How Doctors Buy Their Way Out Of Trouble

Reuters has an article posted online which reports that federal authorities are filing civil actions against doctors engaged in medical fraud, but the victims receive no proceeds from the settlements and state licensing authorities take no actions against the doctors.  Reuters cites one anonymized Michigan case in this report, which is too large to reprint in its entirity:

https://www.reuters.com/investigates/special-report/usa-healthcare-settlements/

How doctors buy their way out of trouble
By Michel Berens - May 24, 2023

Medical practitioners and providers paid $26.8 billion over the past decade to settle federal allegations including fraud, bribery and patient harm, a Reuters investigation found. Paying up means staying in business and, for some, avoiding prison. U.S. prosecutors helped them do it.

When federal enforcers alleged in 2015 that New York surgeon Feng Qin had performed scores of medically unnecessary cardiac procedures on elderly patients, they decided not to pursue a time-consuming criminal case.

Instead, prosecutors chose an easier, swifter legal strategy: a civil suit. Qin agreed to pay $150,000 in a negotiated settlement and walked free to perform more cardiac surgeries at his new solo practice in lower Manhattan.

Qin faced no judge or jury. He did not admit to wrongdoing. He maintained his license to practice. What’s more, neither Qin nor government officials were required to notify patients who purportedly were subjected to vascular surgical procedures they didn’t need. Those included fistulagrams to spot issues like narrowed blood vessels or clots, and angioplasties to open clogged coronary arteries.

Within months of the settlement, a registered nurse working for Qin at his Manhattan practice alerted authorities that something seemed amiss. The nurse, who ultimately turned whistleblower, alleged to federal prosecutors that the surgeon was performing unnecessary procedures on patients, mostly elderly Asian and Black immigrants whose care was covered by the public programs Medicare or Medicaid.

Prosecutors indicted Qin in 2018 on a felony count of fraud, which carried a maximum sentence of 10 years in prison. But in 2021, in a deal brokered behind closed doors, prosecutors dropped that charge in favor of yet another civil settlement, court records detailing that agreement show.

Once again, Qin kept his New York license to practice with no restrictions; a restricted license is one of the few ways the public can learn that a doctor has been disciplined for bad behavior. Qin agreed to pay a total of $800,000 in annual installments ending in December 2025, deposited with the U.S. Department of the Treasury. As an added penalty, he was banned from billing public health programs until February 2025.

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Tasked with protecting public health programs from waste and fraud, more than two dozen current and former federal prosecutors and investigators who spoke to Reuters defended settlements as a cost-effective compromise to recover taxpayer monies. They contend that compliance, not punishment, is the aim so that accused wrongdoers can stay in business, thus preserving public access to vital healthcare services.

Among the physicians who kept their licenses:

The Michigan doctor who treated the woman who said her reproductive organs were removed unnecessarily. He was accused of performing unwarranted radical hysterectomies and administering excessive chemotherapy treatments. Prosecutors allege the physician had already scheduled at least one patient for surgery before examining her for the first time. He paid $775,000 last year to settle.

A California doctor – the founder and owner of a national hospital chain – accused of a profit-driven scheme to hospitalize patients who required less costly, outpatient care. The doctor and his chain paid a combined $37.5 million last year to settle that case, which followed two similar settlements totaling $66.25 million.

Michigan and California medical board and health officials, who regulate healthcare licenses and impose disciplinary actions against offenders who violate state codes of conduct, told Reuters they were aware of the federal settlements in these respective cases. They declined to comment about whether they had received any complaints about these doctors or had initiated their own investigations.

Membership on nearly all state medical boards is dominated by doctors who make rules about conduct and decide punishment for their peers, according to Matthew Smith, executive director of the Washington-based Coalition Against Insurance Fraud. As a result, the system tends to protect physicians, he said.

“They look the other way. They don’t want to know,” said Smith, whose organization advocates anti-fraud laws on behalf of insurers and a consortium of government agencies, law enforcement and consumer groups.

Some state medical boards have policies that seemingly thwart or discourage complaints of wrongdoing, Smith said. These include requiring parties making complaints to do so in notarized statements, and disclosing their identities to accused doctors, according to data from the Federation of State Medical Boards, a Washington-based nonprofit trade organization.

Secrecy is also pervasive, federation data shows. In at least 28 states, boards can issue confidential disciplinary orders to close cases without public disclosure; not even the complainant is allowed to know what happened......

Much more at the hyperlink, above.