Doctors lose licenses but stay employed
200 remain on Medicare rolls despite discipline
Doctors who land in hot water with state regulators have a helping hand when it comes to keeping their practices running:
The federal government.
At least 216 doctors remained on Medicare rolls in 2015 despite surrendering a license, having one revoked or being excluded from state-paid health care rolls in the previous five years, a
Milwaukee Journal Sentinel/ MedPage
Today investigation found. In all, these doctors were paid
$25.8 million by taxpayers in 2015 alone.
Among them:
Glen Marin, a family practice doctor from New York City.
According to New York Department of Health disciplinary records, Marin didn’t contest charges that he was sexually inappropriate with a female pa-
tient. In California, as a result, he surrendered his license in 2014 rather than go through a full disciplinary hearing.
He was allowed to keep practicing in New York but only if he had a chaperone present when he met with female patients.
Since 2007, Marin settled at least three separate malpractice cases, including one for failing to diagnose the cancer that eventually killed a patient.
Despite that, taxpayers helped foot the bill for him to practice medicine. In
2015, the year after he surrendered his California license, he was paid more than $280,000 through Medicare.
Other individual doctors who faced serious sanctions were paid as much as
$1.4 million that year.
Breakdowns in patient protections
The Journal Sentinel/ MedPage Today analysis focused on 2015 because that is the last year for which payment details from the annual $720 billion Medicare program are available.
To identify these cases, reporters from the Journal Sentinel and MedPage Today worked from a list compiled by MD, a Los Angeles-based company that collects information on doctors from state boards, courts and other sources. The news organizations focused on the most serious cases — those in which doctors were stripped of their ability to practice or barred from state-run health care payments — then compared those names with Medicare payment data.
On its website, the U.S. Centers for Medicare and Medicaid Services, which oversees the Medicare program for the elderly and Medicaid program for disabled and low-income residents, pledges to “put patients first.”
But the Journal Sentinel/ MedPage Today analysis found a repeated failure on the part of the federal government to connect the dots. Medicare is part of the U.S. Department of Health and Human Services — the same department that operates the National Practitioner Data Bank, which tracks discipline against doctors, including sanctions by state medical boards. Connection after connection was missed.
“That’s astonishing to me that HHS allows that to happen,” said Michael Carome, a physician with the watchdog group Public Citizen. “If someone has a pattern of such adverse actions, that ought to be a red flag.”
Attempts to reach Marin were unsuccessful. His profile on the New York Department of Health website shows that he is retired but retains hospital credentials. The website says prospective patients can “contact the doctor’s office to see if this doctor is taking new patients.”
The Department of Health and Human Services is required to drop doctors from payment rolls if they are convicted of several specific charges, such as abusing patients, defrauding the system or improperly prescribing controlled substances.
There are 16 categories of problems on which officials may act — including failing to meet basic standards of care or even having a medical license revoked. Though more than 1,500 doctors had li- censes suspended or revoked or were put on probation in 2015 by state medical boards, only 305 were prohibited from billing Medicare that year.
Todd Echols, an official in the HHS inspector general’s office who reviews such cases, said regulators can act only in cases in which a state takes disciplinary action.
“Clearly, there’s a lot more out there that we can do,” he said.
Echols said the pace of enforcement comes down to one thing: staffing.
The agency has more than two dozen staffers, including investigators, to cover the whole country. California, which alone has more than 150,000 physicians, is overseen by one investigator.
More protections in private sector
Private insurance companies spend money to make sure they don’t pay doctors more than needed or support bad medicine, said Leslie Paige, vice president for policy and communication for Citizens Against Government Waste, a non-profit watchdog group that lobbies for reduced government spending.
Medicare doles out far more money and doesn’t even use the data the department gathers on bad doctors, she said.
“They need to do a better job of tracking these people down and stopping them before they abscond with taxpayer dollars or hurt patients,” Paige said. “Seniors should not be sitting ducks for predators simply because they’re on Medicare.”
According to Echols of the inspector general’s office, workers managing Medicare payment rolls can be overwhelmed by a flood of information about shady health providers.
For decades, the process was driven through relationships with state medical boards. The boards kept an eye out for cases that fit the criteria for exclusion from the federal system, then passed them along.
Last year, the inspector general’s office started getting a data feed from the Federation of State Medical Boards. In the first year alone, the group sent more than 2,000 referrals — actions that might lead to a doctor being kicked off Medicare rolls — to investigate.
“We can’t get through 2,000,” Echols said. “There are some actions that we just don’t even have a chance to get to.”
This story was reported as a joint project of the Journal Sentinel and MedPage Today, which provides a clinical perspective for physicians on breaking medical news at medpagetoday.com.
“Seniors should not be sitting ducks for predators simply because they’re on Medicare.”
Leslie Paige Citizens Against Government Waste