Awareness of Pain Mismanagement Spreading

Medicare Set-Aside Blog on August 2, 2012
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The Maryland State Board of Physicians held a Case Resolution Conference yesterday to determine whether there are grounds for action against Maryland Orthopedics physicians: Dr. Raymond Drapkin, Dr. Mark Cohen, Dr. Kevin McGovern, Dr. William Launder, and Dr. Michael Franchetti, for multiple violations under the Maryland Medical Practice Act, including gross overutilization of pain management techniques solely for their own profit.

Maryland Orthopedics commonly treats workers’ compensation patients. A complaint was filed by a Maryland insurance company on August 27, 2007 alleging questionable billing practices with respect to workers’ compensation patients. The insurance company provided evidence of multiple IMEs where the IME provider questioned the treatment and billing practices of the above named physicians. The complaint alleged that these doctors were “billing patients for treatment that was: not (a) clinically indicated; (b) appropriately performed; (c) adequately documented; and/or (d) likely performed.”

The pain management techniques in question included sciatic nerve blocks (SNB) and trigger point injections (TPI), as well as the prescribing and dispensing of multiple narcotics and controlled dangerous substances. An example of the overutilization of treatment is clear with respect to the practice’s use of TPIs. The standard practice guidelines by the ASIPP recommend a maximum of six injections with at least a two month interval between injections to assess the effectiveness of the procedure. Multiple patients received well over six injections and some received injections once a month for an entire year. One patient, over the course of 13 years, received 140 nerve blocks and 142 prescriptions of Percocet. Another was estimated to have received over 160 injections since her injury in 1983. Yet another received 60 injections and 90 controlled dangerous prescriptions over the course of four years.

As part of the Board’s investigation, the matter was referred for a practice review of the treatment in question. Peer reviewers found that these physicians failed to meet appropriate standards of care, failed to keep adequate medical records and grossly over utilized healthcare services. Reviewers also relayed their suspicions that many of the procedures may not have been performed, but billed for nonetheless.

If grounds for action are found, possible sanctions could include revocation or suspension of their licenses, reprimand, probation and/or possible monetary penalties. Due to the gross nature of the abuse, we suspect the physicians will be sanctioned. Should a resolution not be forthcoming from the conference, hearings for each physician are set for the end of 2012, beginning of 2013.

Note, this issue would not have come to light without the diligence of insurance adjusters who identified the gross misuse of healthcare. The patients who were receiving these treatments and excess narcotics prescriptions would likely have had no idea what procedures they were receiving and what was being billed. Even if these patients did recognize that certain procedures were billed but never performed, they would not likely report their physician to the authorities.

Doctors are given huge latitude by state workers’ compensation commissions and by CMS, often to the detriment of the people they serve. The majority of physicians adhere to their oaths to provide patients with the best care possible and would be appalled at the care that was provided by this practice. Nevertheless, as in any human endeavor, there are always a few rotten apples. Kudos to the company that filed this complaint and hopefully saved not only money but also the health of those mistreated.

Below are copies of the hearing notices.

Dr. Raymond Drapkin
Dr. Mark Cohen
Dr. Kevin McGovern
Dr. William Launder
Dr. Michael Franchetti

P.S. Interestingly enough, previous sanctions by the Board of Physical Therapy Examiners which resulted from fraudulent billing practices and inadequate documentation did not seem to deter Maryland Orthopedics from continuing this practice.