Saint Joseph Health Care Settles Fraud Allegations: Analysis of Court Documents

Worse than I thought.

I prepared an earlier article about this settlement based on press releases from the U.S. Attorney’s Office and that of the FBI. I had slim hopes that more information would be available any time soon, but once again I was wrong. I subsequently obtained the full text of the Settlement, but also the recently-unsealed qui tam Relator’s Complaint to the court that started it all. The Complaint revealed a staggering degree of malfeasance with a parade of examples of medically unnecessary procedures extending beyond angioplasty alone to major cardiac surgery, and involving more than one St. Joseph Hospital. It also suggests the direction future prosecutions are going. The Settlement does not protect Saint Joseph Health System from future financial or programatic penalty as much as I expected. Both documents can be downloaded using the links provided above or at the end of this article.

Continue reading “Saint Joseph Health Care Settles Fraud Allegations: Analysis of Court Documents”

KentuckyOne Health Hospital Settles Fraud Prosecution for $16.5 million.

Civil allegations of false or fraudulent billing at St. Joseph London Hospital for medically unnecessary heart procedures settled. Criminal investigation ongoing.

In the same week that KentuckyOne Health announced statewide layoffs of its employees, the Federal Prosecutor’s office of Eastern Kentucky announced the second largest settlement in history for its region. One can only speculate if the timing was a coincidence. Although the $16.5 million represents only a small portion of the $217 million target savings that KentuckyOne hopes to achieve, that self-insured institution is also facing hundreds of civil lawsuits. The hospital system and some of its doctors are paying a high price for someone’s bad behavior. Continue reading “KentuckyOne Health Hospital Settles Fraud Prosecution for $16.5 million.”

Disability-Abuse Alive and Well in Eastern Kentucky.

disability-250I wrote earlier about how an economy and culture in Eastern Kentucky so dependent on disability payments might so easily overlook, and even accommodate widespread abuses within our medical and legal structures. The “angioplasty abuse” that I and others have been writing about these past months unfolded in that setting. Full-fledged “disability abuse” is again emerging into the sterilizing light of day. It seems all you have to do to find these things, is look for them.

A flurry of media reports began yesterday focusing on a U.S. Senate investigative report accusing specific doctors, lawyers, and even judges of conspiring to inappropriately award disability to hundreds and even thousands of people. The scam could not have been more out in the open– billboards advised people to step right up and take advantage.

Stephen Ohlemacher reported prominently for the Associated Press, but the story is making the rounds in many venues. The matter plays well politically to those who would seek to gut any-and-all governmental safety net programs. (I am not one of them!) I have not been able to secure a copy of the actual Senate report, perhaps due to governmental furloughs. If anyone can help me, I will follow-up with more specifics.

I know a little about disability.
In my hands-on medical career as a rheumatologist, I had much personal experience with disability programs. Some people shop for accommodating physicians who will “award” them with a declaration of disability in the same way some patients doctor-shop for prescription narcotics. Continue reading “Disability-Abuse Alive and Well in Eastern Kentucky.”

Alleged Angioplasty Abuse in Kentucky – Instant Replay.

paulus-heart-center Another shoe drops: New lawsuit in Ashland.

Just when I thought it was safe to write about something else, I learned about a new lawsuit against the King’s Daughters Medical Center, Comprehensive Heart & Vascular Associates, Inc., and Dr. Richard E. Paulus, M.D., all of Ashland KY. Of course, claims made in a legal action represent the views of only one party. Nonetheless, the complaint specifies issues essentially the same as those currently playing out at St. Joseph London in southeast Kentucky and are on their face inherently possible.

The case was filed in Boyd County Circuit Court on September 30, 2013 on behalf of a single plaintiff and his wife by the Poppe Law Firm of Louisville. This is the same firm handling numerous civil claims against St. Joseph London in Laurel County. The alleged circumstances and actual facts are disturbingly familiar. As stated in the complaint, the plaintiff is said to have undergone unnecessary angioplasty with the placement of a stent. The rate of angioplasty in the area surrounding King’s Daughters Medical Center is the highest in the state, and indeed one of the very highest in the nation. Following the purchase of the medical practices of two large cardiology groups, the number of angioplasties increased substantially. According to the complaint, following an investigation begun by the United States Department of Justice, the number of procedures dropped by 70%, remaining nonetheless the second highest for Kentucky hospitals. Continue reading “Alleged Angioplasty Abuse in Kentucky – Instant Replay.”

