OFFICE OF THE MAYOR

CITY AND COUNTY OF HONOLULU

530 SOUTH KING STREET, ROOM 300 HONOLULU, HAWAII 96813 PHONE: (808) 768-4141 FAX: (808) 768-4242 INTERNET: www.honoIuIu.ov
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PETER B. CARLISLE MAYOR

DOUGLASS. CHIN MANAGING DIRECTOR CHRYSTN K. A. EADS DEPUTY MANAGING DIRECTOR

October29, 2012

The Honorable Joshua Booth Green, M.D. Senator Hawaii State Capitol 415 S. Beretania Street, Room 222 Honolulu, Hawaii 96813 Dear Senator Green: Thank you for your letters dated August 9, 2012 to city director of human resources Noel Ono and to me and for your advocacy on behalf of Automated Healthcare Solutions (AHCS). I apologize for the delayed response; however, your charges against the City and County of Honolulu (the city) were so severe in tone that it prompted the city to carefully consider your letter and evaluate its actions up until now. To summarize, you requested the citys prompt and immediate payment of the balance billed and cite, among other reasons, the convenience of AHCS services to the drug dispensing physicians and citys claimants to whom they dispense drugs. Please be advised that the city considers this to be an internal billing dispute between itself and AHCS. I respectfully must inform you that we are unable to agree to the discount proposed by AHCS for the reasons stated below. As you are a strong supporter of controls against the unsustainable rate of increase in healthcare costs, you are aware of the abuse now taking place in physician dispensing that has caused an exponential increase in the city and State of Hawaiis prescription drug costs. Furthermore, physician dispensing is unique only to the workers compensation and automobile insurance segment of the market (less than 3% of the total Hawaii healthcare market). This practice does not currently exist under group health plans like Hawaii Medical Service Association (HMSA) or federally funded programs like Medicare and Medicaid. Only a few physicians engage in the practice of drug dispensing and their practices are not in areas underserved by pharmacies.

The Honorable Joshua Booth Green, M.D. Senator October 29, 2012 Page 2 of 4 Under workers compensation insurance, prescription drugs are reimbursed at the Average Wholesale Price (AWP) as published in Red Book (a Thompson Reuters reference source), plus a 40% markup, which companies might then exploit as follows: 1. A drug re-packager or manufacturer fills out a form to list their drug with Red Book. Red Book merely publishes what is identified on the listing form and does not provide any data services. Therefore, the AWP has no relevance to any actual average or wholesale amount. It is merely an amount listed on the form by the re-packager/manufacturer of the drug and published as such by Red Book. When the citys medical payment integrity vendor asked Red Book if they would publish their repackaged AWP for Acetaminophen (Tylenol) at $1 million per pill, Red Book purportedly replied, yes. 2. Drugs endowed with Red Book-listed AWPs are sold to physicians for physician dispensing by various firms. These firms appear to compete for the physician business on the basis of having higher registered AWPs than their competitors. The pitch to the dispensing physician is, once you compare our AWPs with the AWPs from your current sources, you will clearly see which ones are more profitable. 3. Physicians dispense these drugs and wash their hands by passing their claims for collection to companies like AHCS who is the expert collection agency for such claims using their strategy of influence wielding through practices such as lobbying and campaign contributions to receptive politicians. Dispensing physicians also now appear to prescribe all sorts of compounded drugs that are amended from readily available substances. The best example of this is th th 25 / diluted Ben Gay at 1/1 0 to 1 of the active strength contained in its ingredients. The citys contractor used this example in its testimony in support of a Hawaii legislative bill that sought to control this practice. The city has a claimant for whom the dispensing physician prescribed and dispensed over $8,600 of this compound even though the claimant repeatedly objected stating that he did not use it and it was stacking up in his garage. The dispensing physician still insisted the claimant walk out with a few tubes of this compound each visit anyway at a billed cost of $299.00/tube. How much are dispensing physicians actually paying for the medications they dispense at such high AWPs while claiming that it is because of low purchasing volumes that their prices reflect costs higher than retail pharmacies? This table shows a handful of examples that the city obtained from a dispensing physician and offers a comparison of the rates actually billed to employers (such as the city and the State of Hawaii) and insurers compared to rates offered by a sample local pharmacy:

The Honorable Joshua Booth Green, M.D. Senator October 29, 2012 Page 3 of 4

Medication Dispensed Carisoprodol 350mg #30 Diclofenac Sodium 100mg #30 Naproxen 500mg #60 Orneprazole 20mg #60

