InvestigateTV - Surgeries gone awry. Unnecessary procedures. Extra hardware implanted in patients’ bodies. Insurance companies and government insurance over-charged.
According to government research, doctors who own medical distributorships are more likely to operate. For example, the rate of spinal surgery, according toAccording to the Health and Human Services Office of Inspector General's data analysis in 2013, the rate of spinal surgery grew more rapidly in hospitals that utilized POD-supplied devices.The government has warned about the potential for issues with physician investments in medical companies.
When it comes to financial interests, proponents also say that many doctors are already paid based on the number of surgeries they do and that owning a piece of a distributorship they buy equipment from helps keep down costs for hospitals and clinics.Some doctors have made extra money by cutting out big device companies and acting as their own middleman to funnel devices into their own operating rooms.
“I’m supposed to have several surgeries over the last decade, and I’ll never get another surgery in my life again. I’d rather die than trust,” said Paul Shinn. “I can’t hold food down. I pretty much get sick and lay on the floor,” Shinn said. “You’re spinning, you’re lightheaded, you’re sick, you’re throwing up, but you have nothing to throw up.”
A surgeon removed this hardware from Paul Shinn’s back. He said some of the fusion material remains lodged in his back.Days after his initial surgery, he went back in for emergency surgery. Shinn said his main escape from pain is being creative. He paints and plays music and is a tattoo artistInvestigateTV identified Shinn as a patient of Dr. Aria Sabit, a surgeon who operated in California, through public court records and news articles.
Sabit performed the surgeries unusually fast, prosecutors said. And he performed a lot of them in his short time at his California post. In many of Sabit’s surgeries, he used hardware from a company called Apex. Sabit, it turned out, had financial interest in the company. A court complaint filed against Dr. Aria Sabit in California details some of the allegations about surgical procedures. A federal court complaint against a medical device company details a list of payments made from the company to Sabit. The complaint alleges prior to his financial involvement, he did not use that company's products; however, after his investment, he used those products in 90% of his surgeries.It was ultimately his billing of government insurance that landed Sabit in prison.
“When they put an implant in, the doctor makes extra money on every implant they put in, every screw, every piece of metal. Everything that goes into a patient is conceivably owned by the doctor, and so that doctor will make more money with more implants that they put in,” Lederhaus said. “In fact, a lot of the early PODs that got started were viewed as competitors of the big device companies,” said Charles Oppenheim, an attorney with expertise in the laws potentially at play in this area. “The big device companies were selling name brand products at high prices. And the physician-owned distributorships were purchasing and reselling as distributors, sort of generic, much lower cost products that were functionally equivalent.
HHS too looked at the device costs. In its research, it did not find a significant cost difference for the hospitals between POD and non-POD devices in any areas except spinal plates, where POD-provided parts averaged higher in the sample.also found in its sample that surgeries involving PODs devices used about two fewer devices per surgery than non-PODs-supplied surgeries.
“When it came down to it, it was about hardware. It was about physician-owned distributorships. It was about money, capital gains,” Reynolds said. “He took it upon his own accord to do more levels, three to four levels in total. So two extra levels without our consent,” Reynolds said. “In hindsight, with the amount of fraud and the amount of savage carnage that he inflicted on people, it seemed to be the … incentive was to get financial gains, I would say, personally.”
The Affordable Care Act created a disclosure program called Open Payments that was supposed to help patients understand the financial relationships between medical providers and drug and device companies.to file disclosures with the federal government when they pay for things like royalties or research — or when a doctor or their families own a stake in a medical company.
A 2016 report from the Senate Finance Committee Majority Staff highlighted a number of concerns it had with PODs. The excerpts shown specifically pertain to issues of transparency the committee staff brought up, including an apparent under-reporting of disclosure to the government and a lack of disclosure to hospitals and patients.HHS’ survey
“It’s kept a secret, and then even the doctors in the community don’t know. The hospital purchasing agent who purchases the implants doesn’t know. And so it’s such a secret that it becomes very difficult for anybody to be sure what they’re getting or whether it’s a reputable product. So who knows? Well, the doctor knows who puts it in,” Lederhaus said.
In 2020, one such neurosurgeon, Dr. William Choi of Colorado, settled a case in which he was accused of receiving illegal kickbacks through a distributorship he secretly owned and defrauding Medicare, Medicaid and TRICARE, the insurance for military members and veterans. “The hospital received money for it. And so did Dr. Choi. He’d received money for those surgeries. And then of course, the hospital’s buying the implants from Dr. Choi’s distributorships, prior to the surgeries occurring,” Harshaw said.
Choi’s attorneys spoke with InvestigateTV and provided a statement on his behalf. In his case, they said, he hired an executive to manage his business affairs and that person “established the POD pursuant to favorable written advice that executive received from a prominent national law firm.” “Our clients are pleased with this result.
Charles Oppenheim is an attorney who specializes in health care laws, particularly those that sometimes come into play with physician-owned distributorships. He and his firm are frequently referenced in trade journals and government publications., or the self-referral law. That law makes it illegal in most cases for doctors to make a referral to an entity with which they have a financial relationship for medical services reimbursed by Medicare, unless it falls under a specific exemption.
Finally, the OIG notes the company is transparent and gives every patient written notice of the arrangement. Reynolds, the son whose mother died after an operation involving a PODs doctor, wants more regulations for PODs. He believes there are arrangements where profit motives could be lessened — but he wants rules spelled out.“This type of stuff wasn’t disclosed,” Reynolds said. “I hate the word transparent in the medical field because I didn’t experience any of that.”
We have never represented Dr. Sabit. He had an ownership interest in one of Reliance’s spinal implant distribution/design companies, Apex. Dr. Sabit came highly recommended to our clients by other surgeons, including the surgeons who recruited him to provide complex spinal fusion surgeries at Community Memorial Hospital in Ventura California in 2009-2010. Our clients did not learn about Dr. Sabit’s alleged malpractice at Community Memorial until February 2012, long after Dr.