Kentucky Doctor Goes to Prison for Billing Fraud: Part 2.

The Sentencing of a Cardiologist.

For someone like myself, yesterday’s sentencing hearing in federal court was educational– even though many of my questions went unanswered. Had I not already known from earlier reporting of civil lawsuits against Dr. Sandesh Patil that he has been accused of performing hundreds of medically unnecessary cardiac angioplasties and indeed, pleaded guilty to falsifying medical records to collect payment from Medicare for at least one case, I would not have known why he was going to jail.

Because Dr. Patil pleaded guilty, the US attorney’s office did not have to present in court all of the evidence it and the FBI had collected. It did not have to call in medical experts to testify whether or not the procedures performed at St. Joseph London were medically necessary or not. This method of settling cases is apparently quite standard and is considered to be an efficient use of the courts time and public resources. I cannot quarrel with that general policy.

However, it appears that all the undisputed information collected by the extensive investigation is now sealed and not available to the public. This does trouble me! I previously offered my opinion that I believe the best interests of all involved; the patients, the public, St. Joseph London Hospital, KentuckyOne Health, Medicare, other health payers, and even Dr. Patil are best served by more complete disclosure and accountability. Sunshine disinfects. No one should have to continue to serve the public under a cloud. After all, reinforcing trust in the medical community was one of the stated goals of the sentencing proceeding. Continue reading “Kentucky Doctor Goes to Prison for Billing Fraud: Part 2.”

Kentucky Cardiologist Sentenced to 30 months Imprisonment for Fraudulent Billing.

frankfort-fed-courtAngioplasty Abuse Update

[Breaking News.]

Today in Federal District Court in Frankfort, KY, Dr. Sandesh Patil of London, KY was sentenced to 30 months in a federal facility near Beaumont, TX. He will begin serving on November 19, 2013. Dr. Patil had pleaded guilty to submitting an improper bill to the Medicare Program for a patient on whom he had performed cardiac angioplasty at St Joseph London Hospital. The sentence was at the lowest end of the 30 to 37 month range agreed upon in the plea bargain of June 2013. No fine was imposed. There was no discussion of eligibility for parole.

Court documents detailing the felony acts committed and justifying a substantial sentence for billing fraud were sealed and “not available to the public.” My earlier concerns that the public might never find out exactly what happened at St. Joseph London Hospital and in Laurel County appear to be being validated. The discussion in the courtroom was interesting and the legal proceedings were obviously conducted deliberately and fairly, but as a physician I was left feeling uncomfortable when it was declared to be a mitigating factor that no patients were harmed by Dr. Patil’s misconduct. Neither my notes nor my memory recall that the word angioplasty was used. Something is not computing for me that I need to more fully understand.

I will describe the afternoon’s events in more detail very soon.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
1 October, 2013

Deaths Linked to Cardiac Stents Rise as Overuse Seen

StentsReporters Peter Waldman, David Armstrong, and  Sydney P. Freedberg of Bloomsberg News published an extensive report on overuse of angioplasty today that I have known was coming for several months.  Our fair state of Kentucky figures large in their expose of angioplasty abuse nationwide.  The article illuminates the reasons why this fee-for-service industry is out of control.  You will not be happy when you read it.

The profound shame is that this same scenario plays out for many other medical services in many other settings and with many other providers. Until we have a system that can deal with the misplaced incentives built into our healthcare system, we will never get a handle on the run-away health costs for services of lesser quality than we all deserve.  The medical-industrial-governmental complex has not be able to deal with this issue by itself.  It needs the knowledgeable cooperation of the public who pays for the whole thing!

Read KHPI’s coverage of this matter over the last year by clicking the “Angioplasty Abuse” link below.  This scandal is far from over, in Kentucky or the nation.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
September 26, 2013

Cardiologist Pleads Guilty to Doing Unnecessary Angioplasties at St. Joseph’s Hospital London.

