Las Vegas Infectious Disease Specialists Accused of Fabricating Medicare Services

Photo by a.drian via Flickr

The Las Vegas Sun reports that the Nevada Medical Examiners Board is investigating into the falsification of medical records at HealthSouth Tenaya.  Raye Kraft, wife of a patient at this hospital, began to notice “infectious disease specialists Dr. Dhiresh Joshi and his then-employee, Dr. Fadi El Salibi,” writing in Kraft’s husband’s medical charts that they were examining him when they were not.  As her suspicion rose, Ms. Kraft took detailed notes of when the specialists charted activity on her husband, compared these notes with her insurance bill and her own notes of the times they actually examined him, and then sent these notes and comparisons along with a complaint to the Nevada Medical Examiners Board.

The Sun reports:

Her claim: that on an ongoing basis, Joshi and El Salibi were writing in the chart that they had examined her husband when they hadn’t, and then billing for it. One supposed exam was nothing more than the doctor’s friendly wave from the door, she said.

Ms. Kraft’s was not the only person suspicious.  The article notes that another patient “had complained a year earlier to the medical board of similar experiences.”  Additionally, nurses at MountainView Hospital Medical Center also filed complaints  “about El Salibi’s fly-by visits.”

In addition, the number of patients Dr. Joshi has claimed to have examined in the course of  a day has been deemed further cause for suspicion. According to the Sun, Elizabeth Neubauer, Dr. El Salibi’s former billing manager, “said that Joshi himself routinely billed for 70 patients a day. Other infectious diseases doctors say that’s double the number they could reasonably see in a long day of hospital rounds.”

The Sun also reports:

Indeed, a 2004 Medicare audit showed that in a single day, Joshi billed for an impossibly high number of patients - 104, according to Neubauer’s recollection. Joshi said it was 81 Medicare patients, and 20 of them were seen by medical residents under his supervision.

One might have thought that the audit would have served as a red flag for further examination for fraud and abuse at that time.  An  “impossibly high number of patients” is, after all, impossible– and therefore seemingly either the result of either inadvertence or knowing falsehood. If a pattern of such “impossible” billing emerges, “inadvertence” begins to seem less likely– especially when coupled with independent allegations of “overbilling.”

The articles reports that “[a]llegations about doctors fraudulently billing Medicare and insurance companies are whispered throughout the Las Vegas medical community . . . .” One might hope that the numerical evidence derived from audits in cases such as this would do more than whisper– and would occasion heightened scrutiny.

Some have questioned the efficacy of current enforcement and penalty practice:

Investigations usually result in little more than a hand slap for the physicians. In November, six Las Vegas doctors - Dr. Robert Shreck, Dr. Tony Q.F. Chin, Dr. Craig M. Jorgenson, Dr. Wen Liang, Dr. Mohammed Najmi and Dr. Edmund Pasimio - several of them leaders in the medical community, paid $625,000 to Medicare after being accused of getting kickbacks for referring patients to a nurse practitioner, who performed unnecessary procedures. They were not required to admit any guilt in the settlement and continue to practice in the community (emphasis added).

Given the large amount of money the government spends on health care through Medicare, there are seemingly large opportunities for abuse.

The Sun reports:

Neubauer said that when she worked for him, Joshi billed up to $4 and $5 million annually.

“He said all the time, ‘I’m not making enough money. I need more money. I need more money,’” Neubauer recalled.

The actions allegedly performed by these doctors are said to be commonplace in the medical community:

Pat Burns, spokesman for the national advocacy group Taxpayers Against Fraud, said that bill padding — doctors up-coding to make more money or charging for things they have not done — is rampant in health care. The cases are difficult to prove because of the complexity of providing medical care, the fear people have of blowing the whistle, and ignorance about where to go with their complaints. The government devotes few resources to recruiting whistleblowers or going on site to ferret out fraud, he said.

Las Vegas itself is further suspect, the Sun reports:

Medicare, the federal government’s insurance for the disabled and those age 65 and over, spends more per patient in the Las Vegas region than in 90 percent of the regions nationwide, a recent study found. The high level of billing could suggest better care. But it is more likely, according to experts, that the government is paying for unnecessary services or ones that weren’t even rendered.