Who Guards the Guardians? - From DeVry at a Time of Alleged Fraud to Anti-Fraud Enforcement for the Department of Education

There seems to be another fox ready to guard the already flustered educational, including medical educational hen house.

Dr Julian Schmoke to Lead Student Aid Enforcement Unit

According to Politico on August 30, 2017, the new head of enforcement for the Department of Education will be one Dr Julian Schmoke Jr,

The Trump administration has tapped a former for-profit college official to lead the Education Department unit that polices fraud in higher education.

Julian Schmoke Jr., who previously directed campus operations at West Georgia Technical College and served as a dean at DeVry University, will be the department’s new chief enforcement officer, according to an internal email obtained by POLITICO.

Schmoke will lead the Student Aid Enforcement Unit, which was established by the Obama administration to more aggressively combat fraud and deceptive practices at colleges and universities.

The unit has been without a permanent leader since the departure earlier this year of Robert Kaye, a former top consumer protection attorney at the Federal Trade Commission.

'Julian possesses over 16 years of experience in higher education leadership with extensive knowledge in the development and implementation of strategies for achieving student success, higher education policy and evaluation of academic programs,' the head of the Federal Student Aid Office A. Wayne Johnson wrote in an internal email last week.
Dr Schmoke's Work for DeVry University, and its Previous Fraud Settlements

Left unsaid by Department of Education officals was that Dr Schmoke had a significant role in DeVry University.  However, per Politico

Schmoke worked in various roles at DeVry University between October 2008 and April 2012, including as an associate program dean, according to his LinkedIn page.

DeVry’s parent company, which has since rebranded as Adtalem Global Education, last year agreed to pay $100 million to resolve allegations by the Federal Trade Commission that the for-profit college company misled students about their job and salary prospects.

The company also separately reached a settlement with the Education Department over similar allegations. Obama administration officials cited those cases against DeVry as they announced the formation of the Student Aid Unit last year.

The unit Schmoke will oversee is also responsible for processing debt relief claims filed by federal student loan borrowers who say they’ve been defrauded by their college. DeVry students had 1,872 'borrower defense to repayment' claims pending before the department, according to a July 7 letter from acting Undersecretary of Education James Manning.

A bit more about the fraud settlements made by DeVry appeared in the Atlanta Journal Constitution:

In December, the Federal Trade Commission announced a $100 million settlement with DeVry Education Group, parent of DeVry University. Under the settlement, DeVry will pay $49.4 million in cash to be distributed to qualifying students who were harmed by the deceptive ads, as well as $50.6 million in debt relief. The debt being forgiven includes the full balance owed —$30.35 million— on all private unpaid student loans that DeVry issued to undergraduates between September 2008 and September 2015, and $20.25 million in student debts for items such as tuition, books and lab fees, according to the FTC.

In 2016, we hadposted even more detail about the settlement here.

While Dr Schmoke had left DeVry by the time the settlement was made, he was there at the time DeVry was taking the actions that led to the lawsuits. Per the Wonkette blog,

Dr. Schmoke was a dean at DeVry between 2009 and 2012. During that time, the Federal Trade Commission sued the school for claiming that 90% of its graduates were employed in their field within six months of graduation. In fact, the real number dipped as low as 52%. Per WaPo,

According to the FTC lawsuit, DeVry counted graduates as working in their field when they were not, in order to boost its employment outcomes. A 2012 graduate who majored in business administration was working as a server at a restaurant, while another with a degree in technical management was working as a rural mail carrier.

Yet the creation of the unit of the Department of Education that Dr Schmoke is going to lead seems to have been inspired by the sorts of abuses that his former company, DeVry, was alleged to have committed, (see report by National Public Radio in 2016).

Discussion - In General

We could start a discussion of conflicts of interest, and even the revolving door, but,...

