Doctors accused of behaving badly
The Greeks established it long ago. Since the 5th century B.C., physicians have sworn themselves to some version of the Hippocratic Oath, the official guideline to not be a d-bag doctor.
Which is why the recent $20 million lawsuit against a slew of South Bay clinics, if proven true, is a bitter dose of reality indeed. Especially for patients like us.
Insurance giant Aetna claims that officials of Saratoga-based Bay Area Surgical Management have been coercing doctors to invest in the company’s outpatient clinics, and then referring their patients to the facilities for a big wad of cha-ching.
Now that’s a conflict of interest if we ever saw one.
Dr. Steven Jackson, who serves on the Santa Clara County Medical Association’s committee on bioethics, told the Merc:
“The affordability of health care is being jeopardized, and the ethical principle of social justice is being violated.”
According to the lawsuit, BASM’s outpatient clinics charged astronomical prices for their services, sometimes seven times higher than what other clinics charge for equivalent procedures.
BASM is further accused of paying doctors excessive returns from those inflated charges for their investments in the clinics.
The numbers laid down in the February lawsuit are enough to make a healthy person keel over:
- The bill for a bunion repair was $66,100 at BASM, compared with an average of $3,677 at Northern California in-network providers.
- The average bill for kidney stone fragmentation was $73,526 at BASM, a 966 percent mark up from the average $7,612 charged by in-network providers.
BASM clinics waived Aetna’s out-of-network co-payment and deductible, so patients paid little or nothing.
However, Aetna automatically paid up to 90 percent of the billed amount, which they say has totaled $23 million over the past two years. That’s about $20 million more than Aetna officials say they should’ve been charged.
BASM officials, of course, reject Aetna’s claims. Bobby Sarnevesht, one of three co-founders and managers named in the suit, insisted to the Merc that their practices have been perfectly legal:
“The numbers that they’re using are complete fabrication and completely inaccurate.”
But those who ultimately get screwed, Jackson explained, are folks like you and me, who will pay for the overcharges through higher health insurance premiums.
For Dr. Carl Bertelsen, a surgeon at Good Samaritan Hospital in San Jose, it comes back to the Hippocratic Oath:
“It bothers me that [the BASM officials] have been able to usurp the ethics of medicine.”
BASM operates seven local centers with about 60 Bay Area doctors as investors. Some of them include famous names like former team doctor of the 49ers Dr. Michael Dillingham and Kenneth Akizuki, who operated on Giants catcher Buster Posey’s ankle.
BASM centers include:
- Bay Area Surgical Group, Santa Clara
- Forest Surgery Center, San Jose
- Los Altos Surgery Center, Los Altos
- National Ambulatory Surgery Center, Los Gatos
- SOAR Surgery Center, Burlingame
- Knowles Surgery Center, Los Gatos
- Willow Surgery Center, San Francisco