Federal investigation into spinal surgery uses Mob laws to target health care fraud

A Texas-based consulting firm that runs surgery and other medical care for people injured in car accidents has come under scrutiny in an extensive federal bribery investigation.

Meg Health Care, run by Dallas personal injury lawyer Manuel Green and his wife, Melissa Green, is the focus of a recent lawsuit filed by a federal court in Massachusetts in an alleged prosecution of health care fraud there. The probe is unusual because it uses a little-known law that is intended to combat organized crime racketeering across state lines.

Researchers claimed in the 2019 oath that the Texas company accepted thousands of dollars in sales of SpineFrontier, a company for medical devices in Massachusetts. SpineFrontier; its CEO, Dr. Kingsley Chin; and its chief financial officer, Aditya Humad, were charged in September with charges of paying kickbacks to surgeons. All have pleaded not guilty.

No charges have been filed against the Greens or their company, and federal officials declined to discuss the investigation, which is detailed in the 2019 sealed search.

The Greens were unreachable for comment.

Meg Health Care sets up spinal surgery and other medical treatment through “protection letters,” or LOPs, legal contracts in which patients agree to pay medical bills with proceeds from a lawsuit or other claims against the party responsible for their injuries. These contracts are common in cases of personal injury if people do not miss health insurance or choose not to use it to pay for medical treatments after an accident. The disadvantage is that patients can be left to pay the bills if their cases settle for less than they owe.

On its website, Meg Health Care states that it “represents a group of doctors and hospitals who were tired of seeing injured people without access to medical care they needed after an accident. We hold on to the belief that under the law, and as a matter of basic decency, the person or company that caused the injury should be held liable.

According to researchers, Manuel Green sent injured patients with LOPs to a local neurosurgeon who used SpineFrontier implants in surgery at two hospitals in the Dallas area.

“In exchange for Attorney Green’s referral, SpineFrontier agreed to pay Attorney Green forty percent (40%) of the revenue that SpineFrontier received in connection with those surgical procedures such as bribery,” according to the affidavit .

Kin and SpineFrontier were the subjects of a KHN study published in June that found that manufacturers of hardware for spinal implants, artificial knees, and hip joints paid more than $ 3.1 billion to orthopedic and neurological surgeons from August 2013 to 2019.

Government officials have argued for years that payments from device makers to surgeons and other medical providers could corrupt medical decisions, endanger patients and inflate health care costs. The SpineFrontier lawsuit alleges that the company paid millions of dollars in false consulting fees to spinal surgeons in exchange for using their products, often in surgery paid for by Medicare or other government-funded health insurance plans.

The Texas investigation adds a new dimension to the case by focusing on privately paid medical care that is not treated under federal anti-kickback statutes. Instead, the search warrant alleges violations of a law called the Travel Act. Introduced by Congress in the early 1960s to combat the crowd, the Travel Act makes it a federal crime to commit crimes such as bribery, prostitution, and extortion across state lines, including by mail or by telephone or e-mail. Convictions can carry up to five years in prison, more so in the case of violence.

Jonathan Halpern, a New York criminal defense attorney, said such use of the Travel Act “reflects an aggressive expansion” of the U.S. government’s power to prosecute health care fraud.

One of the first prosecutions for health care fraud under the Travel Act took place in Texas and led to convictions for bribery and prosecution of 14 people, including six doctors, affiliated with Forest Park Medical Center in Dallas. They filed a combined sentence of 74 years and were sentenced to pay $ 82.9 million in restitution.

Chris Davis, a Dallas attorney who specializes in government investigations, said the Travel Act gives federal prosecutors jurisdiction in cases “where you have not involved state or federal money.”

Meg Health Care’s search lists payments of more than $ 93,000 in 10 checks that were allegedly sent by SpineFrontier to the Texas company between April 2017 and October 2018. Investigators claim the money was paid as bribes for referral of patients for surgery with SpineFrontier products.

Investigators also quoted a February 2016 email in which Melissa Green told the device company that a patient’s legal case had been settled and asked, “Please let me know when MEG can expect to receive payment under our agreement. Thank you!”

About two months later, the device maker cut the company a check for $ 3,953.60, according to the search.

Nine of the 10 checks were signed either by Chin, a Fort Lauderdale spine surgeon and the founder of SpineFrontier, as Humad, according to the search warrant. Chin and Humad are the two drivers charged in September. Her lawyers had no comment.

Federal investigators searched the search for Melissa Green’s email account at Meg Health Care in August 2019, arguing they had “probable cause” to investigate the company for violations of the Travel Act, court records show. A federal judge in Massachusetts dismissed the warrant and related documents late last year.

Meg Health Care invites attorneys whose clients have a “significant medical need” to apply to the company, according to its website. If approved, Meg Health Care will schedule an appointment with one of their doctors. “From there, our doctors will treat every aspect of the treatment sought, including surgery (if necessary),” the website says.

In a 2019 court in Dallas County, unrelated to the search warrant issued in the Massachusetts case, Manuel Green said he was the “founder and owner” of the company. He said it “helps doctors and medical facilities reduce their exposure to risk while providing treatments to patients under [a] letter of protection. “

He went on to say that the business model and consulting services it provides are unique within the health care sector in the state of Texas. The company’s website lists medical providers in 11 cities in Texas.

According to investigators in the Massachusetts case, Green referred patients with LOPs to Drs. Jacob Rosenstein, a neurosurgeon in Arlington, Texas, who used implants that sold SpineFrontier to two hospitals, Pine Creek Medical Center in Dallas and Saint Camillus Medical Center in Hurst, Texas. Pine Creek has since filed for bankruptcy.

Neither Rosenstein nor representatives of the hospitals could be reached for comment.

Although proponents say LOPs may be the only option for uninsured or underinsured crash victims to seek medical care, a recent KHN study found that doctors and hospitals they accept often charge much higher rates than Medicare or private insurance would pay for similar care and that the process could saddle patients with medical debt or expose them to safety risks.

Disputes over the size of medical bills and even whether care was needed are common in personal injury lawsuits in Texas. In one 2016 Dallas County case, for example, a spin surgeon charged more than $ 100,000 for his services, while the hospital charged more than $ 435,000. In contrast, an expert hired by the defense set a reasonable fee of less than $ 4,000 for the surgeon and about $ 25,000 for the hospital, court records show. The case has since been settled.

Christine Dickison, a Texas nursing and medical coding consultant, said she regularly sees “enormously inflated” bills in auto-crash lawsuits – and in some cases doubts whether the care was necessary.

“I see people undergoing surgery when there are literally no objective findings that support it,” Dickison said. “That is very disturbing to me.”

Related Topics

Contact us at Submit a story tip

Federal investigation into spinal surgery uses Mob laws to target health care fraud

Source link Federal investigation into spinal surgery uses Mob laws to target health care fraud

Back to top button