Protecting Medicare and Medicaid Patients from Sanctioned Health Practitioners

S. Hwo. 98874 PROTECTING MEDICARE AND MEDICAID PATIENTS FROM SANCTIONED HEALTH PRACTITIONERS HEARING BEFORE THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE NINETY-EIGHTH CONGRESS SECOND SESSION WASHINGTON, DC MAY 1, 1984 Printed for the use of the Special Committee on Aging U.S. GOVERNMENT PRINTING OFFICE 6874 0 WASHINGTON: 1984 SPECIAL COMMITTEE ON AGING JOHN HEINZ, Pennsylvania, Chairman PETE V. DOMENICI, New Mexico JOHN GLENN, Ohio CHARLES H. PERCY, Illinois LAWTON CHILES, Florida NANCY LANDON KASSEBAUM, Kansas JOHN MELCHER, Montana WILLIAM S. COHEN, Maine DAVID PRYOR, Arkansas LARRY PRESSLER, South Dakota BILL BRADLEY, New Jersey CHARLES E. GRASSLEY, Iowa QUENTIN N. BURDICK, North Dakota I PETE WILSON, California CHRISTOPHER J. DODD, Connecticut JOHN W. WARNER, Virginia J. BENNETT JOHNSTON, Louisiana DANIEL J. EVANS, Washington JEFF BINGAMAN, New Mexico JOHN C. ROTHER, Staff Director and Chief Counsel DIANE LIPSEY, Minority Staff Director ROBIN L. KROPP, Chief Clerk (11) CONTENTS Page Opening statement by Senator John Heinz, chairman…----------------- 1 Statement by Senator John Glenn------------------------------------- 3 Statement by Senator John Melcher…-----------------------------______ 4 Statement by Senator Pete Wilson------------------------------------- 14 CHRONOLOGICAL LIST OF WITNESSES Derbyshire, Dr. Robert C., Santa Fe, NM, author and past president of the Federation of State Medical Boards----------------------------- 6 Zimmerman, Michael, Washington, DC, Associate Director, Human Re- sources Division, General Accounting Office, accompanied by Tom Dow- dal, Group Director, Human Resources Division; and Don Warsing, evaluator, Human Resources Division--___________________________ 17 Kusserow, Richard P., Washington, DC, Inspector General, U.S. Depart- ment of Health and Human Services--------------------------------- 24 Ring, Dr. John J., Mundelein, IL, member, board of trustees, American Medical Association, accompanied by Ross N. Rubin, department of Federal legislation, American Medical Association…------------------ 384 Wood, William L., Jr., New York, NY, executive director, Office of Pro- fessional Discipline, State of New York…---------------------------- 41 Carter, R. Thomas, Louisville, KY, legal counsel, Kentucky State Board of M edical Licensure…----------------------- ------------------------ 43 APPENDIXES Appendix 1. Case examples of sanctioned medical practitioners----------- 53 Appendix 2. Newspaper articles dealing with unfit medical practitioners__ 76 Appendi': 3. Mqfgazine articles, "Medical Discipline in Disarray," written and submitted by Dr. Robert C. Derbyshire------------------------- 133 (M) PROTECTING MEDICARE AND MEDICAID PATIENTS FROM SANCTIONED HEALTH PRACTITIONERS TUESDAY, MAY 1, 1984 U.S. SENATE, SPECIAL COMMITrFEE ON AGING, Washington, DC. The committee met, pursuant to notice, in room 628, Dirksen Build- ing, at 9:32 a.m., Hon. John Heinz, (chairman) presiding. Present: Senators Heinz, Wilson, Glenn, Mlelher, anil Bingaman. Also present: John C. Rother, staff director and chief counsel; Diane Lifsey, minority staff director; David Holton, chief investigator; David Schulke, investigator; Isabelle Claxton, communications director; Jane Jeter, minority professional staff member; Robin Kropf, chief clerk; and Kate Latta and Leslie Malone, staff assistants. OPENING STATEMENT BY SENATOR JOHN HEINZ, CHAIRMAN Chairman HEINZ. The Special Committee on Aging will come to order. Ladies and gentlemen, this morning the Special Committee on Aging will investigate a serious defect in our ability to protect our Nation's elderly and poor from treatment by incompetent and dangerous medical practitioners. The problem stems from loopholes in medicare and medicaid which allow doctors barred from practice in one Federal program or in one State, to switch to another program or to pack their bags and set up practice in another State. We will see today what these loopholes mean to the 50 million Americans who trust medicare or medicaid to finance their health care needs. Because many of these practitioners also treat privately insured patients, this problem is a vital concern to all Americans. Some estimate that the number of bad doctors is small. Today we will hear estimates that as many as 36 million Americans may receive treatment from unfit doctors each year. But whether the number is large or small is not the point. The point here is that the Government has no power to prevent incompetent practitioners from enriching themselves at the expense of the American taxpayer-even as they prey on the poor, the old, and the very vulnerable. Let me illustrate how serious and shocking a problem we face with a few case studies that the committee's investigative staff has uncovered: Dr. S. is a surgeon who performed a series of extensive and dangerous back surgeries on a number of patients. As a direct result of his gross negligence and gross incompetence in the operating room, one (1) 2 woman