Imagine paying ten times more than you should for surgery, just to have your doctor pocket some of the extra dough. Outraged? You should be.
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:
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:
Try not to think of this article the next time you go in for major surgery.
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