The Worst Case of Medical Fraud in United States History

Dr Farid Fata, a 50-year old married father of three and native of Lebanon, ran a private practice, Michigan Hematology Oncology, with seven offices in the Detroit area and worked as an oncologist. He was sentenced last July to 45 years in federal prison for misdiagnosing and treating over 500 patients. He had been misdiagnosing patients with cancer and then treating them with powerful anti-cancer drugs for years. Dr Fata made nearly $35 million from Medicare and other insurers.

His scam unraveled when another physician who worked for him detected that patients who were receiving chemotherapy treatments were never officially diagnosed with any types of cancer. He reported his findings to federal authorities.

During the case, several victims testified about their experiences with Dr. Fata.  Most of them detailed how they went through intensive chemotherapy and other anti-cancer treatments and medications completely unnecessarily after finding out that they never even had cancer.

Medical malpractice is usually unintentional, although there are cases like Dr. Fata's which involve deliberate fraud and misuse of medicine, most commonly for financial gain.

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Do Surgery Score Cards Make Surgeons Avoid the Sickest Patients?

The healthcare environment increasingly links reimbursements to measurable improvements in clinical outcomes. Some hospitals are adopting scoring systems to assess doctors with the aim of inspiring physicians to improve performance and measuring performance. Often times, these score cards can have the unintentional effect of making surgeons avoid the sickest patients in an effort to improve their scores, explains The New England Journal of Medicine.

One website for publicly available surgical scores is the online news site Pro Publica. They have scores for over 17,000 surgeons based on eight elective surgeries from information taken from Medicare claims data. Surgeon John Birkmeyer told The New England Journal of Medicine that the scoring system of Pro Publica cannot account for results and complications that don't have anything to do with the surgeon's ability or performance. In addition, there were too few operations in the analysis to create data that is statistically significant.

The risk of score card data is patients can misinterpret it. How patients identified "the best" surgeon depended greatly on the way in which the information was presented, one study found. The most important figure is risk-adjusted mortality, yet most patients only focused on the amount of deaths. This really is deceptive because some hospitals manage more complex and riskier cases that are referred to them by other hospitals that are not able to handle them.

It is not likely that these surgical score cards will go away. Some hospitals and some states are attempting to address this issue in an effort to mitigate physician avoidance of the sickest patients. Massachusetts, for example, is excluding scores for patients that are classified as “exceptional risk” or “compassionate use”. These groups have a much greater danger of surgical complications, which could lower a doctor's score.

To learn more about the complicated issue of physician scoring, contact us.

Defensive Medicine or Careful Medicine?

Many doctors practice “defensive medicine” even knowing that it might drive up costs, waste time, and ultimately be unnecessary. The United States Congress Office of Technology Assessment formally describes defensive medicine as “when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures primarily (but not necessarily solely) to reduce their exposure to malpractice liability.”

One ethics survey done in 2014 found that most doctors said that they have or would employ defensive medicine as a way to protect themselves, mainly from your threat of a medical malpractice suit.

Healthcare professionals recognize that defensive medicine is an important cause of increasing healthcare costs and do want to see the issue addressed as a problem.  An example of how this problem could be addressed is the Ottawa Ankle Rules, published at the Ottawa Civic Hospital in Canada. These policies establish a complete system of evaluation to determine which patients need x-rays to analyze a fracture in place of giving a costly x-ray to any patient with any kind of foot pain.

Physicians are very aware of the threat of malpractice lawsuits during their careers. For this reason, defensive medicine is unlikely to just go away. Many doctors view defensive medicine as careful medicine since it is one way to safeguard their careers.

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Managing Legal Risks Tied to the Growth in Nurse Practitioners and Physician Assistants

More non- physicians are offering medical care than ever before. Often the first caregiver an patient sees during a doctor visit isn't an actual physician. The growth in nurse practitioners and physician assistants indicates a growth in both their duties as well as their numbers. Midlevel providers can be quite a benefit to doctors, relieving them of some of their workload, however, it also increases legal risks. Doctors should understand those risks in order to mitigate them.

The Academy of Physician Assistants measures 85,000 certified physician assistants in the U.S. This represents a more than 100 percent increase in the last a decade. Nurse practitioners are also rising with over 155,000 nationwide, up 28-percent since 2003 according to The American Academy for Nurse Practitioners.

PAs may prescribe drugs but must function underneath the supervision of a doctor. NPs can practice, but must have a formal arrangement with a doctor. Health costs can be reduced by the additional work performed by midlevels, however, the legal risks are increased.

The most common lawsuits seen by midlevel providers are inadequate supervision, or practicing beyond the scope of training. Courts have ruled that the midlevel can be an agent of the physician, who can be held liable for neglect through vicarious liability even if he or she never saw or examined the individual. Physicians have to be conscious of the degree of supervision essential to retain a low liability risk.

To learn more about the legal risks associated with physician assistants and nurse practitioners, contact us!

Weighing the Risks and Benefits of Playing Music During Surgery

Surgical procedures are extremely serious in nature together with the well being of the patient determined by the hands of the surgeon. Operating Rooms can be filled with sounds other than machines and medical devices.

Music is played in many operating rooms and some surgeons claim it helps them perform better. According to a report printed by The BMJ, music is played 62-72 percent of the time with the music normally chosen by the surgeon. Typically the most popular kind of music chosen is classical, though other styles are also heard. The Bee Gees' "Stayin Alive" and Sade's "Smooth Operator" are seemingly popular tracks, while Queen's "Another One Bites the Dust" and REM's "Everybody Hurts", are best avoided.

