The Rest of the Story…

My books, Predatory Medicine and Predatory Medicine-Redux were written primarily to alert anyone coming into contact with the health-care system to the potential hazards of medical care based on my personal experience as a physician taking care of patients for over forty years. Its main purpose was to help those entangled in the health-care system understand what could happen and provide some guidelines so they might navigate through it and avoid some of the pitfalls inherent in the “System”.

I tried to be careful not to make it about me and my personal travail as I discovered fraudulent activity and unscrupulous behavior then tried to do something about it. This blog will endeavor to provide the reader with the events leading to my determination to expose what I encountered and what personal cost I incurred.

Until 1999 my life seemed on the trajectory I had hoped for: I was a founding partner of a successful medical group; financial success seemed secure; I enjoyed what I was doing; I had a loving family with three beautiful children-all seemed good.

One morning while jogging I noted an oppressive discomfort in my chest. As a cardiologist I immediately understood this to be a warning sign that I had developed coronary heart disease at the age of 60. Something needed to be done. I enlisted the assistance of one of my partners whom I trusted completely. I went through the usual tests. A stress echocardiogram was performed, which consisted of a ultrasound of the heart at rest, maximal exercise on a treadmill, another ultrasound immediately after exercise. This test was “Negative” so a nuclear stress test was done which was also negative.

Since my symptoms were classic for angina, meaning a restriction of blood flow to the heart, I insisted on a coronary angiogram for I needed to know if there was a problem and how serious it was. Therefore, on 7/17/99 this procedure was performed. It revealed I had a moderate degree of atherosclerosis in my major arteries. In one smaller artery there was a significant narrowing which was, no doubt, the cause of my symptoms. Because of its location it was not amenable to angioplasty or opening with a balloon. Intense medical treatment was advised. Because of the rather extensive arteriosclerosis my prognosis was “guarded”.

Obviously I was upset and concerned, but was determined to beat the odds. I improved my diet, started appropriate medications, and a careful regular exercise regime.

This seemed to work because my symptoms abated. I seemed to be on the right track. However, a few months later, while “on call” I was summoned to the emergency room for a desperately ill patient. He was in the throes of a heart attack which had disrupted the function of one of his heart valves. He was in profound heart failure and shock. Something needed to be done immediately to save his life.

I immediately took him to the radiology suite where I performed a heart catheterization to confirm the location of the blockage in his arteries and place a pacemaker and a balloon pump device in his aorta to help support his circulation until he could get to the operating room so the valve could be fixed and his blocked arteries bypassed.

During this very stressful situation I experienced chest discomfort and heart palpitations, but there was nothing I could do but complete what had to be done. Fortunately, nothing happened to me and I was successful in getting this patient to the operating room where the surgeon was successful in making the appropriate repairs and the patient survived.

For me this was another important warning sign-I needed to do something to avoid such stress. As I contemplated my situation I realized the best thing for me was not to put myself in these stressful situations. That meant I should no longer be “on call”, but continue to practice only in the office and limit hospital work. It occurred to me I was very fortunate for I was one of the older members of our group and when the group was formed it was agreed informally that at age 62 the partner could elect to refrain from taking call. I was approaching 61.

I put all this information together and made a proposal at our next Partnership meeting. The Group agreed to form a committee to contemplate my request and develop a plan that would address my situation and would also apply to future situations of other members that would inevitably occur as the Group aged.

It took them two years to come up with a solution despite my constant urging. They finally consented to my withdrawal from the call schedule if I agreed to refrain from any hospital activity. After considering the offer, despite the fact that about 30% of my income came from hospital activity, I agreed. This would become an issue, as you shall see, at a later date.

For the next ten years I functioned as an office based physician which considerably attenuated my stress level. Oddly, to the consternation of some of my partners, my income was affected very little. Since I was always available in the office as was able to capture additional patients who could not wait to see another physician and was always available to supervise other testing done in the office, such as stress tests.

However, all was not well and trouble was brewing. In 1999, as outlined in Predatory Medicine-Redux the office received notifications from the U.S.

Government Office of the Inspector General admonishing healthcare providers to report Medicare fraud and abuse. The penalties for such crimes were rather harsh.

