Doctoring the Bills?

FBI investigates possible Medicare fraud in county health-care system

A federal grand jury is investigating possible billing fraud at Maricopa Medical Center, the county hospital.

It's unclear how much money may be involved, but a former resident physician and a doctor with MedPro, a private contractor that provides patient care for the hospital, say they have been cooperating with federal investigators in an inquiry that began last summer.

Dr. Magda Cynkutis-Simon, a former resident at MMC, has been questioned by the Federal Bureau of Investigation and her records were subpoenaed, her husband, Robert Simon, says. She is currently suing the county for wrongful termination based on allegations of sexual discrimination ("Distaff Is Restless," October 23, 1997).

The inquiry seems to be focused on billings for procedures done by residents but billed by other doctors, Simon says.

Simon says the FBI agents asked if the attending physicians, who work for MedPro, were billing Medicare for work actually done by the residents. It's illegal under federal law to bill Medicare for work done solely by residents. Medicare does pay for care given by residents working alongside attending physicians.

The grand jury subpoena demands all records regarding surgeries performed by Cynkutis-Simon at MMC and "billing at Maricopa County Medical Center . . . [and] hospital requirements related to the attending physicians' presence in the operating room and related to the attending physicians' supervision of residents."

On the advice of her attorney, Kraig Marton, Cynkutis-Simon declined to talk about the ongoing federal investigation since she may be called as a witness.

Simon says his wife has seen doctors sign off on procedures they weren't involved in.

"I don't know if she will be called," her husband says. "But if she were asked to testify, she would be an excellent witness to Medicare fraud as I understand the term to mean."

Dr. Peter Kelly, the compliance officer for MedPro, says federal agents have told MedPro the company is not a target of the federal investigation.

"We voluntarily went to the investigators and told them we would voluntarily cooperate," Kelly says. He says the FBI was concerned about a small number of cases, and "we were able to answer their concerns."

Kelly says no MedPro physicians have billed Medicare for services performed solely by residents.

"I am aware that there may be such allegations," he says. "In the course of doing our compliance work, we have not encountered any such instances."

However, Kelly says the company has billed Medicare for procedures done by residents working with MedPro physicians.

Kelly also says MedPro sometimes submitted billings that were inaccurate, but has corrected them. He estimates the errors amount to less than 1 percent of MedPro's total charges.

He won't say how much money MedPro receives from Medicare or how often its physicians bill for work they do with residents. "I don't think that's any of your concern," he says.

MMC, the largest teaching hospital in the nation, depends heavily on residents to do the majority of patient care. The doctors-in-training are supposed to be supervised by MedPro's attending physicians. The county gets federal funds for the training.

Simon says he believes the inquiry came in part because his wife filed suit against the county after she and three other female residents left the program. Cynkutis-Simon's deposition in the lawsuit was taken last week. Maricopa County continues to pay for outside counsel to defend itself and MedPro in that action.

Dealing with the investigation is the latest headache for MedPro, which has a $31 million contract to care for patients at the taxpayer-funded hospital. Residents' grades have fallen, and the staff has suffered high turnover. Almost two dozen doctors have left MedPro in the last year, including some of its top executives.

Dr. James Malone, the former CEO, resigned last July, and several attending physicians, including the heads of the orthopedic and burn units, were laid off in September.

MMC has been a constant source of trouble for the county as well. There have been unsuccessful attempts to sell and privatize the hospital, lawsuits, layoffs and millions of dollars in losses over the past several years.

Dr. Mary Rimsza, a prominent local pediatrician who succeeded Malone as CEO, did not return calls for this article.

County spokesman Al Bravo declined to comment, except to say the county is looking into the allegations.

The FBI, following standard procedure, refused to confirm or deny any inquiry.

If convicted on a fraud charge, the hospital could lose its Medicare eligibility and millions of dollars in federal funds.

Even without a conviction, a fraud charge could cost the public millions. The University of Pennsylvania paid the government $30 million in 1995 to settle charges of overbilling. Teaching hospitals at the University of Chicago, the University of Virginia, the University of Pittsburgh and the University of Texas-San Antonio have also been charged with overbilling by millions of dollars.

Contact Chris Farnsworth at 602-229-8430 or online at cfarnsworth@newtimes.com

 
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