Large financial recoveries are often seen as the principal motivation for the government’s unrelenting efforts to combat healthcare fraud. Perhaps a more important objective of the government’s efforts to combat healthcare fraud, however, is protecting patient safety. Chronic overutilization of healthcare, driven by a fee-for-service system with patient cost covered by a third-party payer (public or private), is not just a financial problem, it is a public health problem. The DOJ’s announcement on May 22, 2015, of a guilty plea by a Detroit Neurosurgeon is a strong example.
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Dr. Aria O. Sabit, M.D., 39, operated the Michigan Brain and Spine Physicians Group, with multiple locations in Michigan. Dr. Sabit has plead guilty to four counts of healthcare fraud involving his alleged performance of medically unnecessary, invasive spinal surgeries and implanting expensive medical devices that were not medically necessary. According to the indictment, Dr. Sabit persuaded some patients to undergo spinal infusion surgeries, which he did not render, and then billed government programs for the fraudulent services. Additionally, Dr. Sabit admitted that while operating on certain patients, he dictated false operative reports that he had performed spinal infusion with particular instrumentation, which had not been done. The invasive surgeries caused serious bodily injury to the patients, according to the indictment.
Additionally, Dr. Sabit was previously involved in a company known as Apex Medical Technologies LLC (Apex), while serving on the staff of a California hospital. Dr. Sabit admitted that he and Apex’s co-owners employed Apex to effectuate an illegal kickback scheme involving the inducement of hospitals and surgical centers where Dr. Sabit (and other neurosurgeons) performed surgeries to purchase expensive spinal implant devices from Apex. In pleading guilty, Dr. Sabit admitted that the financial incentives that attended the subject arrangements caused him to compromise his medical judgment and perform invasive procedures and surgeries that were not medically necessary, resulting in serious bodily harm to patients. In addition to the criminal proceedings, the DOJ has filed two related False Claims actions in California.
Where patients’ cost of care is funded by public or private insurance and physicians (and other providers) are paid pursuant to a pure, fee-for-service model, the patients and the physicians have no incentive to consider the cost of treatment. An unfortunate reality of our nation’s third-party payer system is that some medical providers succumb to the temptation to over utilize healthcare due to financial incentives. The cost of healthcare fraud to the United States is staggering. According to the Federal Bureau of Investigation (FBI), “[h]ealth care fraud costs the country tens of billions of dollars a year.” Fortunately, the vast majority of physicians and other healthcare providers are honest and do not over utilize healthcare. It is imperative for them to properly document
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Source: Press Release