In Whose Best Interest? The Ethics Surrounding the AIDS Healthcare Foundation Lawsuit

In the coming weeks, roughly 17,500 of the brightest medical minds in America will don their gowns and mortarboards and be formally welcomed as the latest initiates into the fraternity of practicing physicians. The ceremonies celebrating the accomplishments of these young men and women will be many, but they will likely not be varied. Keynote speakers may differ and the university names on the diplomas may change, but most of our nation’s 141 accredited medical schools will follow a very similar script which includes—among other things—the recitation of the Hippocratic Oath, in which the newly minted doctors promise to uphold the ethical standards of their profession and do no harm to their patients.

However, while the Hippocratic Oath will be used to swear in the vast majority of American physicians, there will be a select few who will instead recite another oath—the Oath of Maimonides. A 12th century rabbi, philosopher and physician who lived and worked in North Africa, Maimonides is a man known as much for his Talmudic scholarship as his contributions to medicine, and it is this melding of the spiritual and the medical that imbues his oath with a sense of shared humanity and compassion that is lacking from its Hippocratic cousin. In its opening lines, the Oath of Maimonides proclaims:

“The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children.”

It would serve us well to keep the words of Maimonides in the back of our minds as we look at the most recent scandal involving the AIDS Healthcare Foundation (AHF) and their polarizing president, Michael Weinstein. Last month, the AIDS Healthcare Foundation was thrust into an unwelcome spotlight when a lawsuit filed by 3 former AHF employees alleging that the company was violating the Federal Anti-Kickback Statute was made public. According to the suit, AHF handed out cash or other incentives to clients who tested positive and were successfully linked to care at an AHF facility, while also providing its employees with bonuses of between $50 and $100 for facilitating that linkage. These bonuses, the lawsuit argues, are in direct violation of federal law and were instituted in an attempt to game the system and fraudulently increase the amount of funding AHF received from Medicaid, Medicare and federal HIV/AIDS grant programs to the tune of $20 million a year since 2010.

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AIDS Healthcare Foundation President Michael Weinstein Gears Up For Another Round of Litigation, This Time Against Whistleblowers Within His Own Company (Photo Credit: Mark Boster / Los Angeles Times)

For his part, Weinstein has denied all wrong doing, readily acknowledging that it was company policy to incentivize linkage to care for new clients, but claiming that such actions were common industry practice and justified by their outcomes. “We neither broke or abused any law.” Weinstein said in an interview with Karen Ocamb of Frontiers Media. “And in fact, from our vantage point, we’re doing exactly what we’re supposed to be doing…” Whether or not someone believes Weinstein is being sincere in his remarks may have less to do with the facts of the suit than and more to do with their preconceived opinion of Weinstein and his motives. AHF has never been one to shy away from controversy or the litigation that often accompanies it and has burned its fair share of bridges in the HIV/AIDS community on the way to becoming a nonprofit juggernaut that cares for more than 350,000 HIV positive people in 36 countries and can boast of an annual budget of $1.1 billion.

With that being said, critics of AIDS Healthcare Foundation might charge that in their quest for increased dominion over the world of HIV/AIDS care and the pursuit of more clients in more cities, countries and counties, the organization has lost sight of the ethic promoted by Maimonides which encouraged the sublimation of the ego for the good of the patient. Nowhere is this philanthropic myopia more apparent than in Florida, where the most recent whistleblower suit against AHF was filed and where the non-profit was recently awarded a government contract to operate specialty health care plans in the southern portion of the state as part of its new Statewide Medicaid Managed Care program.

The program, which was voted through by the conservative state legislature in 2012, made Florida the first state to fully privatize Medicaid services and provided AIDS Healthcare Foundation with thousands of new clients and millions of dollars in potential revenue. The exact reasons why AHF got the Medicaid contract over other service providers aren’t known, but one would have to be pretty naïve not to think that the $125,000 a year they’ve been giving to one of Tallahassee’s top lobbyists and their propensity for handing out campaign contributions haven’t played a role. Not that there’s anything illegal or inherently wrong about this sort of behavior. AHF wasn’t doing anything that hasn’t been done a million times over at the intersection of non-profits and politics. It is not what they’ve been doing, but who they’ve been doing it with that is of concern.

According to the National Institute on Money in State Politics, the AIDS Healthcare Foundation has given $46,500 in campaign contributions to the Florida Republican Party and their candidates for statewide office since 2002, which is troubling considering the fact that most of the politicians AHF was backing supported policies that were hostile to much of the population they had pledged to serve. Why, one might ask, would an organization that purports to want to get as many HIV positive people into care as possible give $3,000 to a governor who fought against Medicaid expansion tooth and nail until it benefitted private health care companies? Why would AHF give $1,500 to former Florida Speaker of the House Dean Cannon Jr., a man with a perfect rating from the American Conservative Union who was once described by a columnist at the Orlando Sentinel as being, “instrumental in orchestrating the greatest rightward shift in [Florida] since secession”?

