Only a paranoid person would think that his doctor is picking his medicine,
or recommending a hospital or nursing home, because the doctor is being
paid under the table, right? Your doctor really thinks you NEED this medicine,
right? And that the rehab hospital actually can help you recover from
your stroke?
What if you found out that your doctor stuck you in the hospital and performed
surgery on your heart because it was profitable to him – even though
you didn’t need the heart procedure at all?
Sound like something from a dystopian movie? Unfortunately, this past year
a Kentucky hospital paid more than $40 million to the Government to resolve
allegations that it violated the Anti-Kickback Statute (AKS) by paying
cardiologists to perform heart procedures – that were
medically unnecessary.
The Anti-Kickback Statute
Congress was so concerned that doctors were being bribed that it passed
a law forbidding drug companies, hospitals, nursing homes, etc., from
paying doctors. With the Anti-Kickback Statute (AKS) in place, Congress
hoped that it had put a stop to bribery in the healthcare field.
Unfortunately, it seems that the payoffs have just gone underground instead.
I have written several blog entries about the lengths to which pharmaceutical
companies or hospice facilities have gone to try to funnel money into
the hands of doctors who can send them business. Most of these healthcare
fraud cases were brought by whistleblowers — such as the ones I
represent as a lawyer — who found out about the fraud and could
not get it stopped on their own.
Medically Unnecessary Services
Bribery in the medical field is always bad; if a doctor pick a medication
just because it is more profitable for him, then the patient may not be
getting the best treatment for his condition. But the absolute worst case
scenario is when a doctor prescribes a medication, recommends a treatment,
or performs a surgery that the patient does not need – solely because
he is going to get a kickback.
A patient takes the medicine the doctor prescribes because he trusts that
the doctor has selected a medicine that the doctor believes will work.
The patient goes to physical therapy or gets surgery because he trusts
the doctor who said he needed it. If patients lose that trust, then why
should they take their medicine, have surgery, or push their bodies in rehab?
King’s Daughters Medical Center – $40.9 million
In a particularly sobering case filed against King’s Daughters Medical
Center, a Kentucky hospital, the Government said that the hospital was
paying cardiologists fat salaries that exceeded a realistic, fair market
value for their services. The Government said the big payouts were intended
to make the cardiologists send lots of patients to the medical center
– and that the scheme was working so well that the doctors were
actually ordering heart procedures that were medically unnecessary.
The Justice Department said that the physicians were going so far as to
falsify patients’ medical records so that it would look like the
patients needed coronary stents and diagnostic heart catheterizations.
The hospital then billed Medicare and Medicaid for heart procedures that
were never needed in the first place. King’s Daughters paid $40.9
million to settle these claims by the U.S. and Kentucky.
The Special Agent in charge of the investigation into the accusations against
the hospital observed that: “Medically unnecessary procedures can
cause serious health issues, cost the taxpayers millions of dollars each
year and drain the Medicare Trust Fund.”
The hospital paid a whopping $40.9 million to settle this and other accusations
that it had ripped off Medicare and Medicaid. Since the states pay part
of the cost of Medicaid, the State of Kentucky got a $1,018,380 share
of the settlement.