died. When he lost his license in California, he took up practice in Michigan and continued to receive Federal reimbursement under medicare and medicaid. It took Michigan 4 years to finally revoke his license. Today, Dr. S. practices medicine in New York State and is still eligible to bill the taxpayer under medicare and medicaid. Take the case of Dr. T. He said he had graduated from a school in Saigon, Vietnam. Later he changed his story and said he had graduated from a school in Hanoi. Finally in March 1981 he admitted to Cali- fornia authorities that the diploma he had submitted was false. Dr. T. is a convicted felon, found guilty of submitting a false new drug study to the FDA. He has held a license to practice medicine in at least six States and has surrendered his license or had it revoked in at least three. It is not at all comforting to know that Dr. T. now practices in Nevada and is medicare and medicaid certified. One final case in this incredible rogue's gallery is the case of Dr. H., who treated patients in 30 or 40 nursing homes and hospitals in California. In a 2-year period, Dr. H. billed medicare for one-half of a million dollars. He was cited by HHS for placing patients' lives in jeopardy, for substandard quality of care, and for billing for services not rendered. Today Dr. H. is banned from the Medicare Program- thank heavens-but he can continue to treat medicaid patients in any State that will recognize his California license. I am entering additional case examples of sanctioned medical practitioners into the record. Also, a series of articles from the Detroit Free Press dealing with unfit medical practitioners will be inserted into the record." If any one of these practitioners had lost their driver's license for drunk driving, their names would have gone into a national register and they probably would not be given a driver's license in another State. But the current lack of coordination among States allows these dangerous, criminal doctors to hop from Pennsylvania, to California, to Michigan-to any 1 of the 50 States. The current restrictions on HHS authority means a doctor can be banned in 49 States and the Federal Government still will pay him for treating medicare and medicaid patients in that 50th State. That is not what responsibility in Government is all about. It is a dereliction of duty on our part that we in Congress have not given the Secretary of HHS the authority needed to prevent these unfit doctors from continuing to treat federally sponsored patients. So we must set our own Federal house in order, and we must also ask the individual States to strengthen their cooperation and com- munication in enforcement. I look forward to hearing today's witnesses. They are experts in these matters. Their testimony should help us better understand the scope of this problem and what we should do about it. But before I call on our first witness, I want to recognize the distin- guished ranking minority member of the Special Committee on Aging, our friend and good colleague, John Glenn. Senator Glenn. 'See appendixes 1 and 2. 3 STATEMENT BY SENATOR JOHN GLENN Senator GLENN. Thank you very much, Mr. Chairman. Mr. Chairman, access to quality medical care for our Nation's elderly citizens is an issue of longstanding concern to members of this committee. In recent years, proposals to cut medicare benefits have become an annual part of our budget process under the leadership of the Reagan administration. Concern has grown among committee members that increased cost sharing will impose a disproportionate burden on those older Americans least able to afford it-the oldest, the frailest, and the poorest. I have spoken out about the need to preserve access to necessary health services, and have warned against increased health deductibles which limit access to care. Preserving the quality of medical treatment given to medicare bene- ficiaries has also taken on a new importance with the enactment of medicare prospective reimbursement to hospitals. As I said before, while we want inflation reined, in, we do not want the quality of health care sacrificed under the guise of cost containment. Today, we are examining access to quality medical services for our Nation's elderly in a different light. As a result of an investigation being released by the General Accounting Office [GAO] today we have learned that medicare and medicaid patients are being treated in some States by doctors and pharmacists who have been determined by another State, after due process, to be unfit to practice. The GAO looked at the careers of doctors who have their licenses revoked by my home State of Ohio, as well as by Michigan and Penn- sylvania. What the GAO found is that some of these doctors are sim- ply moving on to greener pastures-different States where they set up practice-and are billing Uncle Sam to pay at least part of the cost. They are continuing to participate in the Medicare and Medicaid Programs, a few are possibly finding employment with the Veterans' Administration or other Federal health programs.

Load more