“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…
Let’s start at the end – there is no “happy ending” here – at least not for the conspirators. The surgeon, Dr. David Morrow, lost his license. He is serving a 20-year prison sentence. His wife Linda will likely spend at least a decade behind bars. Both are in their early 70s. Their golden years are turning orange.
The practice misrepresented medically unnecessary procedures as medically necessary and fraudulently billed federal and private insurers for millions. They did this several years before fleeing to Israel to avoid jail time.
As you may have already guessed: Authorities found them. But there are lessons to be learned beyond the obvious. Let’s meet our “protagonists.”
Linda Morrow is the former executive director of The Morrow Institute, a cosmetic surgery center in Coachella Valley, California. Dr. David Morrow worked at the practice as a cosmetic surgeon. Linda Morrow pleaded guilty to a health care fraud conspiracy in which she billed insurance companies between $25 million and $65 million for cosmetic procedures.
The practice filed most of the fraudulent claims between 2007 and 2011. Judge Josephine Staton found the scheme’s losses exceeded $44 million.
The practice targeted public employees with robust insurance coverage. Court documents cite an assistant principal who received lap band surgery (which could very well be “medically necessary” and covered) and a school counselor who received a nose job and a breast augmentation.
The couple bundled procedures together to further entice potential patients – if a patient signed on for a breast augmentation, for example, she could get some Botox at a discounted rate.
This made for a lucrative business model in the short term – and intensified the penalties when the authorities finally apprehended the Morrows since almost every elective (and otherwise not covered) procedure was miscoded as medically necessary.
But the patients played a role in the scam as well – wittingly or otherwise. The Morrow Institute required patients to sign “testimonial letters” or public endorsements, most of which contained false statements relating to the quality of care or the type of procedure performed.
The scheme depended on these false statements to work.
The practice mislabeled tummy tucks as hernia repair or abdominal reconstruction procedures. They equated elective cosmetic rhinoplasties to procedures intended to correct a deviated septum. (Yes, sometimes those two procedures are done in one sitting, cosmetic plus medical, to minimize the need for two anesthetic sessions. But one procedure should be billed to the patient; the other to insurance.) You think “Patient A” got a traditional breast augmentation? No, no, no, you’re mistaken – that procedure corrected a tubular deformity.
You get the picture.
The Morrows coaxed employees into signing false documents. The Morrows (or other employees) then heavily altered said documents to disguise the elective nature of the procedures. Some patients received cash incentives. The more layers of this scam you peel away, the worse it stinks – like an onion.
So, intentionally misrepresenting a procedure is fraud – 99.9% of doctors will never do this. But you can imagine a scenario where a doctor (or an employee or an electronic billing system) misrepresents a procedure or treatment in error. Doctors are not likely to suffer because of isolated mistakes, but routine errors like these create massive penalties when left unchecked. An auditor will look at such a practice and think, “These people are sloppy. What else is wrong?”
Most doctors do not want to give auditors additional reason to probe their practice’s inner workings.
Before this happens, audit yourself. Identifying errors in a vacuum gives you a chance to right the ship. And if you uncover coding deficiencies, create a record detailing your solution.
What do you think? Let us know in the comments below.
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…
Fabulous riches through medicine have been possible. Mostly they occur through academic and corporate medicine. Attempting to do them through private practice have always been fraught with legal entanglements. I recall as a teen many years ago in Detroit, (long before Stark regulations) a local physical medicine MD had an exceptionally profitable “mill” in his office practice. He took to going to a cash practice and “stored” money in his attic in paper boxes to avoid taxes. Some of his kids found out about his “storage” and started spreading it around. Not surprisingly, IRS authorities caught wind of it and invaded his attic, where true “discovery” occurred. It was all over the Detroit News. I don’t remember if he went to jail. Probably.
Government generally detests doctors, whom they regard as rogue actors who are making too much money as it is. Mostly, according to Democrats they are “difficult to control” and too amenable to logical thinking. In other words, they are a threat.
Enter Stark. Most people who read Medical Justice are aware of Stark. If you are not, you should become a Medical Justice member and start to learn immediately about various pitfalls of medicine and dentistry.
I wanted to write a brief note about RE investing here, as a balm against Government oversight of your medical practice. But it would commit the sin of making two points in a posting letter. So I will simply say that unlike Medicine, Government supervision of your RE investments are nil. It worked for me. It can work for you too; and I don’t have to look over my shoulder. The doctor and his wife in this article certainly would agree (now) with my recommendations. Too late for them. Not for you.
Michael M. Rosenblatt, DPM