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Suit reveals clinic’s financial incentives

A Clearwater doctor has filed a “whistleblower” suit against the medical practice that employed him, saying he was fired for complaining about how patients were treated. His contract offered financial incentives, such as a percent of the profits on ultrasound tests he ordered.

Dr. Manuel Abreu’s complaint  says he was pressured to do too much to well-insured patients and too little to those for whom insurers pay a flat fee, called capitation.

The practice “routinely provided less care, or no care at all, to capitated care patients as compared with patients covered by traditional insurance,” the complaint says.

The suit in Pinellas Circuit Court names All Care Medical Consultants. Dr. Mohammed Yamani is the director of All Care, state records show.

Abreu alleges that Yamani overrode him when he tried to refer capitated patients to specialists or admit them to the hospital. Brand-name drugs were changed to generics, he said.

Abreu was fired Feb. 24 of this year without cause, he says. He filed the suit March 29, appending his employment contract, which reinforces his claim.

It says that Abreu is to be paid:
--a base salary of $170,000.
--60 percent of what the practice collects when he sees patients in the hospital.
--$60 for an office visit for a managed-care or Medicare patient.
--50 percent for office visits for fee-for-service patients.

In addition, there was a $5,000 bonus for keeping hospital stays to an average of no more than three days.

None of that is unusual, legal experts say. But they were surprised at one bonus: He was to be paid 25 percent of the proceeds for the ultrasound tests he ordered on fee-for-service patients.

That such a “blatant” financial lure would be put in writing stuns medical-legal expert Jay Wolfson, University of South Florida associate vice president for health law, policy and safety.

“It’s highly suspicious because it provides an inducement to perform specific diagnostic procedures, giving the doctor a piece of the action,” said Wolfson, who also is a professor of health law at Stetson University. “That’s exactly what state and federal anti-fraud guidelines are designed to stop.”

(Disclosure: Wolfson serves on the board of Health News Florida.) 

Yamani, a board-certified internist, did not respond to e-mail or phone calls. A receptionist at his clinic told a reporter on Wednesday that Yamani was out of the office for several days. No one answered the door at his $1-million home in Belleair.

Todd Phillips, director of operations for All Care, declined to comment on the case. So did Abreu’s Tampa attorneys.

It’s not clear where he is practicing. While his name is still on the sign in front of the Highland Avenue clinic and that address is listed with state licensing authorities, the receptionist said he has been gone for a couple of months. She said he  didn’t leave a forwarding address.

The lawsuit draws attention to the inherent financial conflicts of medical practice: managed-care’s pressure to keep spending low, and fee-for-service’s temptation to do the opposite.

Most capitation patients are unaware of the arrangement, since contracts between insurers and doctors are typically kept secret.

State and federal statutes don’t allow payment of financial inducements, or kickbacks. If Abreu’s case led to recovery of state or federal funds, he would stand to receive a percentage of it.

St. Petersburg-based health-care attorney Mike Igel said the All Care contract appears to have sections that are ethically questionable, but he said the wording is unclear.

“It’s poorly written, at the very least,” he said.

 Tampa orthopedic surgeon Michael Wasylik, the Florida Medical Association’s managed-care expert, called the contract “bizarre.” In any event, he said,  “Good doctors take care of patients regardless of compensation.”

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Editor Carol Gentry can be reached at  727-410-3266 orby e-mail. Marty Clear is an independent journalist in Tampa.

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.