In 2014, an internist pled guilty to violating anti-kickback laws for illegal referrals. She accepted monthly cash payments of $5,000 to refer patients to a New Jersey lab, Biodiagnostic Laboratory Services. Apparently a total of 30 doctors have been snagged in the roundup. Biodiagnostic Laboratory Services is now out of business.
Dr. Martinho accepted a total of $155,000 in payments.
She took an ethics training course and thought she should speak to medical students about lessons learned. She emailed 350 medical schools, health groups, and other institutions. She’s given 25 lectures.
Dr. Martinho is a single mother with two small children. She is scheduled to be sentenced shortly. She is facing a five year prison term and $250,000 fine. Future employment prospects as a physician are not rosy.
An article detailing her odyssey can be found at the Washington Post.
What puzzles me is the following quote from the article:
She blames only herself for her situation, acknowledging that she knew when she started taking the cash in 2010 that she was evading tax laws. But she said she didn’t understand that the referral itself was considered a kickback. The idea had been suggested by a friend who helped set up her office and subsequently a rep from the laboratory itself.
I understand the impulse to educate others about what not to do. And I am sympathetic to a single mother with two young children at risk of going to prison. I cannot understand how accepting unreported envelopes of cash to the tune of six figures did not trigger a red flag to this physician. While many nuances of Stark and Anti-kickback can be difficult to understand, this is not the story of a doctor allowing a pharmaceutical rep to bring in lunch to feed staff while going over the risks of a new drug.
What’s irritating about her dilemma is that most doctors will correctly say their advice cannot be bought for the price of a donut or a pen. But, Dr. Martinho is arguing the donut and pen create a slippery slope which leads to $155,000 in unreported cash payments. Call me old fashioned. I still do not believe that doctors can be bought for a pen or donut. But, Dr. Martinho’s rehabilitation tour makes her Exhibit A in the argument against.
What do you think?
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I think that most physicians don’t think that they can be bought for a pen or a doughnut. but, there has to be someone who is vulnerable or else why would the pharmaceutical company do it?
And certainly as a resident, I remember grabbing a pen or a pad with a logo and writing for it because it was easy and within reach.
If you don’t have strong feelings about a particular medication, you may write for the one that gave you some kind of trinket with their name on it…
The practice of bringing a lunch to make it easier for the busy physician to sit and eat some pizza while discussing a medication is most reasonable and practical, in my opinion. To suggest that this practice is going to be the “silent killer,” leading one to take envelopes of cash is ridiculous, to be blunt. Personally, I pick up the check at alternating lunches with my sales reps. It isn’t that I’m so desperate for a free meal as much as the efficiency of the process is favorable to me.
If we could only shed some “Sunshine” on what lobbyists do for our elected officials in DC, this would add some needed perspective to the topic.
I agree that a pen or doughnut is not a slippery slope except perhaps towards inkstains and obesity. But it doesn’t hurt for her to help educate students that there are a bunch of real slopes out there, down one of which she fell.
Whether or not this bit of restorative justice will help rehabilitate her in the judge’s eyes remains to be seen, but the story suggests she was just setting up her practice when this “opportunity” presented itself, recommended by a consultant friend and abetted by the now defunct lab. Considering the dearth of training medical students get in such mundane and practical things as how to procure lab services for patients, it cannot but help the system for something to be taught them by someone outside of the ivory tower.
Incidentally, everyone should look themselves up on “Dollars for Docs”, a site that purports to accurately list all gifts to docs from industry as recorded in a federal database. You never get notified if/when you are listed, and yet the onus is on you to entreat the industry to remove your name if they have put it there, even years afterwards. I had one purported (de minimis) payment when I was on vacation on a ship in the far east, and another at a date while attending a conference. As far as I can tell the first was just hooey. The second might have been for a flu shot that I thought was provided by the conference. Hardly worth the effort of fighting.
But can you see a federal database of gifts to politicians that must be prominently advertised during elections? How about emoluments of office?