AHCS Billed $277.47 $20074 $188.16 $367.11

[ [

Physician Paid $4.80 $1282 $4.40 $11.42

1 1 1

Billed as % of Cost 5,781% 1,566% 4,276% 3,215%

Longs Pricing $18.29 $8559 $32.39 $124.89

AHCS is not a provider of service but rather a self-described technology company/bill collection agency which buys the drug claim up front from the dispensing physician. As such, AHCS enters into a business arrangement with the physician at its own risk. In processing AHCS-referenced claims, IMS (the citys medical payment integrity vendor), pursuant to HAR 12-15-55(c), repeatedly requested from AHCS a copy of the invoice for the dispensed drug that would identify the National Drug Code (NDC) number and the AWP at the time of purchase by the provider of service. AHCS has refused to provide the requested information. This past May, AHCS requested that IMS negotiate an agreement for the city claims. IMS agreed and executed a non-disclosure agreement with AHCS as requested. AHCS then provided a pricing proposal insisting that IMS negotiate with AHCS on the outstanding city claims first, as they represented their largest aggregate billed amount. IMS and the city jointly performed an analysis of the AHCS pricing proposal. The counter-offer presented by the city and IMS was generous relative to local pharmacy pricing and prices available to city claimants through the citys pharmacy benefit management program. AHCS did not respond to the city or IMS, but without notice, immediately began filing billing dispute requests with the Hawaii department of labor and industrial relations. As such, the city intends to present its case during the formal dispute resolution process once the State initiates this. Given the foregoing, the city urges you, in the meantime, as an advocate of responsible medicine and cost-effective care, to investigate the practice of physician dispensing in this state. Here are some key concerns: With so many drug options available to them, why are dispensing physicians choosing the most expensive ones? Why should the city pay $832.37 for Carisoprodol 350mg per 90 tabs when the physician paid $14.40 out of pocket and the local pharmacy sells it for $57.65? How can the government justify this expense to taxpayers?

The Honorable Joshua Booth Green, M.D. Senator October 29, 2012 Page 4 of 4 Why are some dispensing physicians choosing to dispense uniquely compounded preparations of dubious therapeutic value? For example, why the diluted Ben Gay cited above or Speed Gel, a topical anti-inflammatory identified in Red Book as active ingredient Homeopathic billed against the city taxpayers at $41 6.01/tube when the physician pays $43.20/tube? Why do some dispensing physicians insist their patients load-up on the dispensed drugs? Please see the attached department of labor ruling from the Big Island.

HMSAs portion of prescription drug costs account for 15.4% of the total claims costs paid in 2011 with the remainder going to Hospital (48.4%), Professional Services (34.2%), and Dental, Vision, and Chiropractic (2%). Please feel free to use any of the examples provided here as a cost basis and calculate what would happen to health insurance costs in Hawaii if HMSA bore the same impact of physician dispensing in its program as the city does in its workers compensation program. For example, AHCS billed $181.07 for 60 tabs of Hydrocodone/APAP 7.5-500 mg, while HMSAs fully covered benefit allows $12.17. You might reasonably conclude that the cost of prescription drugs under such an arrangement would at minimum eclipse the total cost of all other healthcare services combined and leave Hawaii with a bankrupt system and no coverage. Also note that while severely impacting employers and workers compensation insurers, this practice also affects consumers indirectly in the form of increased automobile insurance premiums and reduced benefits when their personal injury protection coverage exhausts due to the high cost of such physician dispensed medications. Also attached is a New York Times article that might interest you if you pursue this inquiry. We would be happy to provide more articles as AHCS has become the national example of public outrage and scorn for such physician dispensing practices. Very truly yours,

as.n Managing Director Attachments cc: Bruce Coppa, Governors Office Dwight Takamine, Director, Department of Labor and Industrial Relations

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STATE CAPITOL HONOLULU, HAWAII 96813

OFFICE OF SENATOR JOSHUA BOOTH GREEN M.D.

