Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
Early detection is key to prevent or mitigate disease. Routine colonoscopy and mammography save lives. Or at least that’s what the literature suggests.
Is there early detection for sociopathic or violent behavior?
In 1963, JM Macdonald wrote an article called The Threat to Kill in the American Journal of Psychiatry.
The Macdonald triad (also known as the triad of sociopathy or the homicidal triad) is a set of three factors, the presence of any two of which are considered to be predictive of, or associated with, violent tendencies, particularly with relation to serial offenses. The triad was first proposed by psychiatrist J. M. Macdonald in “The Threat to Kill”, a 1963 article in the American Journal of Psychiatry. Small-scale studies conducted by psychiatrists Daniel Hellman and Nathan Blackman, and then FBI agents John E. Douglas and Robert K. Ressler along with Ann Burgess, claimed substantial evidence for the association of these childhood patterns with later predatory behavior. Although it remains an influential and widely taught hypothesis, subsequent research has generally not validated this line of thinking.
That said, if a local teen is setting animals on fire – just because, that’s probably not someone you want to invite to dinner. Most would agree such behavior is not healthy, even if it does not predict who may become a future rapist or murderer.
Are there early prognostic indicators for disciplinary action by boards of medicine?
New England Journal of Medicine published a study a number of years ago: Disciplinary action by Medical Boards and Prior Behavior in Medical School.
Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior.
Then there’s the question of whether unprofessional behavior, as a leading indicator for future Board discipline, is caused by mental health challenges or more likely to be diagnosed in a person who exhibits such behavior (non-causal, just associated).
Special attention must be paid to ensure that addictions, affective disorders, and other mental health disorders are being addressed. A study of psychiatry clerkship directors found that medical students exhibiting unprofessional behavior were referred for mental health evaluation in more than three-fourths of cases. Mental health evaluations were the most commonly reported remediation strategy in a study of US and Canadian medical schools in 2012–2013. Similarly, in a review of 25 years of resident training records at 1 program, psychiatric counseling was the most commonly implemented strategy associated with successful remediation.
Which brings me to the case of Dr. Sohail Mamdani. Dr. Mamdani is in a lot of trouble with the federal government. He has his own headline on the Department of Justice website. Never a good sign.
Merced County Doctor Indicted for Multimillion Dollar Disability Insurance Fraud Scheme, Money Laundering, and Unrelated Drug Charges.
On Oct. 20, 2022, a federal grand jury charged Sohail Mamdani, 46, of Los Banos, with mail fraud and money laundering in connection to a disability insurance fraud scheme, and unlawful use of a DEA registration number and fraudulently obtaining possession of a controlled substance, U.S. Attorney Phillip A. Talbert announced.
The California Employment Development Department (EDD) runs a Disability Insurance program that offers worker-funded benefits to people who meet certain requirements and have had those requirements verified by their physician or medical practitioner. Mamdani was a medical doctor operating a clinic called Walk-In Medical Clinic in Los Banos.
According to court documents, between February 2020 and March 2022, Mamdani submitted over 6,000 initial claims to EDD for disability insurance payments despite having never seen or treated the majority of the claimants. As part of the fraud, Mamdani would charge the purported patient a fee for both the initial disability claim and any supplemental claims. In addition, in order to avoid federal reporting requirements, Mamdani structured financial transactions. The investigation reveals potential intended losses to EDD of up to $99 million dollars with potential actual losses of over $53 million.
Mamdani is separately charged with unlawfully using another doctor’s DEA registration number for the purpose of unlawfully obtaining controlled substances. Additionally, Mamdani wrote a number of fraudulent prescriptions in the names of other individuals in order to obtain controlled substances himself.
Any early prognostic indications?
In 2018, Dr. Mamdani wrote false, negative, and defamatory online reviews about a competing practice on Healthgrades and Google. All while tooting his own horn.
“Worst surgeon!!!!! Thanks to adventist Nurse we asked for a second opinion, and I was home the 2nd day I didn’t even require a surgery. As per Dr Scherer I needed a gastric resection. I will report this medical board this man should not be able to practice medicine. ETHICS!!!!!! DONOT thrust this… [more]”
Joshua Dunn in Hanford, CA: “My mother was admitted for bed ulcer, and she is old and had these ulcer before so I know when they need to be treated after he cleaned her ulcer he told my family my mom doesn’t get a stool bag she will never heal. We trusted him my mom is in worst condition today then when she was ever this man has no… [more]”
“Worst surgeon, my mother was treated a surgeon we chose for some reason / family reason Pt was assigned to Dr. Scherer the day he entered the room he is been pushing for my mom to have drastic procedure with stool back he is unable … [more]”
The competing surgeon hired a digital forensics company to investigate. Based on what it learned, the competing surgeon filed a John Doe lawsuit to unmask the author of these posts. The evidence pointed to Dr. Mamdani or someone he influenced. If accurate, Dr. Mamdani allegedly violated California Business and Professions Code, Section 651, Section 2234(e), Section 2271, and Section 2272. These Sections address dishonest acts, false or misleading advertising, and anonymous (pseudonymous) advertising.
It’s unclear if such preliminary unprofessional behavior would have led directly to allegations of $100 M scheme to defraud the government. Perhaps there were intermediate steps between point A and point B.
What do you think?
Medical Justice provides consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a consultation – or use the tool shared below.