This practice, however, isn't without controversy. Some claim that playing music during an operation may be a risky distraction that unnecessarily increases the potential for error. A negative effect has been noted by some surgeons, especially in less experienced surgeons.

Many surgeons say there are benefits to music in the operating room. Operating room staff claim that it can enhance a surgeon's ability to focus, and that playing music can reduce stress, improve communication, and improve efficiency. Patients may also reap the advantages of music which can help have a sedative effect and reduce nervousness.

If noise levels are controlled, surgeons cited in The BMJ report admitted that music could be distracting, but say, the potential advantages of music might outweigh any surgical risks.

The decision to play music or not, the type of music, along with the volume, should be agreed upon by the surgical team with all the goal of the greatest possible surgical result for the patient. For more information, contact us today!

The Weekend Effect: How Saturday, Sunday Hospital Admissions Can Hurt Health Outcomes

One would hope that no matter what day of the week or time of day, precisely the same standard of healthcare would occur. However, data implies that time and day can have a negative effect on health outcomes.

One study published in BMJ Quality & Safety analyzed data from almost 3 million hospital admissions to 28 different teaching hospitals in 4 different countries.  The outcome of the analysis suggested in three of the four nations, that those admitted on the weekend for an emergency had a higher risk of dying within 30 days than those admitted during the week. In the U.S., the risk was 13% higher. The most dramatic difference was in the Netherlands with a 20% greater risk. The study didn't mention causes for the weekend effect.

Researchers indicate that the higher risks might be a result of decreased staffing levels. Study coauthor Paul Aylin of Imperial College London indicates that patients admitted on weekends, particularly stroke sufferers, are not as likely to get a same-day brain scan, less likely to get clot-busting treatment, and have worse outcomes than those accepted during the week.

Often patients or caregivers hear over and over that it was the weekend, that there was only one person here to do whatever for the whole hospital, or that someone was merely cross-covering and did not wish to produce any changes to the plan - the attending would be in next week.

Johns Hopkins University researchers who looked at more than 38,000 head injury patients. likewise documented in a study the weekend effect. They found that the weekend patients were 14% more likely to die from their injuries compared to patients admitted during the week.

Sadly, the clear solution - to increase weekend staffing – is impractical and expensive. Options could include transferring some patients to trauma centers or facilities that have more weekend capabilities.

To learn more regarding the weekend effect and possible solutions, contact us.

Should Medical Marijuana Have a Place in the Hospital?

As of June 2015, 23 states and the District of Columbia have legalized medical cannabis. Should hospitals be following suit?

Many hospitals such as The Cleveland Clinic have stated that they don't recommend using illegal substances to treat health conditions.  However, the top 17 hospitals in the U.S. including the Maya Clinic, Johns Hopkins, and the Duke University Medical center have either taken no public stance on the issue of have evaded making direct statements on the issue.

One argument against medical marijuana in hospitals is the fear of patients falsifying medical documentation in order to smoke marijuana cigarettes or alternative paraphernalia. Some states have handled this problem by restricting legal medicinal marijuana to only the pill or liquid form. New York only permits medical cannabis in pill and oil form and prohibits the sale of the cannabis flower. All other states with legalized marijuana, recreational or medical, currently limit the amounts of live or dried plants a person can have.

Even in states that have legalized medical marijuana, hospitals have been unwilling to allow the administration in their walls. One issue with this is that it can be difficult to abruptly discontinue this treatment upon admittance to a hospital. This is one of the reasons that New York Minnesota, and Massachusetts are allowing use inside their hospitals.

The execution of laws allowing non-smokable types of cannabis is intended to provide aid for those suffering from some cancers, HIV/AIDS, ALS, Parkinson's disease, and more. By implementing the non-smokable forms, hospitals are working to avoid the stigma a 'physician's note' for a headache as a ticket to recreational drugs.

Contact us and let us know how you feel about medical marijuana use in hospitals.

Expert Witnesses Testimony Results in Costly Verdict Reversal

A three-judge panel in in Florida's Third District Court of Appeals recently stopped a $4.1 million judgment and ordered a fresh trial. The defendant in the event, a Florida pediatrician, argued he was refused a fair trial since expert witnesses and their testimony were improperly applied during trial.

The plaintiff was treated by the physician until 2006 from her birth in 2000. In this six-year period, the parents claim that she endured a kidney condition that the doctor did not identify or treat. According to the parents, physician didn't acknowledge or follow up on elevated levels of protein within urine samples which suggested a serious kidney disorder. The girl ultimately needed a kidney transplant and her parents were awarded $4.1 million in a subsequent medical malpractice lawsuit.

The physician appealed the verdict, claiming inappropriate usage of expert witnesses by the plaintiff’s lawyer. The initial judge in the lawsuit had ruled that both sides were limited to one expert per specialty. Prior to the case being concluded, however, that judge retired.  The subsequent judge did not hold the plaintiff’s lawyer to that ruling. The plaintiff’s attorney called four expert witnesses to testify and also misrepresented that expert testimony in closing arguments.

The Third District Court of Appeals said the improper utilization of medical experts and their testimony required a new trial in this instance and agreed with the defendant’s arguments concerning his denial of a fair trial.

Attorneys must follow guidelines regarding expert witness characterization in their testimony and presentation of expert witnesses. Failing to follow these rules can result in unfair trials and delays in settlements for many who have suffered damage.

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