DHS Halts Medi-Cal Payments to Two Redding Doctors Accused of Performing ‘Unnecessary Operations’
The Department of Health Services on Friday halted Medi-Cal payments to two doctors currently being investigated by the FBI for allegedly performing "unnecessary operations," the Sacramento Bee reports (Hill, Sacramento Bee, 11/23). Tenet officials in late October announced that federal officials searched Redding Medical Center as part of an investigation of two physicians who may have performed unneeded surgeries and potentially defrauded Medicare. According to an FBI affidavit, government officials suspect that the physicians participated in a "scheme to cause patients to undergo unnecessary invasive coronary procedures," including artery bypass and heart valve replacement surgeries (California Healthline, 11/1). DHS officials on Nov. 1 notified Drs. Fidel Realyvasquez and Chae Hyun Moon that they would no longer be receiving Medi-Cal payments but gave them three weeks to "wrap up" remaining cases. Realyvasquez already has filed an appeal, saying that suspension of Medi-Cal funds would force the approximately 100 Medi-Cal beneficiaries he sees each year to travel longer distances for care. Moon also is likely to appeal, according to his lawyer, William Warne. The suspension of Medi-Cal payments is the "first of several actions" the state plans to take against the two doctors, the Bee reports. An ongoing California Medical Board investigation could result in the loss of the physicians' medical licenses. The board is contacting former patients of the two doctors, attempting to obtain waivers to allow the board to review their medical records (Sacramento Bee, 11/23). On Nov. 13, a judge rejected the board's initial attempt to revoke the physicians' licenses, saying that the board lacked solid evidence (California Healthline, 11/14).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.