When fraud and patient safety intersect, greed is the common denominator

In August 2008, I began my first job covering healthcare. I wrote about safety and infection control. Perhaps the biggest story at that time was the hepatitis C outbreak linked to two Las Vegas endoscopy clinics.

That year, after identifying a cluster of patients had developed hepatitis C, the Southern Nevada Health District began an investigation that would identify more than 63,000 people who were at risk for infection. The health authority ultimately identified 105 cases of hepatitis C possibly linked to The Endoscopy Center of Southern Nevada and Desert Shadow Endoscopy. It definitively traced nine cases back to the two clinics owned and operated by Dipak Desai, M.D., a prominent physician in the community. It would become the largest hepatitis C outbreak in the country.

Even as a newbie to the world of infection control and patient safety, the investigation revealed appalling details. The infections themselves were caused by a grotesque method of "double-dipping." In an effort to save money, Desai ordered nurses to use the same syringe to dip back into a single-use vial of anesthetic. It was a crystal clear violation of best-practices, and a shortcut that saved just $5 to $10 per procedure, according to experts.

But the investigation and subsequent trial revealed that this was just one aspect of Desai's practice that valued speed and profitability over patient safety. A 2008 Las Vegas Sun article described the "assembly line" approach to endoscopy procedures. One nurse said that Desai often performed 60 procedures a day in two different rooms.

"The faster we would go, the happier he was," the nurse told the Sun.

In 2013, Desai was convicted of 27 criminal counts related to the outbreak, including second-degree murder tied to the death of one 77-year-old patient. He is currently serving a life sentence.

I rehash this eight-year-old case only because Desai was back in the courtroom last week, pleading guilty to conspiracy and healthcare fraud. Churning through patients as if they were Ford Fusions was not profitable enough, it seems. Desai and his clinic manager, Tonya Rushing, also fraudulently billed private insurance agencies and the government approximately $2.2 million, according to the FBI.

The fraud charges had less to do with vials and focused more on Desai's unique money-making approach: Using certified nurse anesthetists (CNA) instead of anesthesiologists. This allowed Desai to bill payers for anesthesiology services himself--and he did so liberally, by exaggerating the amount of time CNAs spent with patients. Desai and Rushing set up a separate business, Healthcare Business Solutions, which was used to bill for these services. CNAs were instructed to overstate the amount of time they spent with a patient in their documentation. 

The fraud charges pale in comparison to the 114 lives irrevocably altered by Desai's actions, but it also fills in another piece of the puzzle, revealing a physician driven by greed and wealth and more than willing to leave a path of destruction in his wake--the means to a profitable end. 

Desai's business model was simple: Make money at any cost. No, fraudulent billing didn't lead to the largest hepatitis C outbreak in the country, but it certainly contributed to the driving force behind his approach. This was a physician willing to go to any length to achieve maximum profit margins, whether by falsifying documentation or blatantly ignoring basic infection control best practices.

During closing arguments in 2013, Desai's defense attorney argued that he may be a cheapskate, but he did not deliberately infect patients.

The jury didn't buy it. He may not have set out to injure patients but, in an effort to maximize profitability, he was more than willing to turn a blind eye to patient care. In this case, pure, unadulterated negligence is no better than intent.

Rarely is the impact of healthcare fraud so stark. More often, fraud is viewed a paper crime, operated through altered documentation, upcoding, or falsified patients care in which the majority of injuries are financial. I'm all for protecting taxpayer dollars from fraudulent payments, but a strict case of overbilling doesn't typically leave 114 people infected with a life-altering illness.

Cases like this offer a new level of impropriety, reminding us that the barrier between fraud and patient care is not as sturdy as we might like to think. The common denominator is greed. That can be a dangerously overpowering motivator, and in some cases, life-threatening. - Evan (@HealthPayer)

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