Tenet Physicians Settle Case Over Unnecessary Heart Procedures at Redding Medical Center, USA

Main Category: Cardiovascular / Cardiology
Article Date: 17 Nov 2005 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

Federal prosecutors on Tuesday said they have settled civil claims against physicians at Redding Medical Center -- formerly owned by Dallas-based Tenet Healthcare -- accused of performing unnecessary heart surgeries, the Los Angeles Times reports (Girion, Los Angeles Times, 11/16). In October 2002, federal officials launched an investigation into Drs. Chae Hyun Moon and Fidel Realyvasquez, two physicians at Redding Medical Center who allegedly performed unnecessary surgeries and defrauded Medicare. Federal officials alleged that the physicians participated in a "scheme to cause patients to undergo unnecessary invasive coronary procedures," such as artery bypass and heart valve replacement surgeries. In August 2003, Tenet agreed to pay $54 million to settle the federal case (Kaiser Daily Health Policy Report, 8/7/03). In addition, the company in December 2004 announced plans to establish a $395 million fund for more than 769 cardiac patients and their families to settle a civil lawsuit filed over the allegations (Kaiser Daily Health Policy Report, 12/22/04). The latest settlement pertains to Realyvasquez, Moon and two other doctors accused of performing the unnecessary heart procedures. According to the Sacramento Bee, FBI officials had sought to bring criminal charges against the doctors, but federal prosecutors "conceded [on Tuesday] they could not prove a criminal case and settled the matter with a series of civil fines."

Settlement Terms
Under the terms of the settlement, Moon and Realyvasquez each agreed to pay $1.4 million in fines. Kent Brusett, another surgeon in Realyvasquez's group, agreed to pay $250,000 over 10 years. Moon and Realyvasquez also agreed not to perform any procedures or surgeries on patients covered by Medicare, TRICARE or Medi-Cal, California's Medicaid program (Walsh/Stanton, Sacramento Bee, 11/15). In addition, Realyvasquez, Brusett and Ricardo Javier Moreno-Cabral agreed to ask their insurer to pay out $24 million to victims in the case, who have brought a civil lawsuit against the doctors in Shasta County Superior Court. The insurer will decide whether to pay the $24 million or contest the litigation, the San Francisco Chronicle reports (Lucas, San Francisco Chronicle, 11/16). Tenet also agreed to pay an additional $5.5 million to settle claims against the company, U.S. Attorney McGregor Scott said (Bloomberg/Philadelphia Inquirer, 11/16). Tenet also will pay $1 million to California to settle a related state case filed by two of the whistleblowers in the federal investigation (San Francisco Chronicle, 11/16). Scott valued the overall settlement at $32.5 million (Rundle, Wall Street Journal, 11/16). Tenet has admitted no wrongdoing in the case (Los Angeles Times, 11/16). The settlement does not resolve a civil lawsuit brought by 647 plaintiffs saying they underwent unnecessary heart surgeries. The first trial in the lawsuit is scheduled to begin on Tuesday (San Francisco Chronicle, 11/16).

Reaction
Assistant U.S. Attorney Michael Hirst said, "The evidence shows these doctors ran a high turnover, high volume surgery mill. While the evidence did not establish beyond a reasonable doubt that the doctors intended to perform unnecessary heart surgeries, the evidence was convincing that the doctors showed a reckless disregard for whether those surgeries were necessary or in their patients' best interests" (San Francisco Chronicle, 11/16). Scott said, "The question at the end of the day becomes, 'Can you convict?' We came to the conclusion that we could not in good conscience go forward" (Sacramento Bee, 11/15). Tenet said in a statement, "Tenet and its subsidiaries have expressly denied that Redding Medical Center submitted false claims to government health care programs for cardiac procedures at Redding" (Bloomberg/Philadelphia Inquirer, 11/16). "This settles all significant litigation and investigations having to do with Redding," Tenet spokesperson Harry Anderson, said (Los Angeles Times, 11/16). Malcolm Segal, Realyvasquez's lawyer, said, "Today's outcome reflects what we have said all along and what renowned heart specialists across the country have testified to under oath -- Dr. Realyvasquez provided only necessary surgical care to save and prolong the lives of his patients" (San Francisco Chronicle, 11/16). Moon's attorneys issued a statement saying, "[W]e appreciate the objectivity of the U.S. attorney for coming to the conclusion that Dr. Moon has no criminal liability" (Wall Street Journal, 11/16).

"Reprinted with permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.