You have previously been introduced here to Dr. Meera Sachdeva, Monica Weeks, and Brittany McCoskey. Please refer back to my blog post dated 8/17/12. Sachdeva was the oncologist, owner, and operator of the Rose Cancer Center in Summit, Mississippi, whose clinic was shut down by the Mississippi Department of Health after numerous cancer patients were all admitted to the same Pike County, Mississippi, hospital with similar bacterial infections. It seems that Sachdeva’s clinic had been re-using IV kits with patients sharing previously used, dirty needles.

On top of that, Sachdeva billed private insurers, Medicare, and Medicaid for far more of expensive chemotherapy agents than she actually purchased. Though Federal prosecutors were apparently unable to prove that the chemo drugs had been diluted, or useless solutions substituted, it is not hard to make the assumption. It is entirely possible that mere saline solution labeled as something other than what it was had been given to patients who had entrusted Sachdeva and her clinic with their very lives. The prosecutors only said that IV infusions drawn for different patients were drawn from the same bag, reusing dirty needles. One does not have a very long leap to make to get to dilution and  fraudulent substitution; it is about like leaping over the remains of your neighbor’s dog’s visit to your front yard. This is speculation though, and not proven in court. We are allowed reasonable speculations about Sachdeva’s heinous behavior, and those speculations may or may not be true and will continue to be speculations. We are not speculating when we say that Sachdeva is a convicted felon, charged with defrauding her victims. Unfortunately, her victims as defined by the Justice Department were not her patients, but an assortment of 56 private insurers and government programs.

Sachdeva’s accomplices were independent medical billing clerk Monica Weeks and Rose Cancer Center office manager Brittany McCoskey. All three plead guilty to charges most likely reduced through plea bargains in exchange for their guilty pleas.

An October sentencing date had been put off until yesterday, December 7, 2012. Yesterday, the court handed down their sentences.

Monica Weeks received three months house arrest and is required to pay $20,000 in fines for her conspiracy conviction. I also wish she had been forever barred from practicing as a medical billing clerk, but that does not seem to have been part of her sentence. Previously, her attorneys had argued that Weeks never placed the lives of any patients in jeopardy. I wonder how, being a part of the conspiracy, that is possible other than through clever semantics. Congratulations to her attorneys. They did their job well.

Apparently somewhat more culpable in the eyes of the court, Brittany McCoskey received a thirteen month prison sentence and must pay $55,000 in fines for making false statements.

Sachdeva received a 20 year prison sentence and orders to repay $14,000,000 in fraudulent charges. It was previously reported that six-million dollars in cash and other real assets belonging to Sachdeva have already been seized. It was also reported that she has substantial assets in her native India. Sachdeva made several attempts to bond out of jail but Federal judges continually denied her, citing her as a flight risk.

Reiterating, sadly: none of her patients were listed as victims. Some of them are now deceased. To be fair, some would now be deceased had Sachdeva done everything within her power to administer the correct amounts of the correct chemo drugs, because this is the nature of cancer. We have to believe that some of her former patients are now deceased because of the shoddy care they received at the hands of this woman. I wonder if she, with all her expert training, thought to herself, “This patient only has a few months, anyway, so let me see if I can make a few extra bucks since I am not doing any REAL damage to them because chemo won’t change their outcome.”

If she thought that, then perhaps the next extension would be, “Since we all die anyway, why postpone the inevitable?”

Being a physician is not a guarantee of insulation from greed and avarice. We place our physicians on pedestals, take nearly everything they say at face value, never questioning anything about the code-based/fee-for-service based way in which our physicians and clinics bill our insurers or our government. The way medical billing is done and the low rates for specific procedures dictated by Medicare, Medicaid, and our Preferred Provider Organizations who are part of our insurance networks literally leave clinics looking for more ways to put more codes on medical records. I suspect that if the justice department were to draw a dozen different medical clinics at random and audit them carefully, they could find as many prosecutable offenses. The more laws we have, the more criminals we create.