“Can Medical Justice solve my problem?” Click here to review recent consultations…
all. Here’s a sample of typical recent consultation discussions…
- Former employee stole patient list. Now a competitor…
- Patient suing doctor in small claims court…
- Just received board complaint…
- Allegations of sexual harassment by employee…
- Patient filed police complaint doctor inappropriately touched her…
- DEA showed up to my office…
- Patient “extorting” me. “Pay me or I’ll slam you online.”
- My carrier wants me to settle. My case is fully defensible…
- My patient is demanding an unwarranted refund…
- How do I safely terminate doctor-patient relationship?
- How to avoid reporting to Data Bank…
- I want my day in court. But don’t want to risk my nest egg…
- Hospital wants to fire me…
- Sham peer review inappropriately limiting privileges…
- Can I safely use stem cells in my practice?
- Patient’s results are not what was expected…
- Just received request for medical records from an attorney…
- Just received notice of intent to sue…
- Just received summons for meritless case…
- Safely responding to negative online reviews…
We challenge you to supply us with a medico-legal obstacle we haven’t seen before. Know you are in good hands. Schedule your consultation below – or click here to visit our booking page.
Jeffrey Segal, MD, JD
Chief Executive Officer and Founder
Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.
Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.
Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.
In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.
Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With decades of combined experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.
One of the factors I have noted in common with many schema to defraud or commit illegal acts is the obvious “surprise” we have at the blatant nature of the acts. And often connected with this is the extended period of time involved.
We WONDER how on earth did they think they would not be caught. If you are conducting a controlled substance diversion program, eventually you will collect large numbers of customers literally standing in line to get into your office.
Your local pharmacy down the block will hear of this almost immediately.
Perhaps what we need to TELL these malcreants ahead of time is that they are sending out “signals” in every direction.
They may think their local police or DEA investigations department are grossly incompetent. But eventually they WILL be discovered. And the longer they think they can get away with it, the worse it will ultimately be for them.
Michael M. Rosenblatt, DPM
Let’s leave out all of the purported predictive information, since it really has not been validated with appropriate double blinded controlled studies.
As far as this particular physician is concerned, there are two major issues.
The first issue is an apparent substance abuse problem.
The second issue is a deliberate scheme to defraud the government.
Time and again, we are amazed because the federal government doesn’t do what private insurers do, which is to conduct a pre payment review before authorizing payment.
This is why there is very little fraud by comparison reported by commercial insurers, and a lot of fraud reported by federally funded programs.
Also even with all of the automatic triggers in the federal programs to alert someone to look at the claims, the federal government agencies clearly ignored any early warning signs of abnormal claim submission patterns.
So this physician is allegedly a thief. But did the federal government go after this person in the first 3 or 6 months when these claims were submitted? No. Do they ever? Apparently not.
So the alleged their returned to the well because he thought he could continue to get away with this. The amounts are staggering, even in the first year, which should automatically trigger a review. But again, no such review was forthcoming.
Can we predict criminal behavior? No.
But would prepayment review stop most of these fraud cases? Yes.
Yet the government continues not to do this. The question is why?
Do the complaints against another physician have any bearing on this? No.
Can we assess psychiatric illness without a psychiatrist examining this physician? No.
So we really cannot assess if this is all part of a pattern of behavior from the outside.
We just do not know.
It is a mess, and this type of situation is likely to continue until Medicare and Medicaid conduct prepayment reviews like private insurers.
Mike, as usual, submits a keen insight into current events as it relates to health care, medicine, government, and common sense. I have learned much from him over the decades and thank him for that.
Dear Retired: If you wait for “certainty” as defined by relying on ” double blinded controlled studies”, you will wait forever. And, I think from your life experiences, you think so as well.
I will not address this particular doctor’s issues as I do not know the facts, and everyone is entitled to the presumption of innocence. I do think that you and I can agree to this.
Judge Sol Gothard, Court of Appeals, has informally “lectured” me extensively over the decades on topics that interest him. One of them, as he was once a Juvenile Court SeniorJudge, was on his personal insight into the behavior and behavior of those young defendants. Judge Gothard, who was a social worker before going to law school, brought unique insights. What he emphasized was the Triad as described above, as well as those who would commit any crime with a weapon. These actions were predictive of worse actions going forward into the age of majority.
Judge Gothard never spoke to me about coding, modifiers, medical necessity, and all of the other relatively modern methods that are used by the Federal Government in their audits, and to punish by their clawbacks and fines, as well as the reality of loss of liberty.
Medicare and Medicaid used to do “pay and chase”. But, that method is rapidly becoming history. There are huge data bases of data, advanced data analysis, predictive analysis, algorithms, etc.
Additionally, there are contractors employed to add to the power of the government programs. RAC, ZPIC, MIC, CERT, and a new one that was just brought to my attention, which I was sincerely impressed as to how accurate and competent they are . And from their volume of work, there is no doubt that all of the work is automated and with modern tools, was done so rapidly.
Practitioners are watched and allowed to do their deed in order to provide evidence, and then they are caught.
In my own professional experience, I often do have a “hunch” and while I do spend time listening to a doctor discuss his situation, often I feel that I can even “finish his sentences” for him.
This is only a short note as Father’s Day weekend is here and I rather be at the pool with the little ones than typing away!!!
To all of the guys out there, Happy Father’s Day !!!
Richard B Willner
The Center for Peer Review Justice.