Hospital officials arrested for reimbursement collection scheme

Rarely does a doctor in Pennsylvania intentionally act in a manner harmful to patients. In instances of a medical mistake, if there is negligence at play then there could be grounds for a medical malpractice claim. However, sometimes the happening is far more egregious than to be classified as a mistake. In some instances health care providers can be criminally charged for the worst levels of care, much like dentist facing charges outside of Pennsylvania.

But what about when there was no mistake? What about when the lapse of care was beyond just negligence? What about when a doctor is intentionally performing procedures to the detriment of a patient’s health? A better question: What would ever prompt a doctor to act against a patient’s best interest?

In Chicago, several doctors and hospital administrators were recently arrested in an elaborate plan carried out over several years that preyed on vulnerable patients that were elderly or poor to perform medically unnecessary procedures to collect the reimbursement funds from Medicare and Medicaid. In some instances, these doctors would induce the conditions that necessitated such procedures.

This means that when these doctors and hospital administrators were responsible for keeping patients healthy, they instead were harming patients to fund the hospital’s greed. Federal investigators allege that at least $2 million in reimbursements was collected in this manner. However, more troubling is that multiple patients died as a direct result of having their health compromised by these corrupt health care providers.

The hospital made profit from performing unnecessary penile implants, using too much sedation to eventually necessitate tracheotomies, transporting nursing home residents not needing medical attention to the Emergency Room with the help of an ambulance company also in on the act, and so much more. All of these services would be billed to Medicare and Medicaid. Doctors would pocket some of these reimbursements.

So what happens when a health care provider intentionally harms a patient? The health care provider can face serious criminal charges. The extent of the charges in this fraudulent scheme remains to be seen, and additional players may still see arrest. At this point, there is no report of any claim of medical malpractice being filed after the arrests. However, in the coming months such an event would certainly not be unexpected.

Source: Chicago Tribune, “6 arrested in alleged kickback scheme at Sacred Heart Hospital,” Jason Meisner, April 16, 2013

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