August 9, 2012

Noel Ono, Director City and County ofHonolulu, Human Resources Dept 650 S. King Street, 10th Floor Honolulu, HI 96813 ccd: Douglas Chin, Managing Director Dear Director Ono, I recently met with representatives from Automated Healthcare Solutions, a company that provides physicians with a full service solution that allows them to dispense medications to their workers compensation patients. The service improves the care provided to these injured workers as they are given necessary medication at point of care at no cost, as opposed to having to travel to the pharmacy and risk being denied due to insurance verification issues, etc. One of the prescription services provided by AHCS is that they purchase the prescription claims from the dispensing physicians, paying the physicians upfront for the claims and then billing insurance carriers at the Hawaii fee schedule (1.4 x Average Wholesale Price). AHCS has provided me with accounts receivable data for the City of Honolulus injured workers medication claims which demonstrates that through May of 2012 Prescription Partners (AHCS billing arm) has billed your agency $799,685 at the fee schedule but has only received $180,182 in payments from you (see attached). Per its claims purchase agreement with the medical clinics that treat your workers, AHCS has paid the clinics $599,779, leaving them with a LOSS of $379,598! Whats most disturbing is that for the current year, you have only paid 1% of your outstanding invoices. I appreciate the fiscal strain that our government agencies have been under over recent years but I also appreciate the fact that budgets have increased recently and also the Senatwt Joo1ua Bail1 teeu .iJL.
District North Kona I South Kona I North Kohala I South Kohala HAWAII ST CAPITOL, Room 222 HONOLULU, HAWAII 96813 &TE 4

3rd

PhONE: (808) 586.9385 CehI: (808) 937.0991: TOLL FREE hAWAII ISLAND: (808) 974.400 cxl. 9385 FAX: (808) 586-9391 EMAIL: oshinaboothicc,i@yahioo.om

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STATE CAPITOL HONOLULU, HAWAII 96813

OFFICE OF SENATOR JOSHUA BOOTH GREEN M.D. simple fact that one needs to pay ones bills. Your non-payment has already impacted patient care for the City of Honolulu workers as AHCS has been forced to go to a collection-based arrangement with the physicians. As a result, the physicians are reluctant to dispense certain necessary medications to your workers due to the uncertainty that they will ever recoup their costs. AHCS has attempted to negotiate with Kris Kadzielawa at IMS, your Third Party Administrator firm, but his offer of 20 cents on the reimbursable dollar for past and future claims is both unreasonable and unsustainable. AHCS has graciously agreed to a reasonable discount on outstanding payments and th future claims. I ask that you kindly settle up with them by August 24 at the latest. Many thanks,

Josh Green, M.D. State Senate rd 3 District

Seitatoit Jadtw .9)oth eeii M.)

District North Kona I South Kona / North Kohala I South Kohala HAWAII STATE CAPITOL, Room 222 HONOLULU, HAWAII 96813
3rd

PhONE: (808) 586-9385 CeII: (808) 937-0991: TOLL FREE hAWAII ISLAND: (80$) 974-40() exL. 9385 FAX: (808) 586-9391

E-IAIL: josIiuabooLhareeii@yahoo.com

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STATE CAPITOL HONOLULU, HAWAII 96813

OFFICE OF SENATOR JOSHUA BOOTH GREEN M.D.

Billed (1.4x AWP) 2010 2011

2012

Collections $76,637.88 $101,461.82 $2,081.85

$180,181.55

% 93% 28% 1% 23%

Paid to Clinics $57,413.43 $254,978.61 $247,387.65 $559,779.68

AHCS Margin

I (Loss)

$82,019.18 $364,255.15 $353,410.93

$799,685.26

Total

$19,224.45 ($153,516.79) ($245,305.80) ($379,598.13)

Senatwt Jofuu .i3aath Lw j1L93.

District North Kona / South Kona I North Kohala / South Kohala HAWAII STATE CAPITOL, Room 222 HONOLULU, HAWAII 96813
3rd

PhONE: (808) 586.9385 -Cell: (808) 937-0991: TOLL FREE hAWAII ISLAND: (808) 971-400 cxl. 9385 FAX: (808) 586-9391EMAIL: joshnabootIigrecii(yahoo.com

STATE OF HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILIVI COMPENSATION DIVISION WEST KAWAII DISTRICT OFFICE P.O. BOX 4 KEAIAKEKUA, HAWAII oa7u

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ER3EST C TORRICER
PC) BOX 3112

KAILUA KONA HI 96745

DECS1ON
J SUPPLEMLL TO IPULAThD COMPRc5tE AND4ELEASE AGRE)MENTV1JATED J3/2OlO
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GROUP BUl1,D)RS INC

