Hypocritic Oath


The mother also underwent a dilation and curettage (D&C) procedure -- again, she'd never complained of gynecological problems before.

And all three allowed themselves to be subjected to a battery of tests for everything from carpal tunnel syndrome to vertigo to heart palpitations during their weeklong visit. The doctor supervising those tests had pleaded guilty late last year to felony health-care fraud -- he was working at the clinic while awaiting sentencing and now is serving a prison sentence.

The amount billed for services to the family? Almost $350,000.

Lawyers at the AG's Office have balked at moving the rent-a-patient case forward.
Jackie Mercandetti

During his presentation to the Tampa gathering, Martino flashed a copy of a handwritten note on a big screen. Found last year on the wall of a break room inside a Texas factory, it said:

"Those of you who have Aetna, Cigna, Blue Cross/Blue Shield or any PPO medical insurance plan and would like to make 4K-5K in California! NO WORK INVOLVED! HURRY! DON'T HESITATE!"

At the bottom of the page was a suspected capper's cell phone number, with instructions to call any time, day or night.

Despite the talk inside law enforcement circles about breaking the rent-a-patient case, no one yet has been brought to justice for his or her role in the scheme. That includes the surgery centers' owners, doctors and other medical personnel, or the patients themselves.

That lack of criminal or civil sanctions goes beyond law enforcement. The California Medical Board, for example, has yet to punish any of the doctors who continue to perform assembly-line procedures on patients, most of whom they meet for the first time on the day of surgery.

Despite no official action other than the execution of a search warrant on the Unity (now St. Paul) clinic in early May, those investigating the case say that the crooked California surgery clinics have scaled back their operations.

For one reason, they say, insurance-claims adjusters have become much stingier at authorizing reimbursement checks. The investigators also suggest the clinic's owners may just be lying low because they know that law enforcement authorities have them in their sights.

"This outpatient surgery scheme and pharmaceutical fraud are our two major national initiatives right now," says Tim Delaney, the Washington, D.C.-based chief of the FBI's health-care fraud unit. "It's a completely enclosed circle of crime, and it's been successful in part because doctors just are more brazen than they were 10 or 15 years ago about putting themselves in that circle and putting patients in harm's way. It's no secret to the people involved in this conspiracy that we are looking hard at this."

Ken Faustine, director of special investigations for CIGNA, told the Tampa conference last month that "we still pay a few of these bogus bills because you got to get burned to figure it out.

"But I've figured out a strategy for how to deal with the Southern California clinics that we've flagged -- don't pay them. We definitely are somewhat aggressive about that."

Faustine, a former IRS investigator, had a terse answer to a question about why so many insurance companies paid the California clinics so readily: "Don't know. I'm not."

He estimated that his company has stopped about $40 million in payments to the Southern California clinics in the last year.

One reason, he said, is he assigned eight investigators full-time to the rent-a-patient scam.

"Look," Faustine told the audience, "we wouldn't have caught on when we did if the clinics weren't so greedy and charged so much. If they could prove to me that their procedures are necessary and aren't grossly overpriced, we'd pay. That doesn't happen."

In April, New Times described how the Valley residents had become rent-a-patients in Southern California.

The group worked at Onyx Environmental Services, a self-insured Phoenix hazardous-waste plant. Onyx is an international firm with a liberal health plan that allows for easy "out of network" access to medical care, often without mandatory pre-authorization from Highmark, a Pennsylvania-based Blue Cross company that administers the plan.

All of the Arizona rent-a-patients were first-generation immigrants to the U.S., from Cuba, southeast Asia and Mexico. They made weekend treks across the desert during the second half of 2002 and into this year for what they admitted were medically uncalled-for surgeries. The procedures included circumcisions, hernia repairs, colonoscopies, septoplasties, and other procedures, often more than one on a weekend.

Several of the Onyx employees told New Times that the man who had recruited them was a supervisor at the plant named Qui Pham. They claimed Pham would pay them in $100 bills after their surgeries, usually about $800 per procedure. (Pham has denied being a capper and told New Times months ago that he'd never been to California. He could not be reached for comment for this story.)

In turn, the Southern California medical providers -- the clinic, doctors and testing laboratories -- billed Highmark for services rendered. The bills from Unity, in particular, routinely were many times higher than the norm in the outpatient industry.

A typical example: The Unity clinic billed Highmark more than $60,000 in "facility fees" after doctors performed sweat-gland surgery on a 22-year-old Glendale man who worked at Onyx. That sum included a $48,000 claim for "surgical supplies."

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My Voice Nation Help

It is ashamed that people themselves to be used like that. The 800 dollars compared to the thousands the clinic pocketed is nothing. They should be prosocuted also.



Site: septoplastyrecovery.com

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