An appeals court has upheld the conviction and 10-year prison term
of a Louisiana cardiologist accused of conducting medically unnecessary angioplasty and stent procedures on 74 patients between 2001 and 2004.
Dr. Mehmood Patel appealed virtually every aspect of his trial, asserting that the Medicare fraud statute is unconstitutionally vague, that the government’s evidence was gathered illegally, and that the trial judge erred in dismissing a juror and forcing a deadlocked jury to continue deliberating. The 5th U.S. Circuit Court of Appeals in New Orleans rejected each of his challenges.
Patel, a cardiologist formerly based in Lafayette, La., was found guilty of 51 of 91 counts of fraud after a nearly four-month trial in 2008. The allegations against him came to light after a nurse at his practice, Acadiana Cardiology Center, approached an HHS agent in 2002 with concerns about unneeded procedures.
Patel also argued that the convictions should be thrown out because the margin of error for determining medical necessity in arterial blockages is often narrow and subjective. Although the appeals judges agreed with that general statement, the specific facts of Patel’s case were more stark and did not warrant tossing his conviction.
“Count 11 vividly illustrates this,” U.S. Circuit Judge Leslie Southwick wrote. “Dr. Lappin, the government’s expert, found zero blockage, whereas Dr. Patel claimed between 60% and 70% blockage. Dr. Patel performed the stent procedure, which resulted in the patient developing yellow jaundice. From this type of evidence, jurors were entitled to disbelieve Dr. Patel’s claims of good faith, and instead conclude that his figures had been falsifications.”
Legal experts say gathering enough evidence and expert testimony to convince a jury of wrong-doing in a medical necessity case is often a tall order.
“Medical-necessity cases can be hard to prove,” former Tampa, Fla., U.S. attorney A. Brian Albritton said in an interview last week. “They're often based on statistical abnormalities rather than direct evidence that a specific procedure was unjustified.”HCA disclosed a federal government inquiry
into cardiac medical necessity questions in at least 10 of its hospitals. Tenet Healthcare Corp. paid more than $450 million in 2003 to settle claims from plaintiffs and the government over cardiac medical necessity at a California hospital, and two hospitals in Maryland have paid legal settlements in the past year over allegations of unneeded heart procedures provided by cardiac physicians. None of those hospital settlements came with admissions of wrong-doing.