10. Changing The Definition Of "Sick" To Admit More Patients
With the constant barrage of news stories about all the food additives and household objects that can give us cancer or otherwise damage our health, the last thing we need as a society is another excuse to descend into hypochondria. But even when we do succumb to the urge to treat every itch and hiccup as a symptom of the plague, we should still be able to trust nurses and physicians to set us straight with the proper diagnosis.
Florida-based Health Management Associates saw it differently. With the aid of complex software and a little old-fashioned strong-arming, the for-profit hospital admitted an excess of patients who needed little or no medical attention in order to bill Medicare. Hospital staffers were so eager to treat visitors that an infant whose body temperature registered at 37.1 degrees Celsius (98.7 °F)-one-tenth of a degree higher than the average temperature of 37 degrees (98.6 °F)-was documented as having a fever, resulting in needless and costly medical tests.
But not everyone involved in the hospital ruse was a willing participant. According to a whistle-blower lawsuit filed against the company, it was standard practice to fire physicians who refused to play ball, and administrators with ethical concerns about excessive hospital admissions suffered similar fates. Unfortunately, because of the increasingly convoluted financial affiliations and colossal scales that are coming to characterize groups like Health Management Associates, these kinds of abuses will likely be a persisting nightmare for regulators.
9. Delegating Medical Treatments To Unqualified Staffers
Dr. Ravi Sharma was a certified thoracic surgeon who sought to help people lose weight through his Florida-based Life's Image weight-loss center. And while one might not think of a chest doctor as the first person to run to with a severe case of glut-gut, it's perfectly reasonable to expect the clinic to at least be staffed with professionals who know how to treat weight-related medical problems.
Unfortunately, Dr. Sharma was too busy being courted by dollar bills to worry about whether the people tending to his patients had any real clue what they were doing. Instead of recruiting certified professionals to perform vein injections and other invasive procedures, Sharma relied on untrained staffers-including an office manager-to do the work. The thoracic surgeon not only didn't perform the procedures, he wasn't even present to oversee them. Instead, he often texted the instructions for performing ultrasounds and varicose vein injections to his staff, according to one complaint against him.
To make matters worse, many of the invasive procedures were unnecessary, performed only for the purpose of charging extra money. Sharma, who only saw a few patients himself, sought Medicare payments for the procedures that his untrained assistants performed as well. But everything fell apart when he fired office manager Patti Lovell, who repaid the gesture by exposing Sharma's indiscretions in a whistle-blower lawsuit. Sharma, however, having learned that money is the best medicine, simply made his troubles disappear by paying the government $400,000 and has since continued to practice medicine without further punishment.
8. Exploiting Workers' Compensation Claims
For the average Joe just looking to make ends meet, a severe workplace injury offers little more than physical agony and the dire prospect of being unable to provide for your family, not to mention the crippling debt of hospital bills. Thankfully, society has provided an invaluable safety net in the form of workers' compensation, which covers the cost of recuperation from job-related accidents.
However, for orthopedic hospital owner Michael Drobot, workers' compensation insurance was the unwitting inspiration for a 16-year, $500 million fraud. Through a series of bribes issued to doctors, chiropractors, and other professionals, Drobot's clinic pulled in scores of patients who were undergoing surgery for work-related spinal injuries. Thanks to this scheme, many injured workers were sometimes sent hundreds of miles away from their homes for their operations instead of being scheduled for surgeries at the most convenient locations.