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GAII,AGL12R BJ\SSETT SIRVICES INC PIONEER PLAZA 900 FORT ST STE 420 HONOLULU HI 96813 Case No D/A; 90900692 6/23/2009

INTRODUCTION

Pursuant to a Stipulated Compromise and Release Agreement; Approval and Order dated 12/13/2010, the parties agreed the claimaiit had suffered personal jnuries to the lumbosacral spine, left hip, left t1igh, left leg, left knee, left elbow, left forearm, left wrist, chest, and 11th rib by accident arising out of and in the course of employment with the above-named employer on Said greement provided benefits pursuant to Chapter 386, Hawaii 4/23/2009. Specifically, said Order provided for such medical Revised Statutes (HRS) and aupplies as the nature of the injury may require, care, services, temporary total disability benefits beginning (Waiting period 4/24/2009 through 4/2G/0O9) 4/27/2009 through 5/2/2010, fora total of $30,425.00. The parties further agreed the claimant suffered 7% permanent partial disability of the whole person inclusive of the 11th rib, 24% permanent partial disability of the left lower extremity, 5% permanent partial diabi1iI;y of th left hand, 2% permanent partial disability of the left The average weekly wages of the upper extremity, and certain disfigurement. claimant were $1,478.00.
hearing presided over by Hearings Officer Kimoto was held on 6/13/2012.

ISSUE
Is the claimant entitled to further medical care for the injury of 4/23/2009?

I WC ISA (Rev 8!08)

i, 1JG9?2

ERNEST C EOflRICER C90900592) Page 2

PARTIES POSITIONS

The claimant contends that he went to Aloha Pain Clinic and saw Rudolph Puaua, M.D., ior hi left hip and left leg pain, Claimants last attending physician was Terry Smith, M.D., and claimant could not find another doctor On 2/15/2012, claimant was prescribed medications to treat his work injury. including Ondansetron 4mg 430, IZanitidine 300mg fl60, Flector Patch l.3 ff30, Amitiza 24mng ff60, r1eloxicam 7.5mg 60, Speed Gel Rx Pain Relief Gel 30m1, 7.olpidem Tartrate 5mg ff30, Hydrocodone, and Acetaminophen 10-325mg #90. Claimant told Dr. Puana that he did not want to take medicatibns, but he was claimant tries to take as little prescribed all of theme medications. possible for any of hi conditions. medications On 6/12/2012, claimant sent an email to Aloha Pain Clinic questioning the necessity of all of the prescribed medications with the total cost Claimant will be trying to return the medications since exceeding $5,000.00, he will not be baking the medications. The employer contends that they have not denied further medical care Upon receiving the medical bills from Aloha Pain Clinic,. for claimant, employer questi.oned, the $5,201.34 -in prescription medications and wanted an a independent medical evaluation since it appeared claimant may have suffered By letter dated 3/30/2012, employer asked Aloha Pain Clinic to injury. new provided a provide claimant rith a written prescription since claimant was In comparing the cost of the prescription uard from First Script. prescription medications from Aloha Pain Clinic, if claimant utilized the from :Lrs1 Script, the same medications would cost $944.08. card FflDINGS OF FACT The History and Physical report dated 2/15/2012 from Aloha Pain Clinic Claimant was noted claimants ].eft hip pain became more significant lately. In to be taking Diovan and gout medications and no pain medications. rioted noted claimants his report dated 5/25/2010, James Langwortby, 4.D., Claimants medications have been medications were Driovan and AJ.lopurinal. limited to only Diovan and Allopurinal. during these periods. consistently Claimant does not want to take the medications prescribed on 2/15/2012 In refusing the medications, Aloha and he will be returning the medications. shall Pain Clinic cannot charge the employer and it is determined employer Claimant, shall medications. nob he liable for the costs of the prescription not be charged for these prescription medications, Employer has not denied further medical care, claimants work injury: PRINCIPLES OF LAW Sections 386-21 and-386-26, L-1RS, provide tb.at a liable employer ahaJ.l of the injury pay for such medical care, services, and supplies as the nature require. may
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services, or supplies for

ERNEST C TO!flICER Yige 3

(90900592)

CONCLUSZOS OF LAW The Director finds, based on the Findings of Fact and Principles of the claimant continues to be entitled to further medical care, but the Laq, employer is not liable for the prescription medications dispensed by Aloha The Director credits the position of t:he claimant Pain Clinic on 2/15/2012. and the employer. DECISION AD ORDER 1. SectionS 386-21 and 38-26, FIRS, said employer shall continue to pay for such medical care, services, and supplies as the nature of the injury may require, excluding the prescripti.on medications dispensed on 2/15/2 012 by Claimant shall not be charged for the Aloha gain Clinic.

prescription, medications.
BY ORDER OF THE DIRECTOR, AUGUST 8, 2012.

