Reuters recently released the results of a lengthy investigation into practices of the Justice Department which permit accused fraudsters and malpracticing doctors to buy their way out of trouble and continue to practice in return for payment of a civil settlement amount. While such settlements may be in the best interests of the United States as a way to recoup amounts improperly paid to these doctors, the public is not usually informed of them and the doctors are not disciplined by their local medical boards. This is an outrage.
Over the last ten years, Reuters found that there were many, many actions against doctors and hospitals for defrauding the federal programs that pay for health care. Some of the actions began as criminal actions, but all of them became civil enforcement actions by their end. The federal government received over $26 billion in civil settlements. That is a huge number and probably only represents the tip of the iceberg.
The fraud usually involved some form of misrepresentation. Procedures were billed as being more complex than they really were or were never actually performed. Many of them, however, were procedures or other treatment which was not medically necessary. In other words, the doctors and hospitals subjected patients to treatment they did not need so they could bill Medicare or Medicaid for the treatment. All treatment involves risks to the patient and some of these treatments left patients permanently damaged.
Criminal cases are hard to win. The burden of proof is beyond a reasonable doubt. It makes a lot of sense for prosecutors to seek justice instead through a civil settlement agreement in which the defendant doctor or hospital agrees to reimburse the federal government but is not required to admit guilt or fault. While this may help make the treasury whole, it does little or nothing to protect the public against these doctors, who are permitted to go on practicing. The federal government has no power to strip these doctors of their licenses. That is the responsibility of their state medical boards and the boards are clearly falling down on the job.
In my view, the most startling finding of the Reuters investigation is that, over the last decade, 540 doctors and healthcare practitioners have settled up with the government in response to allegations of fraud, often paying hundreds of thousands of dollars, and not one of them, not one, has had his or her license to practice medicine revoked or even restricted. How can that be?
Medical boards are run primarily by doctors. Most of them have some lay people on the board, but they are not medically trained and, of necessity, must defer to the doctors on medical matters. I have watched the Arizona Medical Board over the years. I have seen a lot of malpractice during that time but only a few instances of doctors being held accountable at the Medical Board for their malpractice. The Board is very strong against doctors who have addictions but not so hot when it comes to malpractice. The public deserves better.
Some of the doctors whose conduct got them in trouble with the feds should never be permitted to touch a patient again and yet they go about their business with nary a restriction on their licenses and the public no wiser about their alleged misdeeds.
One doctor was accused of performing dozens of unnecessary gynecologic surgeries, in many instances removing all of the patient’s female organs. Another doctor ordered his patients admitted to the hospital for more costly care when they could have been treated adequately as outpatients. Another doctor administered expensive and dangerous chemotherapy treatments to patients who did not need them. Still another doctor was subjecting patients to cardiac procedures they did not need. This doctor, who received no discipline from his local medical board, kept right on performing unnecessary cardiac procedures and was sued a second time by the government and agreed to settle a second time.
Compounding the injustice of letting wealthy doctors buy their way out of trouble is the fact that the public almost never hears about the case against the doctor and the fact of payment. One patient of a doctor accused of performing unnecessary gynecological surgeries only learned that she might have been the victim of his malpractice when she saw a story on the news about his settlement. Patients should not have to rely a news station deciding to report on a settlement, which itself may or not be made public.
The whole purpose of the state Medical Board is to protect the public. These boards, which allowed these 540 doctors to continue to practice without restrictions, and the other boards, which look the other way when there is malpractice, should take their responsibilities seriously and start doing their jobs.
