recent tax filing.

Although Goldstein became head of Central Maine Medical Group, he retained his connection to Edumedics. He works as the company’s chairman and chief medical officer.

His wife, Gisela Wright, is vice president of operations.

Central Maine Healthcare officials refused to disclose any information about its contract with Edumedics, including cost, requirements and length of commitment. Officials said that information is proprietary.

Edumedics last year told Louisville Business First that its charges depend on what it’s able to save clients in health care costs. 

Health system officials said they signed with Edumedics to help improve the health of employees and their family members with diabetes, high blood pressure and high cholesterol.

“We are very excited about this program, not only as a tool to keep our employees healthy, but to move forward towards our national health care ‘Triple Aim’ goals of simultaneously improving the health of the population, enhancing the experience and outcomes of the patient, and reducing per-capita costs of care for the benefit of communities,” a statement released by Central Maine Healthcare spokesman Chuck Gill said. 

Officials said they chose Edumedics because it provided resources and expertise the health system didn’t have. They pointed out that Edumedics helped one business save 10 percent on its health insurance premiums over three years and that 96 percent of workers who get help from Edumedics report being satisfied with the services and quality of care.

Starting Jan. 1, Central Maine Healthcare workers and their adult family members who use the system’s health insurance and have diabetes, high blood pressure or high cholesterol must either sign up with Edumedics or pay $60 more per month for their health insurance. 

About 2,000 workers and 1,000 family members participate in Central Maine Healthcare’s health insurance program and its wellness offshoot, Healthy Decisions. Officials said just under 1,000 of those people have been identified as having at least one of the three chronic conditions being monitored by Edumedics.

People were identified when the health system’s insurance claims administrator sent patient billing information to Edumedics, according to a letter to employees.

Officials believe additional people will be identified through screenings.

Those who sign up with Edumedics must agree to an initial physical and a full medical history by an Edumedics nurse practitioner, as well as lab work, done during participants’ off hours. If their medical issues are under control and the nurse determines, “You have a strong understanding of your condition,” according to a Central Maine Healthcare website, that one visit may be all that’s required.

The nurse may determine more help is needed. Those participants will be required to meet with the nurse for follow-up visits during their off hours for monitoring, education and counseling about their conditions. The nurse may also recommend additional screenings.   

There is no charge for the required lab work, nurse visits or medications to treat the three chronic conditions, as long as they are purchased through Central Maine Healthcare’s pharmacy.  

Central Maine Healthcare considers the program voluntary. Participants must sign a form in which they release Central Maine Healthcare and Edumedics from liability and acknowledge the program is wholly voluntary.

But Kassirer believes workers and their families are being coerced. By increasing insurance costs for those who don’t participate, he said, the program is not voluntary.

He said it could be called extortion.

“The fact is that they’re being required to do something that will benefit the pocketbook or the wallet of the person who owns the organization,” he said. 

He equated the situation to a practice outlawed about 25 years ago by the federal government. The Stark Law prohibits doctors from referring Medicare and Medicaid patients to a medical facility in which they or a close family member have a financial interest.

“It was declared by the Congress inappropriate,” Kassirer said. “Physicians are not allowed to do that based on the fact it was an overt conflict of interest. This is pretty much the same thing.”

A similar 20-year-old anti-kickback law prohibits anyone from paying, bribing or otherwise rewarding someone else for driving business to federal health care programs. 

A message left for Goldstein at his health system office was not returned. Gill said neither Goldstein nor Central Maine Healthcare CEO Peter Chalke was available to comment Thursday.

Officials said no one from the health system, other than Goldstein, has invested in Edumedics.

ltice@sunjournal.com

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