APPEAL:

tine of appeal with the ntative within of Labor an ThcIustrial Relations or the Directors co1nty represe Director decision ha been sent. twenty days after a copy of this
n Thi. decision may be appeai.ed by filing a written

rial R atiozis that no person shall It is the policy of the Department of Labor and Indust reed, ethnic origin, of race, color, sex, marital atatus, religion, on the basis ity, ancestry, arrest/court recrd, sexual orientatin, and national origin, age, disabil ination, excluded from participation, Mational Guard participation be subjected to discrim the departments services, programs, activtieo, rr employment, or denied the benefi.trj of
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Doctors Cash In by Being Their Own Pharmacist NYTimes.c... Page 1 of 5

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tiorkim

1.2012

insurers Pay Big Markups as Doctors Dispense Drugs

Ey BARRY MEIER and KATIE THOMAS

When a pharmacy sells the heartburn drug Zantac, each pill costs about 35 cents. But doctors dispensing it to patients in their offices have charged nearly 10 times that price, or $3.25 a pill. The same goes for a popular muscle relaxant known as Soma, insurers say. From a pharmacy, the per-pill price is 6o cents. Sold by a doctor, it can cost more than five times that, or $3.33.
At a time of soaring health care bills, experts say that doctors, middlemen arid drug distributors are adding hundreds of millions of dollars annually to the costs borne by taxpayers, insurance companies and employers through the practice of physician dispensing.

iViost common among physicians who treat injured workers, it is a twist on a typical doctors visit. Instead of sending patients to drugstores to get prescriptions filled, doctors dispense the drugs in their offices to patients, With the bills going to insurers. Doctors can make tens of thousands of dollars a year operating their own in-office pharmacies. The practice has become so profitable that private equity firms are buying stakes in the businesses, and political lobbying over the issue is fierce.

Doctor dispensing can be convenient for patients. But rules in many states governing workers compensation insurance contain loopholes that allow doctors to sell the drugs at huge markups. Profits from the sales are shared by doctors, middlemen who help physicians start in-office pharmacies and drug distributors who repackage medications for office sale.

http://www.nytimes.com/20 12/07/1 2/business/some-physicians-makin... 8/21/2012

Sornc Doctors Cash in by Being Their Own Pharmacist NYTimes.c... Page 2 of 5 Alarmed by the costs, some states, including California and Oklahoma, have clamped down on the practice. But legislative and regulatory battles over it are playing out in other states like Florida, Hawaii and Maryland.
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In Florida, a company called Automated HealthCare Solutions, a leader in physician dispensing, has defeated repeated efforts to change what doctors can charge. The company, which is partly owned by Abry Partners, a private equity firm, has given more than $3.3 million in political contributions either directly or through entities its principals control, public records show. Insurers and business groups said they were amazed by the little-known companys spending spree. To plead its case to Florida lawmakers, Automated HealthCare hired one of the states top lobbyists, Brian Ballard, who is also a major national fund-raiser for the Mitt Romney campaign. I consider the fees that these people are charging to be immoral, said Alan Hays, a Republican state senator in Florida who introduced a bill to bar physicians from dispensing pills that was defeated. Theyre legal under the current law, but theyre immoral. Physician prescribing works like this: Middlemen like Automated HealthCare help doctors set up office pharmacies by providing them with billing software and connecting them with suppliers who repackage medications for office sale. Doctors sell the drugs but they do not collect payments from insurers. In the case of Automated HealthCare, the company pays the doctor 70 percent of what the doctor charges, then seeks to collect the full amount from insurers. The number of doctors nationwide who dispense drugs in their office is not known and the practice is prevalent only in states where workers compensation rules allow for large markups. Dr. Paul Zimmerman, a founder of Automated HealthCare, said that insurers and other opponents of doctor dispensing were distorting its costs by emphasizing the prices of a few drugs, rather than the typical price spread between physician- and pharmacy-dispensed drugs.

