Two doctors are under
investigation over possible billing irregularities and unneeded procedures.
By Don Lee and Ronald D. White Times
Staff Writers, Times Staff Writers
Federal authorities are investigating
whether two doctors at a Tenet Healthcare Corp. hospital in
In an affidavit made public Thursday, FBI Agent Michael Skeen said the two
doctors, who practice at Redding Medical Center, performed an unusually heavy
volume of heart catheterizations and other coronary procedures, of which as
many as half -- based on the opinions of other doctors -- may have been
unnecessary.
.
The affidavit said 167 of the patients later died, but did not attribute their
deaths to the two doctors
.
The 57-page document stated that Dr. Chae Hyun Moon
and Dr. Fidel Realyvasquez Jr. billed Medicare for
millions of dollars. Authorities said the investigation involves possible health-care
fraud and making false billings. No charges have been filed against either man.
Neither doctor could be reached for comment, but Realyvasquez's
attorney said the case is simply a disagreement between doctors and insurers
over what constitutes proper medical care.
News of the investigation, which included a Wednesday raid at the 238-bed
hospital, was another setback for Tenet, the nation's second-largest hospital
company.
Tenet had been a star on Wall Street since early 2000, but since Monday, when an
analyst questioned the hospital chain's Medicare reimbursements, its stock has
been under severe duress. Thursday's disclosure of the raid and investigation
created a full-blown crisis of confidence with investors.
After falling about 20% in the prior three days, Tenet shares lost an
additional 26% on Thursday, down $10.22 to $28.75, and it triggered a broader
sell-off on Wall Street.
Before the afternoon ended, trading in Tenet was halted momentarily and the
company, at the behest of New York Stock Exchange officials, issued a second
news release, which denied rumors spreading on the trading floor that federal
agents had raided Tenet's corporate headquarters in
"This is the last thing the company needed," said Sheryl Skolnick, a
managing director at Fulcrum Global Partners in
Tenet executives, saying they learned Thursday of the
"This is an investigation of doctors, not the hospital or Tenet,"
said Harry Anderson, a Tenet spokesman. He said the company had no prior
indication that there was anything out of the ordinary occurring at
In the FBI affidavit, another cardiologist at the hospital that he took his
suspicions about the two doctors to the hospital's chief executive and chief
financial officer last spring.
The affidavit said the cardiologist believed that both hospital administrators
were aware of what was going on and looked the other way "because Moon and
Realyvasquez produce tremendous revenue for the
hospital."
The FBI affidavit stated that the two doctors derived enormous income compared
with other physicians, noting that Realyvasquez
ranked as the top Medicare biller in a list of 50
physicians of a similar specialty in the
.
Moon was ranked No. 2 among doctors of a similar specialty.
Realyvasquez is alleged to have billed Medicare Part
B nearly $3.6 million, for which he was paid $767,600, between
In one instance cited in the affidavit, a woman evaluated by a cardiologist in
August was found to be in "relatively good health and not suffering from
any coronary artery disease."
She went to Moon for a second opinion, and she received a heart catheterization
that same day, according to the affidavit. Moon further told the mother that
she needed immediate bypass surgery, which she subsequently received at
Realyvasquez's attorney, Malcolm Segal, said his
client has done nothing illegal or wrong. He said it wasn't unusual that some
doctors may find problems in patients that other doctors don't, depending on
what tests were performed.
"Our view of the circumstances is that the doctor has long taken the
position that his patients are entitled to the best diagnostic tools available
in order to obtain a favorable outcome," Segal said. "He has enormous
respect in the medical community, and while insurance carriers may want to take
the position that the tests could be performed less expensively, the doctor
wants to make sure that his patients obtain the best result."
Anderson, the Tenet spokesman, said "more and more doctors are being
aggressive about treating the beginnings of heart problems," in large part
because of new technologies.
He said Tenet would hire outside cardiologists to examine records of procedures
performed by the two doctors to decide whether they were medically unjustified.
Tenet, which operates 113 acute-care hospitals nationwide, including 40 in
The company has said that has been a big reason for its strong earnings growth;
Tenet's earnings have surged more than 25% in each of the last eight quarters.