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    Wednesday, August 30, 2006

    Be Careful What Tests You Order: Lest you get hauled to jail:

    A Stark County doctor and his wife have been arrested on federal health-care fraud charges, accused of billing insurers for testing their patients didn’t need.

    ...The FBI says Premier’s owners, Dr. Mohammed Aiti and his wife, Susan, billed Medicare, Medicaid and private insurance companies for unnecessary heart-related exams.

    It sounds like it's a little more substantial than a disagreement of when to order what tests:

    Susan Aiti told office staff to write false symptoms of heart conditions in patients’ files to justify tests such as carotid artery ultrasounds, nuclear stress tests and echocardiograms, court papers show.

    Mohammed Aiti would then falsify the test results and order more tests, not on the basis of medical need, but by how often each insurer would pay for the tests, court papers show.

    The doctor also removed patients from the hospital so that he could charge for office visits, refused to forward medical records and told patients that he would prescribe them narcotic painkillers if they agreed to come in for stress tests, court papers show.

    ....Mohammed Aiti’s conduct also drew complaints from other doctors, patients and hospitals, court records show.

    posted by Sydney on 8/30/2006 01:35:00 PM 3 comments


    While not this extreme, this practice is a little more common than most doctors would care to admit. For 20 years I have been told I need to be medicated so that I could be seen more often by a doctor, in one case, four times a year. One doctor told me I was taking food off his children's table. A nurse told me I was wasting insurance dollars by not agreeing to extensive testing.

    I ended a three year relationship with a doctor earlier this year after two blood draws and EKG's could not find anything wrong. During this time there was constant pressure for heart imaging, followed by a whole body scan, followed by more imaging and a stress test.

    The final blows came when I had $400 in co-pays for my physical followed by $100 in extra fees for a prescription because, she does not do generics. I learned after the fact that her drug reps set her prescription policy.

    The only saving grace in this mess was her nurse who gave me enough information to question what was going on.

    Steve Lucas

    By Anonymous Anonymous, at 2:46 PM  

    Steve: I refuse to believe this is common practice among legitimate phsyicians. What I hear, between the post and your comment, is that there are different levels of physicians perpetrating medical scams out there.

    This is not a judgement call. This is fraud pure and simple. I'm probably being naive, but I believe the line between medical judgement and scam is easier to define than one might think. It involves documentation and medical reasoning. Without those, you're dealing with a scammer.

    By Blogger #1 Dinosaur, at 5:19 PM  

    My concern is innocent billing error: I've seen a clinic I was in get penalized for what were clearly such errors; in fact, review of random records revealed as many errors in Medicare's favor as not. Yet it was guilty until proven innocent. In this case it represented an error rate of 1/2% of the Medicare bills: an accuracy rate far higher than Medicare itself.

    By Blogger Sid Schwab, at 6:22 PM  

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