http://www.nytimes.com/2O 12/07/1 2/business/some-physicians-makin... 8/21/20 12

Sorne Doctors Cash In. by Being Their Own Pharmacist NYTimes.c... Page 3 of 5 Both Dr. Zimmerman and physicians who sell drugs also said the workers compensation system was so bureaucratic and complex that an injured employee could wait days before getting a needed medication through a pharmacy.
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We did not institute this because of the money, Dr. Marc Loev, a managing partner of the Spine Center, a chain of clinics in Maryland, testified last year at a public hearing in Baltimore. We instituted it because we were having significant difficulty providing the care for workers compensation patients. The loophole that raises the price of physician-dispensed drugs often involves a benchmark called average wholesale price. The cost of a medication dispensed through a workers compensation plan is pegged in some states to that benchmark, which is supposed to represent a drugs typical wholesale cost. But doctor-dispensed drugs can undergo an average wholesale price makeover. It happens when firms that supply doctors with medications buy them in bulk from wholesalers and repackage them for office sale. These repackagers can set a new average wholesale price, one that is often many times higher than the original. For example, in 2010, a physician associated with the Spine Center, Dr. Loevs practice in Maryland, gave a patient a prescription for 360 patches containing a pain-numbing drug, lidocaine. The workers insurer was charged $7,304, according to a copy of that bill provided to The New York Times by a lawyer, Michael S. Levin, who represents insurance companies. A similar number of patches dispensed by a doctor in California, which changed its regulations in 2007, is about $4,068, according to the California Workers Compensation Institute, a research group. Warren G. Moseley, the president of a company in Tulsa, Okia., Physicians Total Care, that repackages drugs for office sale by doctors, said it charged physicians $2,863 for 360 patches. Dr. Loev, who uses Automated HealthCares services, declined to be interviewed and did not respond to specific written questions from The Times. http://www.nytirnes.com/20 12/07/1 2/business/some-physicians-makin... 8/21/2012

Sorne Doctors Cash In by Being Their Own Pharmacist NYTimes.c... Page 4 of 5

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Dr. Charles Thorne, a principal at Multi-Specialty HealthCare, another Maryland-based chain of clinics that dispenses drugs, also declined to be interviewed. Dr. Zimmerman, the co-founder of Automated HealthCare, said that drug prices are set by companies that repackage medications for office sales.
He added that Automated HealthCare referred doctors to about a dozen

repackagers. But the company has a relationship with one repackaging company called Quality Care Products, based in the Midwest. The two firms have exhibited their services together and jointly sponsor a charity golf tournament. The president of Quality Care, Gene Gunderson, declined to be interviewed and the company did not respond to written questions. Data collected by Florida insurers who handle workers compensation claims shows that Quality Care supplies about 40 percent of the drugs sold by doctors in the state, a market share three times as high as that of its closest competitor. Robert M. Mernick, the president of Bryant Ranch Prepack, a company in North Hollywood, Calif., that repackages medications for office sale, said he found it extraordinary that lawmakers in other states like Florida and Maryland were allowing such drug markups to continue. I see it as corruption, he said. I think it is horrible. In 2010, Abry Partners, a private equity firm in Boston, bought a stake in Automated HealthCare for $85 million. Officials of Abry also declined to be interviewed for this article. That same year, Florida lawmakers tried to clamp down on how much doctors could charge for drugs. Automated HealthCare responded with a major lobbying and spending campaign, focusing its efforts on state leaders like the president of the Florida senate, Mike Haridopolos. When the bill was reintroduced this year, Mr. Haridopolos declined to allow a vote. The states insurance commissioner had backed the move, saying it would annually save firms and taxpayers $62 million, a figure disputed by Automated HealthCare. http://www.nytirnes.com/20 12/07/1 2/business/some-physicians-makin... 8/21/2012

Somc Doctors Cash in by Being Their Own Pharmacist NYTimes.c... Page 5 of 5 Mr. Haridopolos said he didnt believe the bill had a chance of winning. It seemed like a big political food fight, he said.
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Mr. Hays, the legislator who introduced the measure, said he found that hard to believe. The strategy of the people that were opposed to this bill was to put the right amount of dollars in the right hands and get the bill blocked, he said. And they were successful in doing that.

Ii ttp ://www.nytimes. com/20 12/07/1 2/business/some-physicians-makin... 8/21/20 2