While I can’t answer any of those questions with absolute certainty, I can say that I can think of no altruistic reasoning for an HIV/AIDS healthcare organization to be giving money to homophobes and religious zealots who believe that health care is a privilege and not a right. How can supporting men and women who are hell bent on marginalizing the poor and the sick and the different possibly fulfill our divine appointment to watch over the life and the health of our fellows? The short answer is that it can’t. It won’t. And it never will.

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Categories: HIV News, US Politics

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3 replies

  1. Had, of course, heard of Maimonedes, from your Grandfather – but appreciate knowing the quote. I cannot tell you how much I am honored to be learning so much from you, Drew. What a privilege!

  2. So many incredible people are working in AIDS non-profits for next to nothing. Many, many of them of them struggle with HIV themselves. It is not really as easy as some would like to conveniently assume. It is hard fucking work, and its gravitas is difficulty. It is a place where hope for a cure is always, always just around the scientific corner of the fantastical AIDS-free generation slogan a slogan we get slogans. We’re sloganed out, Mary. We don’t get cures from the suits we get slogans created by publicists to keep out spirits up, and I have news for you bitches it won’t work. The numbers are too big. What makes it hard is the stuff where we have to come to terms with this hope they talk about as not meaning us. This is a big varied group, but they keep working at it. Another big part of this group is not about what they are, but what they are not. They are not the suits. And they tend not to play the suit games because they do not have time there is no time to play courtroom with all of its attendant drag, or Wall Street with all of its attendant, corporate indifference, we’re fucking out here still making sack lunches and sandwiches. Can you get it. When we are not making sandwiches or washing dishes or doing someone’s laundry, these days, we’re on the Internet making trouble, and sometimes causing a light to shine that picks up the fragment’s mirrored pieces of a puzzle that leaves evidence everywhere that indicates AIDS is not over. You tell the kids I work with that AIDS is over. You can’t. For one thing, the hard to reach are the hard to reach and often we’re hard to reach because sometimes you have to get out of Dodge and go find some other state to live in like Indiana. Which is insane. Or they run away from their loving homes in places like Indiana to go live at the Port Authority where they will blow you for five bucks in the toilets. They’re out there doing sex work to survive the street. Tell them to come in from the street, and they’re going to throw come in where back at you in your face. And spit. Come in so we can take your name and your photograph and your ID and your history (often, colorful) and your viral load and let us put you in the system designed by the suits on a shoestring you poor unfortunate dingdong. Full do-gooder mode until this group burns out again. The kid will run. I wish more suits would run than kids at-risk. Because the suits are the ones who make the rules and there is never enough money even with Ryan White funding, there is not enough money and Indianas are everywhere. Pockets like the ones in bone marrow lurking. Appalachia is an Indiana. I tell the newly diagnosed to run as fast as they can because the suits here in le south are in state legislatures and they take their cut, too, everyone’s hand is out, and do really think that now that AIDS has been corporatized this is the paradigm that will give you an AIDS-free generation. Girlfriend, are you a fool. This is the paradigm that keeps HIV alive and suits fed because being fed is what they do. The corporate Big Girl suits and their attorneys know how to play this game. Calling them on it is not ladylike. The Big Girls who are not suits know this: Their houses can all come tumbling down, too. This is AIDS and no one is immune, and all of your slogans, and all of your publicists put together, cannot reassemble Jack Shit you have sucked him dry, and sucked him off, and bled him, and now he’s making sandwiches and and packing sack lunches and driving around to bitches who have no money because Big Pharma has sucked their cocks off, too. It’s about the money and an office, and all the credit cards, until it isn’t. I want their new cars to drive sack lunches around in. I can’t even tie a fucking tie because I have no occasion to wear one and gag me with a suit’s dick in my mouth we are all getting fucked because a suit is a suit is a suit. It’s not going to change because the purpose of any suit and her money is to render you powerless and that is what you are. I blame the suits because they want to make me vomit, but I have to go now and make 397,566,249,101 sandwiches and drive them around to my girlfriends who are not the ones out there with jobs and don’t even go there it’s not going to happen they can barely leave the house. Baby’s hip broke last week because the Prednisone they used to keep his lungs open attacked his bones which are now slowly dying IN him and it hurts a lot a lot a lot like being fucked in the ass with a big cock that does not come out and it hurts and to get out of the wheelchair she needs to coordinate a hip replacement, but sure, why not, she will leap out of the wheelchair in her old housecoat and get that job you bet and if you believe the suits and their paternalistic hierarchal corporate money machines are going to suddenly find Jesus and overturn the money-lender’s table in the Corporate Temple of AIDS, then you will believe that I am Marie of Romania.

  3. think Magic Johnson would do well to distance himself from AHF in Jacksonville where some medical providers there even refuse to approve, under the ADA, discounted bus passes paid to JTA by the client. In S. Florida, they are given free to AHF clients. A real world application of what you say appears, pertaining to AHF in Jax in that, is not supportive to the older HIV community in this town.

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