This set of an alarm with me for my new duties allowed me to have greater involvement in the clinical practice in the office for I was frequently called upon to temporarily take over care of my partner’s patients if they were on vacation, ill, called away for and emergency, or any number of reasons. I discovered their charts were woefully deficient falling below what was acceptable according to the Medicare guidelines exposing the Group to serious consequences in the event of a Medicare audit. This issue is outlined in my book. The bottom line is they did not seem to care and for the most part did not alter their behavior despite internal audits and my constant admonishment.

I accepted the situation but in order to attenuate the risk of a Medicare audit they did agree to sign a document that stated that in the event of a Medicare audit where significant offenses were found it would be the responsibility of those found negligent to pay any fines levied. I believe that did irritate some of my partners.

The workings of the office remained stable until the practice integrated an electronic medical record (EMR) system. I described in the book in detail how this changed everything for me. On a regular basis I found evidence of fraud and abuse especially with older, vulnerable Medicare patients. This left me with a difficult ethical and moral problem. Do I look the other way or do I attempt to expose this behavior in hopes my partners would accept my findings and change.

I concluded I needed to act. I collected data demonstrating my concerns and presented my findings to the group 7/7/11. I describe the reaction of my peers on page 74 of the book. This started a chain of events that culminated in my colleagues conspiring to expel me as a Partner.

The ensuing several months were the most stressful and unpleasant in my career involving numerous meetings, discussions with attorneys, subtle harassment in the office. They had to find a way to “legally” revoke my Partner status. What they eventually decided on was to rewrite and amend the Group’s Partnership Agreement. They decided to change the Agreement to state that a requirement for Partner status was to require all partners to take “call”. They knew that at age 73 and the fact I had not taken call for ten years this would pose an exception burden upon me.

When I tried to explain that ten years prior I had been granted this exception at the expense of a prohibition on any hospital activities, my logical argument did not sway the majority of my colleagues, and they voted in the changes of the Partnership Agreement essentially sealing my fate.

I consulted an attorney about “inappropriate termination”. They believed I had a “good” case, but it would cost me about $250,000 to find out and the outcome was not assured. They did negotiate with the Group and a compromise was reached-I would be allowed to stay on for two years as an employee. After much soul-searching I accepted this offer.

During the ensuing two years I collected more data to support my allegations. I went through various steps, as I described in the book, to try to expose the fraudulent and unethical practices I observed, all unfortunately, to little avail.

Thus, my book, Predatory Medicine-Redux is the result of what I first thought of was my failure but realized it was a failure of a “system” that wanted nothing to do with anything that would upset the status-quo. I went through what I believed was a logical and reasonable approach to correct the unscrupulous behavior I observed: peer pressure; Ethics Committee; Hospital Medical Executive Committee, all to no avail. I even thought about contacting individual patients directly, but felt this would be too unsettling to the patient and unethical.

My final attempt was to contact the Office of the Inspector General as the notices I had received admonished doctors to report Fraud and Abuse. As described in the book was unrewarding. My only and final path was to file a Qui Tam (whistleblower) lawsuit. My experience with this is also described in the book, and after two years my suit was denied, they declined any intervention. They did not provide any reason, but it seemed to me a thorough investigation, as promised, did not occur. As a last resort I decided the public should be made aware of what I had observed and documented so I resolved to write a book.

As I look back at the sad ending to my career I am often dismayed. I sometimes think-was it all worthwhile for I had suffered emotionally and financially. I knew that if I had looked the other way and gone along my financial future would have been more secure. The managing partner, who was instrumental in lobbying against me, used the argument that I personally had cost the Partnership at least one million dollars over the past ten years. I never did find out how he came up with that figure but presumed it was derived from the fact that I didn’t overbook, up-code, and order unnecessary tests like many of the partners did.

In the end, as of this day, I have a clear conscious and believe I did the right thing. So, at some future time when my children or grandchildren ask me what was the most important thing I accomplished in my life I can comfortably say I opposed unscrupulous behavior and a “system” that was faulty by trying to protect patients by writing a book that made a difference for people facing a healthcare crisis.