Tue, 12 Aug 2003 19:00:00 | Shelley Wood
New York, NY - A New York Times front-page exposé examining the FBI's investigation of Redding Medical Center's cardiology program takes aim at the "twisted finances of American healthcare," which may have fostered the alleged fraud at Redding.1 Misgivings voiced by physicians at the hospital to administrators were repeatedly ignored, the article notes.
Redding has been in the news since October 2002, when the FBI raided the offices of Dr Chae Hyun Moon, chief cardiologist at Redding, and Dr Fidel Realyvasquez, the hospital's "top surgeon" and director of the California Heart Institute at Redding. The two doctors are being investigated for allegedly performing unnecessary invasive coronary procedures on patients, including heart catheterizations, angioplasty, and open-heart surgeries, as reported by heartwire.
The 4000-word story notes that hospital administrators fielding almost 10 years' worth of complaints and suspicions from Redding staff may have been reluctant to acknowledge potential wrongdoings by the two doctors at the center of the controversy. After all, these men were also bringing in the most money for the hospital, and administrators' salaries grew if Redding's profits exceeded the expectations of the hospital owner, Tenet Healthcare.
Times reporter Kurt Eichenwald writes that no charges have yet been laid against Moon and Realyvasquez. The criminal investigation is continuing, and the doctors have been suspended from their work at the institute.
Dr Patrick Campbell (Redding Medical Center) first voiced his concerns to the hospital's chief executive in 1993 and was told he should "mind his own business," Eichenwald writes. He has since filed a suit on behalf of the government under the federal whistle-blower statute.
Half a dozen other Redding physicians, including cardiologist Dr Roy Pick and oncologist Dr Thomas Drake, along with other hospital staff and patients, also expressed concerns to hospital administrators, who consistently downplayed the issue and never conducted the peer reviews of the cardiology program that many of the doctors requested. Even Dr Bruce Kittrick, an internist at Redding who "does not believe the allegations against Dr Moon," led a group of doctors, including Campbell, requesting an independent peer review of the cardiology program. The review never took place.
At least four successive chief executives at Redding were alerted to the potential problem at Redding and appeared to turn a blind eye.
In the meantime, Tenet has agreed to pay $54 million to the government"the largest [settlement] ever for accusations of billing federal health programs for unnecessary care." Tenet, while not admitting to any wrongdoings, has agreed to cooperate with the FBI investigation and to create strict monitoring and education processes at Redding. Tenet stock has plummeted to a share price of $14.58, from $52.50 in the fall of 2002, when FBI agents first raided the hospital.
Still, many people are at a loss to explain how it is that Tenet and hospital administrators were able to overlook the suspiciously high numbers of procedures and profits at the hospital and, apparently, push for more. A former administrator told the Times that by the winter of 1998, Redding was "beyond full" and had exceeded its pretax profit by almost 50%, yet Tenet was still demanding that the hospital "do better next year."
The pressure bolstered the hospital's dependence on Moon, who in the 2001-2002 fiscal year billed Medicare for $4 million and for 876 left heart catheterizations, four times the number performed by any other cardiologist in Northern California.
A Princeton University economist interviewed by the Times commented, "I sometimes just shake my head at the American system, where the financial intent is almost cleverly designed to create mischief. For administrators, it creates a conflict of interest when they're trying to deliver the numbers at the same time that doctors are saying the hospital is doing too much cardiac surgery."