Thus, as an opinion piece in the Atlantic asserted, the appointment of Dr Schmoke "provoked complaints from critics who pointed out that DeVry recently settled several claims brought against it by regulators alleging it had engaged in some of the very abuses the unit is charged with eliminating."  A writer for Gizmodo put it  more bluntly,

the new student protection bureau of the federal government just hired a guy who worked at the same company whose malicious practices inspired the creation of that new student protection bureau. It’s like hiring one of Al Capone’s henchman to run the FBI!

Of course, the appointment was made by an administration headed by the man for whom Trump University was named, the same bogus university which also settled fraud allegations (see the New York Times story from November, 2016 here, and our post here).

The issue is no longer laxity or timidity in the protection of the public from fraud and deception.  The issue seems to be that the fraudsters are now to be in charge of the public's protection.  This has dire implications for the country.

Discussion - Implications for Off-Shore Medical Education

But we are focused on health care dysfunction, and this particular case also seems to have dire implications for medical eduction.

DeVry University, as we have posted, most recently here,  owns American University of the Caribbean School of Medicine, and Ross University School  of Medicine. These are off-shore medical schools that cater to US and Canadian students who wish to go back to the US and Canada to practice. However, they are located in various small Caribbean countries, and since they do not train doctors to practice in those countries, essentially operate without much regulation.

As we have said before,
Admission to US medical schools is increasingly difficult.  So many who seek medical careers may be tempted to apply to schools outside the US.  In the last 30 years, American entrepreneurs have opened offshore medical schools, mostly in the Caribbean, that cater to US students.  They teach in English, and do not require immersion in an unfamiliar culture, so may be more attractive than medical schools in other countries whose mission is to educate physicians to practice in those countries. In 2010, Eckhert documented that the number of offshore medical schools, "for-profit institutions whose purpose is to train U.S. and Canadian students who intend to return home to practice," but not to train physicians to practice in the countries in which these schools are located, was rapidly growing.(Eckhert NL.  Private schools of the Caribbean: outsourcing medical education.  Acad Med 2010; 85: 622-630.  Link here.)  By 2010, there were 33 such schools, 20 of which were new since 2000.

Such offshore medical schools exist in a grey area.  The small countries or colonies in which they are located usually do not seek to regulate them, since the physicians they produce are going to practice elsewhere. There is no requirement that these offshore medical schools be accredited in the US.  Such  accreditation is currently not required for individual graduates of such schools to be admitted to US house-staff programs or for US licensure.  So perhaps it is not surprising that little is known about these schools.

How they choose students, the qualifications or even names of their faculty, their curriculum, how they supervise clinical training (which is mostly done by affiliated North American hospitals), and what happens to their graduates are obscure.  Eckhert attempted to describe what is known, but noted 'variability exists in the availability of information on faculty; where data exists, it is noted that most of the permanent on-site basic science faculty are internationally trained, many have no documented medical education experience in the United States, and it is not uncommon for them to be OMS [offshore medical school] alumni.'

Since I wrote that, several anecdotes about life as an off-shore medical student have appeared (in February, 2017, and in March, 2017, in KevinMD).  Both stressed that the modus operandi of these schools is to have relatively lax entry criteria, make a lot of money from the tuition of the students initially enrolled, and then ruthlessly weed out the weakest, who may nonetheless be left with tremendous debt.  Furthermore, the March, 2017 post noted further signs of poor quality, including "mandatory lectures are nearly pathetic. There are so many mistakes made by the inexperienced professors, and the lecture becomes confusing and muddled."  Further, students who have any "emotional distress/burnout/sickness" are left to sink or swim, as the "staff is disconnected and said either repeat the term after you seek medical attention or just quit."    

Given that there are no widely accepted ways to measure the quality of medical schools, there are thus even more reasons to worry about the quality of the education received in off-shore medical schools than in US and Canadian schools. 

Things are likely to get much worse, though, if those in charge of US government agencies that are supposed to protect the public in general, and patients' and the public's health in particular are run by people who previously were involved in predations upon the public. 

It seems silly for me to go on about true health care reform at a time when crooks can be recruited into the police department.