As you can see, I am of two minds on this. Physicians are simultaneously culpable and very vulnerable. I can’t see much improvement coming down the pike with the continuing implementation of the ACA (Obamacare). I see more and more physicians retiring while the gates are forcibly and desperately opened to more and more people to attend medical school, paid for by the government, to become primary care physicians. The State of Mississippi has announced the relaxation of MCAT scores and pre-med training, and a significant increase in the number of students allowed to enter the University of Mississippi Medical School, with the promise of free tuition and the forbearance of student loans for those graduates who agree to a family practice in rural areas. Some of these new students will not become good doctors, though their names will carry the letters “M.D.” affixed. Many of them will only stay in the rural areas for as long as required to fulfill their obligations, and some, less. Our recent spate of Advanced Nurse Practitioners has shown their proclivity to abandon rural areas for the urban areas where they can make more money, and in particular, an abandonment of Mississippi entirely, in favor of those states where they are allowed an independent (and urban) clinical practice. If we lower the standards for medical practice, we just might get what we deserve. Physicians should be able to make a good and comfortable, even an excellent living without resorting to medical billing shenanigans. A few shenanigans might be called mistakes, but a consistent pattern of mistakes might more correctly be labeled as fraud.

We are back to the premise I have stated over and over: Our medical care is mostly paid for with someone else’s money. I’m a lot more careful with what’s in my pocket than with what is likely to be in yours. I suspect if we all had more skin in the game, and were presented an a la carte menu of medical services and their prices, we may be more diligent about discussing with our physicians just which ones are really necessary. We don’t get that choice, nor can anyone tell us in advance what medical procedures will cost, though they seem perfectly capable of billing us after the fact. What else on this whole wide earth do we purchase in this manner? Perhaps we have gotten to the point that when we hear the word “Doctor” or see the letters “M.D.” that we lose our sense of frugality. If someone else is paying for it, even if it is my employer provided insurance, why should I care? I have actually had people with the letters “M.D.” affixed to their name say this to me, but they say it only ONCE.

Meera Sachdeva had the letters “M.D.” affixed to her name, too. Maybe at one point she was a good doctor. Maybe at one point, she cared more about the outcomes of her patients than the balances in her many domestic and international bank accounts. But she is testimony that the letters “M.D.” and being a good doctor have no connection. And, the letters “M.D.” and being a responsible, honest, caring human being have no connection whatsoever. The letters “M.D.” certainly allowed her the opportunity to inscribe, or have inscribed, medical billing codes on patient charts for services she never provided. In her case, it was not only billing fraud, but shoddy, second-rate, and wicked medical malpractice.

We often forget that running a medical practice is a business, and successful businesses make profits. When the business of running a medical practice, or more particularly the avarice of its owners, gets in the way of good medical care, the letters “M.D.” don’t quite have the significance they once had; though I daresay that thousands of good clinics and medical practices are just like many other small businesses: overwhelmed with rules, regulations, uncertainties, and the costs of business operations, wondering just how they are going to meet this week’s payroll. Just a couple of additional billing codes here or there might be just the ticket. Tempting, it is not?

I hope Meera Sachdeva enjoys her new home as best she can. She certainly will enjoy being sentenced in a country where she has the right against cruel and unusual punishment, else I’d see that she was IV fed a continual dose of diluted cyclophosphamide, just enough to keep her nauseated beyond measure while taking years to finally send her off to whatever god at whose altar she worships. I can’t be certain what god that is, since Sachdeva did not say, and if she did, well . . . we know she is a fraudster.

Money is a poor god if you ask me. 

If she has any assets left in this country, the wave of civil suits that will follow will consume them. If her family has any of the benefits of these assets, they have no right to them; they belong to her defrauded patients or their survivors, who were her real but unnamed victims. No doubt the government, which was also truly defrauded, has extended its long arm to attach every asset it could find in this country for its own reimbursement. Private insurers and her patients will just have to get in line behind the government. There is nothing left here, but the sad stories of people whose trust was violated in a most personal and tragic way.

There is nothing left here but grief, shame, and what seems a triflingly small amount of justice.