Not Just a Bad Idea.  It’s Against the Law!

gavel-icon

Yesterday, the Office of the US Attorney, Eastern District of Kentucky, released a public notice that cardiologist Dr. Sandesh Rajaram Patil “pleaded guilty to charges that he falsely recorded the severity of patient’s illnesses in order to receive payment for numerous [medically unnecessary] heart procedures” while working at St. Joseph Hospital in London, then and now part of the CHI/KentuckyOne Health system.  A prison term of some 3 years is anticipated. St. Joseph London has repaid the government $256,800 for an unstated number of cardiac stent angioplasties done in its hospital in 2009 and 2010 for which falsified bills were submitted. You can download a copy of the announcement at the FBI site, or here.

This means that we do not have to hedge anymore by referring to “alleged” angioplasty abuse. Frankly, I was not aware that criminal proceedings were underway but should not have been surprised. Neither do I know if there are ongoing criminal charges against other physicians at the hospital, or the hospital itself. Certainly there are a multitude of civil suits from patients pending against physicians and hospital alike. If I were a Blue Cross or a Humana, I would be getting in line for some refunds as well. The story is, unfortunately, far from over at this hospital and others in the state. The phrase “tip of the iceburg” comes to mind.

What was agreed to? Can we know?
As seems to be the case in such “settlements,” there appears to be a discrepancy between what the court assumes it has extracted in terms of admission, and what Dr. Patil is willing to concede. According to reporting by Andrew Wolfson, reprinted often in today’s papers, Patil’s attorney appears to claim (in contrast to the the use of the pleural in the announcement) that the degree of blockage in an artery was exaggerated for only a single patient, and that Dr. Patil “didn’t do anything that he didn’t think was medically necessary.” Its hard for me to get from one artery to three years in jail without access to the charges and the pleadings. What does the United States Attorney know that we do not? I am not completely surprised at the sentence, but how are we to judge its fairness without access to the facts. St. Joseph Hospital London had to give back a quarter of a million dollars. Was that too much… too little? The hospital submitted bad bills for payment. Does it have any culpability? If it does not, then it deserves to have its name fully cleared. As I have suggested for several months now, without full transparency and accountability, a cloud will hang over these and other hospitals and cardiologists for the foreseeable future. No one deserves that. Local physicians must be able to recommend their hospitals to their patients without reservation. Patients must feel comfortable going there.

[Addendum: I obtained additional insight into the matter of “how many” arteries were at issue, and what the magnitude of the hospital pay-back might tell us.  See my comments below. Add your own] Continue reading “Cardiologist Pleads Guilty to Doing Unnecessary Angioplasties at St. Joseph’s Hospital London.”

Angioplasty Abuse Not Going Under the Rug.

images-3Curtis Morrison expanded Kentucky coverage in Insider Louisville of the emerging national scandal of Angioplasty Abuse. Not that this is a new phenomena or anything. The healthcare industry has been riding the gravy train for a long time, taking advantage of our communal willingness to pay for volume rather than necessary and effective medical care. What else should we have expected? What is best for us as patients gets easily rationalized at the altar of economic development, or even ignored.  Angioplasty is just the tip of the iceberg! Continue reading “Angioplasty Abuse Not Going Under the Rug.”

Hundreds of Lawsuits Against KentuckyOne Health’s St. Joseph London.

Bad and getting worse– but not without precedent
broken-heart

The matter of “Angioplasty Abuse” at St. Joseph London Hospital has now truly gained national attention. I have been reporting on the lawsuit against the hospital and some of its physicians and analyzing medical utilization data in this Policy Blog since last December. It was alleged that for several years that doctors at the hospital were performing invasive cardiac procedures on patients who had no need for them, and that the hospital should have known this. On Sunday, Courier-Journal reporter Andrew Wolfson published an in-depth, front-page article that was reprinted by USA Today and further commented upon in Forbes.com. Other news outlets are now also following the story more closely– a story that gets worse as it grows. Continue reading “Hundreds of Lawsuits Against KentuckyOne Health’s St. Joseph London.”