A concerning story out of Chicago revealed two hospital executives, three physicians and a podiatrist had been participating in an elaborate health insurance scheme to defraud patients and collect illegal kickbacks.
According to the arrest report, the six medical professionals were arrested by federal agents for conspiring to give and receive illegal kickbacks by referring Medicare and Medicaid patients to one another. They were exposed after six other individuals who had been targeted in the scheme decided to secretly record conversations to reveal the depth of the operation.
The FBI and US Department of Health & Human Services now has the task of sifting through the recordings to determine if any additional charges should be brought upon the suspects.
Prolonged Stays, Unnecessary Sedation
The scheme operated by keeping patients in the hospital longer than normal, which would then result in bigger health insurance payments to the hospital. The leaders of the scheme would then provide kickbacks to physicians under the guise of job duties that they never preformed. Some of the alleged kickbacks included:
- $2,000 a month in the form of rent payment for an office space that was never used.
- $2,000 a month disguised as payments for teaching medical students, which never happened.
- $4,000 a month for supervising podiatry students, which never occurred.
In order to receive the kickbacks, the healthcare workers needed to bring in extra revenue for the hospital. One way they did this was by performing a high number of intubations. These patients were then placed under heavy sedation so they could not breathe without aid. That made them ideal candidates for a tracheotomy, which according to Edward Novak, president and chief executive officer of Sacred Heart Hospital, was the “biggest money maker” for the center. According to records, the hospital could receive $160,000 in payments for the procedure if the patient stayed in the hospital for 27 days.
A look into the 14-day mortality rates for Medicare patients that underwent a tracheotomy preformed by one of the named surgeons revealed that it was roughly triple the rate of the state averaged over a 3-year period.
Those implicated in the scheme will likely face other charges as the recordings also alluded to unnecessary penile operations and an agreement with an ambulance company to bring elderly patients to Sacred Heart instead of another medical center.
Dr. Silverman comments
I am shocked at the alleged behavior of doctors. They violated the most important tenet of medical care. “Primum non nocere” is a Latin phrase that means “first, do no harm”. These workers did not stand by that creed.
If proven to be true, these doctors and administrators used nursing home patients as a means to harvest money. Fraud and kickbacks are the least of the charges leveled. This is first and foremost a crime against people.
Beyond stopping and punishing these criminals, the next step will be for the medical profession to work towards restoring the loss of public trust. These behaviors are unthinkable to most people. How challenging will this story make communication with my patients? Building trust with patients will be more challenging.
I hope the public realizes these crimes were committed by a tiny fraction of medical individuals (I refuse to call them professionals), and as a whole, the medical community works extremely hard to ensure the health of our patients.
Related source: Medscape
