Let’s say you are going through chemotherapy. You are miserable,
losing hair and your last meal by the minute. Could it get worse?
Why, yes, it could. How about if you learned that you sat there, receiving
chemotherapy, for hours more than were necessary? And then let’s
say you found out that the reason you sat there for longer than you had
to was because your doctor decided he would like to make more money, and
having you sit there for longer was just the ticket?
According to a Department of Justice press release,
Owners Of Elizabethtown Hematology Oncology, PLC Agree To Pay Over $3.7
Million To Settle False Billings To Government Health Care Programs, cancer doctors in Kentucky lengthened the time over which patients had
to receive chemotherapy infusion treatments in order to get more reimbursement
from Medicare and Medicaid. The fraud led to aFalse Claims Act lawsuit filed by a whistleblower.
This isn’t just Medicare and Medicaid fraud under the False Claims
Act. This conduct amounts to a betrayal of the basest sort. When your
doctor puts you through pain and suffering just to make more money, how
can you trust anyone?
The Government says that two doctors at Elizabethtown Hematology Oncology
Dr. Rahman, Dr. Deshmukh, and EHO deliberately “extended the duration
of chemotherapy infusion treatment times for their patients in order to
improperly bill Medicare, TRICARE, FEHBP and Medicaid for those additional
hours of chemotherapy infusion treatments.”
Apparently a whistleblower doctor, Dr. Ijaz Mahmood came forward to tell
the Government about what was happening. Mahmood said that the company
even wrote out protocols to make sure that patients got three times more
chemotherapy than they needed!
As a result of the suit that Dr. Mahmood filed, the Government is going
to get $3.7 million, and Dr. Mahmood will get $283,412.90 of that amount.
The United States Attorney for the Western District of Kentucky said that,
“Manipulating treatment protocols and lengthening infusion times
to increase reimbursement reflect an extraordinary lack of regard for
patient welfare and the integrity of our health care system.” You
could say that again.
The Inspector General of the U.S. Office of Personnel Management, Patrick
E. McFarland, put it this way: “To subject cancer patients to unnecessary
treatments that are physically draining and emotionally stressful is utterly
The Attorney General of Kentucky, Jack Conway, said he was absolutely committed
to making sure that taxpayers did not lose money for Medicaid fraud in Kentucky.
One question I have is why the whistleblower, Dr. Mahmood, is getting such
a small percentage of the settlement. The minimum amount, under the False
Claims Act, is 15%. Using that calculation, Dr. Mahmood should have received
$555,000, not $283,412.90. It seems counter-intuitive to give less than
the statutory minimum; as a society, we obviously would like to encourage
whistleblowers like Dr. Mahmood.
As part of the settlement, DOJ entered into a corporate integrity agreement
with Dr. Deshmukh and EHO. Notably absent? Dr. Rahman.
A corporate integrity agreement is essentially a promise by a company that
has been accused of fraud that it’s going to do better in the future. (Really, mom. This time I’m going to do better!)
That’s sort of a “duh.” Of course medical providers and
other types of contractors should agree to behave themselves.
But a corporate integrity agreement means that the Government is giving
the medical practice and Dr. Deshmukh another chance to do business with
Medicare and Medicaid.
Since the press release does not say that Dr. Rahman is not included in
the agreement, it led me to wonder whether he is being banned from getting
payments from Medicare and Medicaid.