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Two Former Cardiologists Awarded $10.6 million for Reporting Patient Care Problems and Overcharging

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Cardiologists who complained about poor patient care and improper billing practices for Medicare and Medicaid won $10.6 million arbitration award

Detroit, MITenet Healthcare was accused of acting with malice when a Michigan hospital demoted two cardiologists after the complained about cost-cutting measures, overcharging and substandard patient care. The doctors filed a False Claims lawsuit and retaliation is costly—to the tune of $10.6M.

Dr. Amir Kaki and Dr. Mahir Elder were two of three heart doctors at Detroit Medical Center (DMC) stripped from leadership positions and later lost their staff privileges. The arbitration award won against the hospital's parent company Dallas-based Tenet Healthcare also included reinstatement of their medical staff privileges, according to the Detroit Free Press

The Free Press was told by the hospital that it will try to get the arbitrator's award vacated in federal court. The DMC reported that:

"On behalf of our dedicated employees and medical staff, we stand behind the decision of our Governing Board to not renew the expired medical staff membership and clinical privileges of Drs. Kaki and Elder for another two-year term.”

Tenet History of Overpayments, Fraud and More

The cardiologists' False Claims lawsuit against Tenet isn’t a one-off. Tenet has been under federal investigation since at least 2005 when it paid $43M in 2012 to resolve allegations for overbilling in its Atlanta hospitals from 2005 to 2007.

In 2006, the Dallas-based company agreed to pay $725M to settle allegations of illegal Medicare payments to Tenet hospitals in Los Angeles, San Francisco, St. Louis, New Orleans, Memphis and El Paso.

And in 2016, Tenet paid a $514M fine for improperly paying doctors to refer Medicaid patients under a kickback scheme for obstetric and other medical services in Georgia and South Carolina

Allegations in Elder and Kaki's lawsuit also include that DMC and Tenet:
  • Billed Medicare and Medicaid for procedures knowing that the surgical equipment used in many procedures were not sterile.
  • Put patients at risk of contracting life-threatening diseases that include HIV, hepatitis B and C, fungal infections, pneumonia, and other infections.
  • Submitted claims for payments to Medicare and Medicaid that were false or fraudulent.
  • Allowed physicians to conduct medically unnecessary procedures.
According to the lawsuit, Kaki and Elder reported multiple incidents of above violations and false claims to Tenet officials and their reporting culminated  in their terminations.

Patients at Risk

In one instance, Kaki and Elder reported that physicians found supposedly sterilized surgical instrument packages containing unsterile, dirty instruments, some with visible tissue and blood. The last time problems were reported was one month before they were terminated, said the lawsuit.

"After (Kaki and Elder) were terminated on October 1, 2018, (DMC and Tenet officials) falsely made representations to the public that their facilities and instruments were sterile."

The lawsuit also described several instances of how DMC cost-cutting led to quality of care problems and at least one potential patient death and an unsafe environment for patients.

The lawsuit further states that in early 2018, DMC removed the "stat blood lab from the cardiac catheterization unit at Harper Hospital" as a cost-cutting measure. However, this created “an immediate and serious patient safety issue, as time is of the essence in receiving blood work results for cardiac patients…One patient died because his high potassium levels were not reported to the cardiac team for hours." The medical device was eventually returned.

Future Plans

In late February 2021, the Free Press reported health care plans aimed at increasing access to health care and reducing costs for patients. The Michigan House of Representatives is introducing legislation to include the following proposals:
  • Capping insulin co-pays at $50 for a 30-day supply. The cost of insulin can cost hundreds of dollars a month for those who need it, even with insurance. 
  • "Right to shop" for medications: The proposal seeks to not penalize patients for buying prescriptions from out-of-network providers if it would cost less than medication purchased in-network. The bill would allow patients to count money used out-of-network toward yearly out of pocket costs for in-network purchases. Many other states have some version of "right to shop" laws, according to the National Conference of State Legislature. 
  • Expanding telehealth: Proposals would allow out-of-state medical providers to offer telehealth services in Michigan, such as contact lens prescription renewals.
Limiting gifts to doctors: Currently pharmaceutical representatives can give large gifts to doctors in Michigan. A bill would cap the value of these gifts so companies cannot influence doctors regarding which medications they decide to prescribe. 

Access to oral chemotherapy: Preventing providers from charging higher co-pay or deductibles for these treatments. Legislative supporters say 43 other states have already enacted this change.


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