FBI Raids Docs 

On October 30, forty FBI agents raided the offices of two prominent physicians in Redding Medical Center in California: Dr. Chae Hyun Moon, the hospital's director of cardiology, and Dr. Fidel Realyvasquez Jr., the chairman of cardiac surgery.  The two are being investigated by the FBI and the Office of the Inspector General at the Department of Health and Human Services for possible performance of unnecessary invasive procedures, including cardiac catheterization, angioplasty, and open heart surgery.

While Tenet HealthCare, one of the nation's largest for-profit hospital chains and the owner of Redding Medical Center, has so far not been named as a target of this investigation, word is that Tenet was made aware of "concerns" several months ago. Redding is one of Tenet's most profitable institutions, and Tenet shares lost more than 25% of their value the day following this raid.

There is no word of emotional or physical harm coming to any of the patients who might have been in the waiting room as 40 FBI agents stormed the offices.

DrRich comments

DrRich has no way of knowing whether Drs. Moon and Realyvasquez might have been abusing the system (not to mention their patients.)  Apparently the Feds have had the cooperation of other doctors in this investigation, though, which suggests there may be some substance to the allegations.

Whatever the facts turn out to be, this is going to be one messy investigation, if only from the standpoint that it apparently hinges on the determination of "medical necessity."  It is often difficult to get two doctors to agree on whether and when a procedure is medically necessary - there's a lot of judgment (or "art") involved in making many of these decisions.  One man's indication for angioplasty is another's indication for nitroglycerine tabs.  The court case will be a lot of fun, and DrRich hopes they televise it.

However, it seems very plain to DrRich that, to a growing extent, "medical necessity" is determined by whether the doctor (or the hospital in which they practice) makes money or loses money when a procedure is performed. If the decision is not obvious and falls into the realm of medical "art," well, something you get paid for starts to look a lot like Rembrandt, and something you don't get paid for begins to resemble graffiti.  Since most docs are humans and thus respond similarly to stimuli, pretty soon "community standards" develop that offer the docs plenty of cover in a court of law. 

For instance, reimbursement from Medicare and HMOs has "progressed" to the point that it is difficult not to lose money seeing patients in the office.  This is why it seems that many docs discourage patients from actually showing up in the office, or alternately, find some billable procedure to do once they get there.  After all, if you're losing money every time you see a patient, it's hard to make it up on volume alone.

Angioplasty and cardiac surgery, on the other hand, are procedures that continue to reward handsomely both the doctors and the hospitals that shelter them.  Indeed, these procedures are like the football programs in many major colleges - they wind up providing the funding for all the other "sports" that don't themselves make any money.  If the decision on whether to do a procedure could go either way, financial considerations push hard toward doing them.

Further, docs who do lots and lots of these procedures become very important people in their respective institutions, and often wind up as chairmen and directors of cardiology services, the better to assure that the institutional systems continue to work to their (and their hospital's) maximum benefit.  They develop so much local prestige, and become so used to having administrators and colleagues bow to their whims, that they often come to believe that if it's them making the decisions, then the decisions must be right.  Whether this is what happened with Drs. Realyvasquez and Moon (who, one news report says, considers himself one of the top 10 cardiologists in the country), DrRich obviously cannot say. 

Whatever finally happens to these doctors, and to Tenet Healthcare for that matter, the Feds have clearly made a statement here.  The FBI is not above raiding doctors offices on the suspicion that docs are performing procedures that might not be medically necessary.  If you're a cardiologist or a cardiac surgeon, you'd better begin to factor this in to your decisions on whether to do a particular angioplasty or bypass surgery.

And if you're a patient, keep in mind that not performing one of these procedures when they're needed is often more deadly than performing them when perhaps they're not.  And keep in mind that when your doctor is deciding what to recommend, he/she must necessarily take into account a few factors beyond what's best for your health - things like whether they'll get paid, or whether they'll get sent up on a federal rap.

November, 2002

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