For quite some time, I have been a strong advocate for ongoing medical ethics training outside of the medical education setting. I personally do not feel that many physicians, nurses and para-professionals are equipped to handle the medical-ethical challenges that the real world presents. Today more than ever medical ethics training is a necessity with issues arising from patients, insurance companies, and the government. It’s impossible to avoid issues and training in the real world is critical.
Medicine can be quite insular, even though they are obviously dealing with life and death matters. It is sometimes a harsh and unforgiving world but then again, so is piloting a jetliner or being a police officer. As with any profession then, within the narrow world of medicine, there are some medical care providers who forget their ethics and their responsibilities and practice not medicine, but common place fraud.
From the Attorney General’s office comes news of a conviction that occurred on July 29, 2016 of New York. The surgeon’s name is Dr. Syed Imran Ahmed, who had a medical practice based out of hospitals in Brooklyn, New York and on Long Island. He submitted millions of dollars’ worth of claims to Medicare. In addition to submitting the claims, he also was charged with money laundering. The charges leveled against Dr. Ahmed are significant and are the very reason that it’s important to have an effective medical ethics training program.
At the core of the surgeon’s foul-up, was that he charged Medicare for minor surgical procedures he did not perform. To increase his payments, the doctor stated the minor surgical procedures were conducted in operating rooms. Operating room charges are always billed at a higher rate. He compounded one lie on top of another lie. When I think of medical ethics training its not about what we should do – the rules – but rather about what motivates unethical and in many cases illegal behavior.
In all, the surgeon submitted more than $25million in such claims and his pockets were lined to the tune of about $3 million dollars of taxpayer money. Ahmed submitted over $25 million in false claims to the Medicare program for surgeries he never performed and he received over $3 million from Medicare as payment for the false claims.
In the past, I have talked about the Medicare Fraud Strike Force that was formed only in 2007. To date, they have uncovered more than $10 billion in out and out fraud!
Upstate Issues – Medical Ethics Training lacking here…
Lest we focus just on Dr. Ahmed, one day later (August 1, 2016), and about 300 miles from Ahmed’s office, the Attorney General’s office charged St. Joseph’s Hospital in upstate Syracuse, New York, agreed to pay $3.2 million in penalties because they submitted claims for psychiatric services they did not perform. Actually, someone performed those services, but no one fully qualified to do so.
What I am illustrating just from an ethical perspective, is that this fraud, only within a two day period and in just one state cost the taxpayers millions of dollars. Somehow the health care providers neglected to understand the money to pay for their bogus invoices comes from the very same people in the states that they are serving.
While the idea of a “strike force” is a good one, from an ethical standpoint it is extremely disturbing. It is also a vicious cycle. We (physicians, healthcare providers and patients) are all complaining about our escalating medical costs – and with good reason. At the same time, some of the very same people who are screaming the loudest are also responsible for defrauding every one of us. The best of strike forces cannot possibly catch everyone, and so it is important that all providers are trained and refreshed in ethics.
I am obviously not talking about medical ethics e.g. the improper use of a treatment or performing the incorrect procedure, rather situations in which out and out fraud could be prevented.
When a lack of common-sense or illegal, “non-medical” ethics fraud is being committed, it is not a victimless crime by any means. In addition to the patient and responsible members of the profession, the fraud ultimately costs every taxpayer. It is ironic, in the greater scheme of things, that the very same patients being treated may also be defrauded!
I recommend independent ethics training for the medical profession attached to any groups or practices claiming Medicare benefits. If nothing else, such training will lend reality to an already dysfunctional system.
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