I am an older physician who goes back to the days Eli Lilly gave each medical student a consultation bag with our names on it upon graduation. I recall “Detail Men” passing out pens, reprints of articles, and offers of paid trips to medical meetings. However I never accepted any paid trips “back in the old days” because I realized it was unethical. Today it is getting harder to make ends meet and while not condoning unethical behavior I can understand the temptation. Ethics for physicians is equally important as biochemistry or physiology.
We learned eleven months ago, that the decision making on whether or not someone would be referred to the JD for prosecution rests on the premise of intent to subvert the law. The explanation given was that this conclusion was regardless of whether or not the statute calls for intent to be proven. So, if we take this logic to its next level, did the lab entrap the doctor into signing on with payment? And, did the good doctor realize she was doing something illegal?
I concur with my colleagues that virtually all physicians cannot be “bought” by a breakfast, lunch or even a presentation by a paid “expert” promoting a product. Yet, we are assumed to be unethical, so the Congress and in some states, like mine, have passed arcane overreaching statutes that require specialized legal services to interpret much of what we do. I hope this case is judged fairly.
The government in it’s infinite wisdom has fixed a problem by over-reaching. The all or nothing approach (cutting the head off the snake by chopping off the tail) is typical. I fail to see a drug rep showing up with lunch to educate a physician and it’s staff on a new drug as unethical. I DO see where paying for a cruise to listen to a 1 hour pitch as unethical, but the government can’t or won’t distinguish between kick-backs and education. It’s ok for a SNF representative to bring lunch to the doctor’s office as a “thank you” for sending patients to their facility (and to entice the doctor to send more….), but not ok for a drug rep to bring lunch for education of a new product.
One major problem in this is the fact that the physician advocate organizations (AMA etc) won’t fight for the group they pretend to represent. The doctors really don’t have a collective voice.
We saw the same thing in the same state when a doc was accepting cash envelopes for referral to a certain imaging center. As the Fed agent handed the doc the envelope, the response was – “I pledge allegiance to the Imaging Center of Stupidville”. Doc went to jail for two years in exchange for keeping his license, and he/she’s now practicing with a new first name. I have to agree that accepting envelopes of cashish in exchange for MRI referrals is unethical and bad judgement. This doc has a family and kids too. Moral? Don’t become a doctor for “the money”, but do it for the patients. Thank you.
It may seem obvious to “seasoned” doctors that certain agreements for cash or recompense “push” the limits of integrity or even honesty. Yet, the legal profession itself is replete with various business agreements that strain the realms of reason, in terms of fee splitting and paid for referrals. Yet they are done every day without any Government interference or oversight by the Bar Association.
Yet those same business agreements have been “felonized” by Congress and Pete Stark against doctors. It may be true that it is not proper for doctors to receive certain kinds of gifts and payments for various non-professional favors.
But there is a big difference between that and making them a felony. The Medical profession openly allowed Pete Stark to put legal handcuffs on it in such a way that is unknown to other professions. It’s as though doctors were ashamed of getting paid. Stark made himself an “expert” on attacking the medical profession.
But there have been no such constraints on the cost of medical education and the fact that most doctors have to pay for this themselves. What I am saying here is that doctors permitted themselves to not just be stepped- on but overcome with trampling by Congress.
I don’t know what you are paying your leaders for, but you didn’t get your moneys worth then or now. They literally stepped aside and let Government do whatever it wanted.
Michael M. Rosenblatt, DPM
Not sure I completely understand the gist of this article. Is the accused physician going around saying that ‘if you accept food from a pharmaceutical representative you are on the proverbial slippery slope towards accepting envelopes of cash in return for referrals?’.
Thats is plainly absurd.
On the other hand, thanks to the Stark laws, primary care physicians can no longer maintain a sustainable income and have all been forced to sell their practices to hospitals, and thus we see the rise of corporatized medicine.
Which world is (was) better?
Hmmmmm……
When we fail to hold ourselves to ethical standards, it is nobody’s fault but our own. I normally do not eat those lunches or dinners but from time to time I take a bite just to prove to myself and to the pigs that running our American Health Farm that for good physicians, there is no money that can buy some of us.
How does one go about correcting erroneous entries on the “Dollars for Docs” site? I found the entries for me completely erroneous. The listings are for meds in completely different specialties.