Wednesday, April 15, 2020

PS - Links Regarding the Previously Mentioned - CHI/St.Joseph Hospital Cardiology Scandal

(Edited - links corrected). 

Yesterday - while discussing the small minority of doctors advocating reopening businesses this soon - I mentioned a group of CHI-St. Joseph Hospital Lexington cardiologists who were caught performing unnecessary procedures on patients during the recession - frauding both public (Medicare and Medicaid) and private insurance -  to make more money during the recession.   

First, I need to clarify that the doctors involved were part of the London, Kentucky satellite facility of the CHI/St. Joseph Hospital Healthcare System.

However, CHI/St. Joseph Hospital - Lexington (the base hospital) was not innocent - the contract agreement they had with the London practice was such that the London satellite facility agreed to pay the main base hospital in Lexington "kickbacks" for referring patients to their London facility.

Being that I did not follow the results of this case, knowing that it was ongoing, I did a little digging to find the results, because the last time I heard, even though the U.S. Department of Justice was involved (for Medicare fraud), none of the doctors went to prison or lost their license.  

It appears that when the criminal justice system was too slow, the non-Medicare/private insurance patients sued 11 doctors in a civil case (which apparently is ongoing) for putting them at unnecessary life risk and reimbursement of coinsurance payments they made to their insurance companies for unnecessary procedures.

As for the results of the US. Department of Justice and FBI investigations, first note that it was 3 of the best cardiologists at the Lexington base of CHI/St. Joseph Hospital  who blew the whistle on their own employer and the physicians performing unnecessary procedures/fraudulent billing, under the False Claims Act (and were thus protected from retaliation).

The 3 doctors sued their own employer hospital, St. Joseph Hospital, plus the 2 MDs who ran the satellite center in London that entered into a "kickback" contract with the base Lexington hospital (to give the the base, main hospital "kick-back" incentives for referring patients to their satellite center), plus  2 of their colleague cardiologists for malpractice and fraud.

They were investigated by the U.S. Department of Justice, the FBI, and Medicare investigators, and including the two practice owners (who also saw patients as MD) and at least 2 other cardiologists. 

The 3 whistle-blowing doctors successfully won their lawsuit against the CHI/St. Joseph and the doctors performing unnecessary procedures and fraudulent billing practices, and now practice at Baptist Health Lexington.

They work alongside my husband's interventional cardiologist (not one of the three). Having transcribed for them shortly after they arrived (until transcription was replaced by EHR).

In fact, I can personally attest that not only due to the care of my husband (see below), but after working for them (and several other cardiologists in the last 24 years) - all of the cardiologists at Baptist health are top-notch excellent. 

More than that, they are heroes - not just for saving lives, but for what they were up against and successfully won.

So you can rest assured, after their whistle-blowing of the prior, that they will not be performing unnecessary procedures and performing fraudulent billing lol 

Thus, as a result, CHI/St. Joseph Hospital Cardiology, previously the heart gurus of Lexington, tanked and never recovered - and has been replaced by Baptist Health Lexington Cardiology as the new "go-to" place for cardiology in Lexington and surrounding area.

(In fact, when my husband had a stroke in 2017, caused by a congenital anomaly we could see clearly on transesophageal echocardiogram and "bubble study," there's no other cardiology group I would've even considered to perform the PFO closure surgery.)

So what happened to the 11 doctors who allegedly performed unnecessary procedures and devised a "kickback" referral scheme, and frauded both public and private insurance?

In addition to the civil case mentioned above with the 11 doctors (which apparently is ongoing?), St. Joseph Hospital and the doctors settled with the government to pay back the $165 million in fraud.

They also settled on a separate claim for the "kick-back" contract agreement with the main hospital.

Only 2 of the 11 doctors were sentenced to prison (but it was unclear to me whether they have yet served any time). 

The first is in the link above - sentenced to 30 months in 2014. The second physician fought it and only recently was sentenced - 24 months in 2018

... but has tried to appeal once more, denied in January 2020.

And as far as I could find, he is the only one who actually lost his license, as a result, barred from practice? 

As for the 2 satellite practice-owning doctors, who were not found guilty of performing unnecessary procedures, but were found guilty of master-minding the "kickback--for-referrals" scheme? 

See in the above link for yourselves -  they simply paid the settlement - and they still practice today, including seeing patients, in London, Ky.

This is what we refer to in America as "white collar crime" - and in my opinion, it is one of the major problems with our justice system.

Whoever has the most money, power, and fame is perceived to be innocent and upstanding, and the side with the most money, fame, and power usually wins, even if guilty - and as you can see, even in this situation, where they lost -  they were still able to pay their way out of jail time -  even the 2 doctors unquestionably guilty have been able to spend money to keep it tied up in court to prevent jail time. 

Regardless, my point is - most doctors took their oaths seriously and put their patients ahead of their pocketbooks - but some don't, particularly during recessions/hard financial times - and anyone advocating "reopening" this early, and minimizing the contagiousnesss of the virus, is suspect.

Being that I now have two transcription contracts (one with a large well-respected university) - and none are recommending reopening business yet - I can thus tell you, with some certainty, that the only doctors who are nay-saying the virus and advocating for reopening business are doctors akin to the above - they are putting their wallets ahead of the health of their patients.

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