In August 2017, a Texas Surgeon was accused of violating federal anti-kickback laws after purportedly referring patients requiring neuromonitoring to a company he held financial interest in. The Texas Medical Board filed a complaint which held broad reach for surgeons using neuromonitoring companies. The complaint also raised red flags for patients relying on their healthcare providers to be honest and ethical in their treatment.
In November 2017, the surgeon was formally punished by the Texas Medical Board. A mediated order allowed the surgeon to continue practicing medicine, but he would permanently be required to notify patients of his financial interest in the neuromonitoring company in question. He was also ordered to attend classes, pass an ethics test, and pay a fine. The mediated agreement was reached in exchange for the more serious charges against the surgeon being dropped. This surgeon was reportedly the first in Texas to be sanctioned for such a business arrangement, or for failing to disclose his financial interest to patients. He denied the allegations against him, but agreed to the punishment issued by the Medical Board.
Read on to learn more about the accusations, the complaint, and what it could mean for other doctors and patients in Texas. Protect yourself, your finances, and your legal rights by contacting the Houston medical malpractice attorneys at MedMalFirm.com.
Texas Surgeon Accused of Violating Anti-Kickback Laws
Surgeons, surgical centers, and hospitals often contract with outside companies when they have patients that require nervous system monitoring after spinal or brain surgery. In such cases, healthcare providers contract with the chosen company to provide equipment and trained professionals to hook up electrodes in the patient’s skin, muscles, and scalp, and then monitor them remotely.
The accusations against the Austin, Texas surgeon claimed that he referred patients to a company that he was personally invested in. The claim suggests that patients paid up to $80,000 more than what their insurance coverage provided by using the surgeon’s referral. It further claims that the surgeon did not provide signatures proving that he informed patients about his financial interest in the company.
At the heart of the Texas Medical Board complaint is the issue of doctors owning stakes in the companies they refer patients to. Apparently, many doctors have financial relationships with neuromonitoring organizations. In response to the allegations and continued investigation, the President of Revolution Monitoring in Dallas said that his company has lost a great deal of business to doctors who “expected some sort of remuneration for the referral”.
Reach of the Complaint
Many people in the healthcare industry watched closely as the complaint was reviewed by the Texas Medical Board. Even though this case has been resolved, there continues to be a great deal of controversy over whether it is legal for doctors to refer patients specifically to companies they are financially invested in. There is also increasing skepticism about how patient referrals are managed, and whether they damage patients.
The complaint against the Texas surgeon discussed herein includes six patients ranging in age from young adults to elderly. The cost of surgery and neuromonitoring are staggering, with bills as high as $80,000 to $128,000 per patient. Some insurance companies do not offer coverage for monitoring, while others only cover monitoring requested by the patient rather than the doctor. Further investigation into how much doctors get as kickbacks is ongoing.
One neuromonitoring company did come forward speaking out about a doctor requesting $300 payment for each referral made to the company. The company declined to work the doctor or enter such an agreement. Neither party was identified in the media report. According to the Texas Medical Board, punishment against doctors violating anti-kickback laws could range from dismissal of the charges to revocation of the medical license.
Reach of the Potential Harm
Not only is violating anti-kickback laws illegal, it is also unethical and potentially harmful to patients. Patients undergoing major surgery rely on their doctor to provide quality options within the scope of their insurance coverage and other applicable considerations. A Texas surgeon who refers a patient to a particular neuromonitoring company not covered by insurance, or who receives a kickback for the referral, could cause damage to the patient’s finances and insurance coverage.
Healthcare, and surgery in particular, can be extremely expensive. Insurance is a great way to keep costs down, but many patients do not realize that certain providers and services may not be covered. When a doctor who is familiar with your record refers you somewhere that is not covered by your insurance and you are left with a startling bill, you may feel betrayed. You trust your doctors, and when they behave in a negligent or unethical way, it adds another layer to your pain and suffering.
Understand Your Insurance and Options
One of the best ways to avoid surprises on your billing statement or insurance claim is to understand your insurance. Consider the following tips:
- When choosing a provider, contact your insurance company to make sure they are in-network, then contact the provider to verify directly. Some insurance companies accept particular plans offered by an insurer, but not others.
- Review your benefits to find out if you need a referral to see a specialist, or if authorization from the insurance company is required in advance for certain procedures.
- When your doctor recommends you be referred to someone else, make sure they know you want to see a provider that is covered by your insurance. Keep this in mind when being referred to a surgical center, hospital, lab, or other facility.
- Never be afraid to ask about the costs associated with a particular procedure before agreeing, and contact your insurance company to find out how much, if any, will be covered. That way, you can estimate what you will owe after treatment.
Understand Your Legal Rights
If you believe that you have been treated negligently or unethically by a Texas surgeon, doctor, or other provider, or that he or she has intentionally referred you to an out-of-network provider for personal gain, you may also find it helpful to contact an attorney. Negligent or unethical care is never acceptable, and you have the right to learn more about protecting yourself and getting the quality care that you deserve. To learn more about your legal rights, contact MedMalFirm.com. To schedule a free consultation, fill out our online form.