Back in the days when I was a hospital lobbyist, my colleagues voiced the generally accepted fact that Medicare and other insurers overpaid for cardiology services. As a medical student, I was taught the Willie Sutton Law of Medicine– “When looking for a diagnosis, think of common things first.” [When Willie Sutton was asked why he robbed banks, his answer was, “Because that’s where the money is.”] While I by no means wish to imply that all hospitals are stealing our tax and premium dollars, an increasing parade of nationwide criminal investigations, indictments, and convictions make it clear that some hospitals and their doctors are shaking the cardiology piggy bank too hard.
The latest in this series of embarrassments for hospitals came across my desk today. Modern Healthcare reported that the “Cooper Health System in Camden, NJ, has agreed to pay $12.6 million to settle whistleblower allegations that it inappropriately encouraged cardiologists to refer patients to its hospitals by paying them $18,000 a year to serve on a local advisory board.” Paying doctors money, or giving us inappropriate benefits in exchange for referring patients is against the law. (Of course, when doctors are employees of the hospital, as seems to becoming the norm, this patient-protection measure becomes much less meaningful.)
The case was settled before trial, so all the facts are not in the public domain to allow us to make our own judgments. When reporting on lawsuits, the usual disclaimer is that a lawsuit presents only one side of the story. Alas, when cases settle, we are often still left with both sides of the story. An official of the New Jersey Attorney General’s office is quoted as saying, “Cooper has taken responsibility for its past misconduct.” A spokesman for the hospital system is quoted to have said that the hospital was not admitting wrongdoing in the settlement, but rather ending the case after a three-year investigation “to avoid the burdens and uncertainties of a protracted litigation.” Patients of the hospital system are left to wonder if their interests were properly served. I have expressed before my opinion that more of these kinds of cases need to go to trial. Patients should not have to wonder one way or the other whether they are being used to further someone else’s interests. Without both transparency and accountability, we can never know.
The big winner may be the whistle-blower physician who reported and initiated the lawsuit after he was recruited to the “advisory board.” He walked away with a $2.4 million share of the settlement. Here in Louisville we have attorneys who are skilled in advancing whistle-blower lawsuits. I think they need more business.
Peter Hasselbacher, M.D.
President, KHPI
Emeritus Professor of Medicine, UofL
January 28, 2013