Becker's ASC Review

38 ORTHOPEDICS New York orthopedists indicted in $31M 'trip-and- fall' scheme that preyed on poor By Alan Condon A group of physicians and lawyers were indicted in August, accused of recruiting a network of people for a trip-and-fall scheme that defrauded New York City businesses and insurance compa- nies of more than $31 million. e Aug. 25 Justice Department indictment charges two physicians and two attorneys with conspiracy to commit mail and wire fraud as part of a "scheme to obtain fraudulent insur- ance reimbursements and other compensation for fraudulent trip-and-fall accidents." e defendants are: • Sady Ribeiro, MD, pain management specialist • Andrew Dowd, MD, orthopedic surgeon • George Constantine and Marc Elefant, attorneys From about January 2013 to April 2018, the defendants allegedly coerced people to stage trip-and-fall accidents aer which the attorneys would file lawsuits. About 400 fake patients participated in the scheme, which used cellar doors, cracks in concrete sidewalks and apparent potholes to stage accidents, prosecutors said. Patients were referred to specific attorneys, including Mr. Constantine and Mr. Elefant, who filed fraudulent personal injury lawsuits against businesses and/or insurance compa- nies, according to the Justice Department. Prosecutors said patients were also in- structed to receive chiropractic and medical treatment from certain providers, including Drs. Dowd and Ribeiro. e defendants al- legedly told patients that they were required to have surgery if they wished to continue their lawsuits, and patients were typically told to have two surgeries. As an incentive, patients would receive $1,000 to $1,500 aer they had surgery, the Justice Department said. Drs. Dowd and Ribeiro allegedly performed several of these surgeries that were not medically necessary. Members of the fraud scheme "preyed upon the most vulnerable members of society," ac- cording to the Justice Department, recruit- ing individuals who were extremely poor, many of whom came from homeless shelters in New York City. e defendants face a maximum sentence of 20 years in prison. n Orthopedic surgeon base pay fell 13% in 2020-21 By Laura Dyrda T he base salary for orthopedic sur- geons dropped 13 percent in the past year, according to the Merritt Hawkins "2021 Review of Physician and Advanced Practitioner Recruiting Incentives", released Aug. 9. The average salary for orthopedic surgeons dropped from $626,000 in 2019-20 to $546,000 in 2020-21. This year, orthopedic surgeons on the low end of the salary spec- trum received $300,000, compared with $425,000 in 2019-20. On the high end, orthopedic surgeons did better in 2020-21 than the previous year. The high end of the pay spectrum extended to $1 million annual base salary in the most recent year, compared with $850,000 in 2019-20. Orthopedic surgeons were the 13th most recruited specialist, including physicians and advanced practitioners. n National Spine & Pain Center to pay $5.1M billing fraud settlement: 5 details By Laura Dyrda A Rockville, Md.-based spine and pain center chain will pay millions to resolve Medicare fraud claims. Five details: 1. National Spine & Pain Center admitted to contracting with Proove Biosciences, a defunct genetics testing company, to pay physicians for referrals disguised as compensation for a clinical research program. 2. Proove allegedly paid National Spine & Pain Center physicians per test and per patient to complete timesheets saying they spent more time than they did with patients on clinical research. Some physi- cians also said they performed tasks on the timesheets when Proove employees completed the tasks. 3. National Spine & Pain Centers said its team told Proove it would not provide genetic testing unless the company stayed current on pay- ments, and Proove set expectations for the physicians to order a certain number of tests. 4. Physical Medicine Associates, a physician group associated with National Spine & Pain Center, received $1.1 million from Proove, and Medicare paid Proove $4 million for the fraudulent claims. 5. National Spine & Pain Center agreed to pay $5.1 million in restitu- tion to settle allegations that its agreement with Proove violated the Anti-Kickback Statute. n

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