Federal Spine Surgeries Investigation Uses Mob Laws to Target Healthcare Fraud

A Texas consulting firm that arranges spinal surgery and other medical care for people injured in car crashes has come under scrutiny in a federal investigation into Corruption.

Meg Health Care, run by Dallas attorney Manuel Green and his wife, Melissa Green, is the subject of a recently unsealed search warrant in Massachusetts federal court in an alleged drug fraud prosecution. health care. The investigation is unusual because it uses a little-known law intended to crack down on organized crime racketeering across state lines.

Investigators alleged in the 2019 affidavit that the Texas-based company took thousands of dollars in kickbacks from SpineFrontier, a Massachusetts medical device company. Spine border; its CEO, Dr. Kingsley Chin; and its chief financial officer, Aditya Humad, were indicted in September for paying bribes to surgeons. They all pleaded not guilty.

No charges have been filed against the Greens or their company, and federal officials have declined to discuss the investigation, which is detailed in the now unsealed 2019 search warrant.

The Greens could not be reached for comment.

Meg Health Care arranges spinal surgery and other medical treatments through “Letters of Protection,” or LOPs, legal contracts in which patients agree to pay medical bills using the product of a lawsuit or other claims against the party responsible for their injuries. These contracts are common in personal injury cases when people do not have health insurance or choose not to use it to pay for medical treatment after an accident. The downside is that patients may be forced to foot the bill if their cases settle for less than they owe.

On its website, Meg Health Care states that it “represents a group of doctors and hospitals who were tired of seeing injured people without access to the medical care they needed after an accident. We strongly believe that under the law, and out of decency, the person or company that caused the harm should be held accountable.

According to investigators, Manuel Green referred injured patients with LOPs to a local neurosurgeon who used SpineFrontier implants in surgeries at two Dallas-area hospitals.

“In exchange for Attorney Green’s recommendation, SpineFrontier agreed to pay Attorney Green forty percent (40%) of the earnings SpineFrontier received from these surgeries as a bribe “, according to the search warrant affidavit.

Chin and SpineFrontier were the subject of a KHN investigation released in June which found that manufacturers of spinal implant, artificial knee and hip joint equipment paid more than $3.1 billion to orthopedic and neurological surgeons from August 2013 to 2019.

Government officials have argued for years that payments from device makers to surgeons and other medical providers can corrupt medical decisions, put patients at risk and inflate health care costs. SpineFrontier’s indictment alleges that the company paid millions of dollars in fictitious consultation fees to spine surgeons in exchange for the use of its products, often in surgeries paid for by Medicare or other government funded health insurance plans.

The Texas investigation adds a new dimension to the case by focusing on privately paid medical care, which is not covered by federal anti-bribery laws. Instead, the search warrant alleges violations of a law called the Travel Act. Passed by Congress in the early 1960s to curb the mob, the Travel Act makes it a federal offense to commit crimes such as bribery, prostitution, and extortion across state lines, including by post, telephone or e-mail. Convictions can result in up to five years in prison, more if violence is involved.

Jonathan Halpern, a white-collar criminal defense attorney from New York, said such use of the travel law reflects “an aggressive expansion” of the US government’s power to prosecute health care fraud. .

One of the first health care fraud prosecutions under travel law took place in Texas and led to convictions for bribery and kickbacks of 14 people, including six doctors, associated at Forest Park Medical Center in Dallas. They received a combined sentence of 74 years and were ordered to pay $82.9 million in restitution.

Chris Davis, a Dallas attorney who specializes in government investigations, said the travel law grants jurisdiction to federal prosecutors in cases “where you don’t have any state or federal money involved.”

The search warrant for Meg Health Care cites payments of more than $93,000 in 10 checks allegedly sent by SpineFrontier to the Texas-based company between April 2017 and October 2018. Investigators allege the money was paid as bribe for referring patients to surgeries using SpineFrontier products.

Investigators also cited a February 2016 email in which Melissa Green told the device company that a patient’s court case had been settled and asked, “Please let me know when MEG can come back. expect to receive payment in accordance with our agreement. Thank you!”

About two months later, the device maker gave the company a check for $3,953.60, according to the search warrant.

Nine of the 10 checks were signed by either Chin, a Fort Lauderdale spine surgeon and founder of SpineFrontier, or Humad, according to the search warrant affidavit. Chin and Humad are the two executives charged in September. Their attorneys have not commented.

Federal investigators requested the search warrant for Melissa Green’s email account at Meg Health Care in August 2019, arguing they had “probable cause” to investigate the company for violating travel law, according to court records. A Massachusetts federal judge unsealed the warrant and related documents late last year.

Meg Health Care invites attorneys whose clients have a “significant medical need” to apply to the firm, according to its website. If approved, Meg Health Care makes an appointment with one of its physicians. “From there, our doctors will take care of all aspects of the treatment sought, including surgery (if necessary),” the website states.

In a 2019 Dallas County filing unrelated to the search warrant issued in the Massachusetts case, Manuel Green said he was the “founder and owner” of the company. He said it “helps doctors and medical facilities reduce their exposure to risk when providing treatment to patients under [a] protective letter.

He went on to say that “the company’s business model and the consulting services it provides are unique in the state of Texas healthcare industry.” The company’s website lists medical providers in 11 Texas cities.

According to investigators in the Massachusetts case, Green referred patients with LOP to Dr. Jacob Rosenstein, a neurosurgeon in Arlington, Texas, who used implants that SpineFrontier sold to two hospitals, Pine Creek Medical Center in Dallas and the Saint Camillus Medical Center in Hurst, Texas. . Pine Creek has since declared bankruptcy.

Neither Rosenstein nor hospital representatives could be reached for comment.

Although proponents claim LOPs may be the only option for uninsured or underinsured accident victims to seek medical care, a recent KHN survey found that doctors and hospitals that accept them often charge rates much higher than Medicare or private insurance would pay for similar care and that the process can burden patients with medical debt or put them at risk to their safety.

Disputes over the amount of medical bills and even whether the care was necessary are common in Texas personal injury lawsuits. In a 2016 Dallas County case, for example, a spine surgeon billed over $100,000 for his services, while the hospital billed over $435,000. By contrast, an expert hired by the defense set reasonable fees at less than $4,000 for the surgeon and about $25,000 for the hospital, court records show. The case has since been settled.

Christine Dickison, a Texas nurse and medical coding consultant, said she regularly sees “extremely inflated” bills in car accident lawsuits – and in some cases she doubts the care is necessary.

“I see people having surgery when there’s literally no objective conclusion to back it up,” Dickison said. “It’s very disturbing to me.”

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