JANE ANN MORRISON: Accident victim's medical bills raise questions about anesthesiologist - News

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Nov. 24, 2008
Copyright © Las Vegas Review-Journal

JANE ANN MORRISON: Accident victim's medical bills raise questions about anesthesiologist

JANE ANN MORRISON
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Dr. Michael Braunstein has been an anesthesiologist in Las Vegas for more than 30 years. For the past 15 years, he has had a separate business called IME, where he looks for medical billing errors. In other words, he knows what he's doing, unlike the rest of us, who stare at complex medical bills in bewilderment and wish upon a star that they're accurate.

So when he said Dr. Raimundo Leon submitted an inflated bill to a patient who asked IME to review the bill, I figured he knew what he was talking about. Doctors don't make such accusations lightly.

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The patient asked that her name not be used but gave Braunstein permission to discuss the $13,481 bill with me and show me her records.

The patient was in an auto accident in 2005 and went to an attorney to file a personal injury case. Eventually, she was referred to Leon, a pain management specialist and anesthesiologist.

Leon treated her over a four-month period in 2005 with 13 nerve blocks and injections. She received two injections on April 19, then four nerve blocks on May 24 and seven injections on July 5.

Braunstein said two types of billing errors were obvious. She was overcharged three times for anesthesia and charged $360 for a simple test that should have been free.

Leon was using the wrong billing codes and billing for 10 units of anesthesia for procedures that only required either three or five units, according to Braunstein.

Leon also was charging $120 for every use of the pulse oximeter, when there should have been no charge.

Braunstein showed me the code books used by the American Society of Anesthesiologists, which state that a nerve block injection for a prone position requires five units of anesthesia plus time. For a nonprone position, it's three units plus time.

His friend was charged a total of $4,200 on the three dates she was anesthetized for procedures. He said the charges should have totaled $1,400 and the actual customary payments from an insurance company would have been about $650.

A $3,550 overcharge would be the bigger bill inflation in actual dollars, yet a smaller fee of $360 for pulse oximetry seemed more egregious.

A pulse oximeter is that thing they stick on your finger in nursing homes and hospitals every time they check your vitals. It monitors the amount of oxygen in the patient's blood.

Braunstein said there's not supposed to be any charge for it, but Leon was charging $120 each time for "pulse oximetry." It would be like billing patients for taking their blood pressure, Braunstein said.

He spoke with Leon last Monday about the charges and incorrect codes and said he received a hostile, even threatening response. "He (Leon) said it was the right code for monitored anesthesia care and said: 'I've been using it for three years and I'm not going to change it.'"

It didn't sound like a friendly conversation between colleagues.

I called Leon's office Thursday and Friday to ask him and his partner, Dr. Michael Prater, for comment, leaving detailed voice-mail messages. No one returned my calls. Leon handled the procedures while Prater handled the anesthesia.

Leon and Prater were among the doctors who were served with search warrants in 2006 as part of the FBI's ongoing probe into possible collusion between doctors and lawyers to run up the costs of medical bills in personal injury cases.

I first wrote about Leon in 2005 in connection with the first personal injury case in federal court that made federal prosecutors question what was going on in state court -- the case of Cynthia Johnson who was rear-ended by a federal prosecutor. Johnson's medical records showed a $350 consultation fee by Leon. However, he admitted the consultation with Howard Awand never occurred, so that's another example of an "incorrect" bill.

Maybe that was a mistake.

But in this case, Braunstein said, "when confronted with the errors, he refused to do anything about it."

Braunstein's client doesn't want to be overcharged and he's fighting it on her behalf. Meanwhile, Leon has responded by threatening to turn her over to collection.

The bills are complex, but if you've been charged $120 for pulse oximetry by Leon, or any anesthesiologist, Braunstein contends you've been overcharged.

Wouldn't you want to know?

Jane Ann Morrison's column appears Monday, Thursday and Saturday. E-mail her at Jane@reviewjournal.com or call (702) 383-0275. She also blogs at lvrj.com/blogs/morrison/

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Please enter your name Name: Please enter your email Email: Please enter a comment COMMENTS : (word count limit is 300) You have reached the maximum number of words allowed Current Word Count: Note: Comments made by reporters and editors of the Las Vegas Review-Journal are presented with a yellow background. Nevada is just corrupt wrote on November 24, 2008 09:27 PM: People are starting to leave this hell hole and the tourist are wising up. Nevada is running a tight race with New Orleans for top of the list corruption. Make no mistake corruption will eventually destroy if left unchecked. UNBELIEVABLE wrote on November 24, 2008 03:22 PM: What a pathetic bunch wrote on November 24, 2008 07:14 AM: "...The sad part is, the pleas and cries of the citizens fell on def ears. It took a federal prosecutor getting raked over the same coal that the citizens endure daily for law enforcement to do something..." You said a mouthful! I am tired of being BAR-B-QUED! You'd think we were cooked to a tender golden color and devoured...But damn if most times they don't come back to pick at the bones. What they can't do in one court, they do in the other. Ring around the rosey... "...I bet the citizens would be appalled to discover how many doctors, lawyers and politicians have taken their ill gotten gain and pooled it together behind the scenes (LLC'S) and have a hand in the current construction housing dilemma in Nevada..." All the crooked court teams (Varsity and JV) are HEAVILY INVOLVED IN REAL ESTATE...not just HOA either. Take a gander. Trisha Sciortino,PT wrote on November 24, 2008 02:11 PM: I have a degree in journalism but chose, by today's journalistic standards, a more noble profession, physical therapy. Like all other licensed professionals, why do journalists have no professional accountability? I suppose because there is no criteria for calling yourself a journalist. It is sad and irresponsible. I know my former journalism professors are cringing at what the media has become today. For the record I treat the elderly and do not have a PI practice. Johnathan L. Abbinett wrote on November 24, 2008 12:47 PM: Another good story Jane Ann! I've heard so many horror stories about doctors and lawyers inflating fees and billing for services that were never even provided - it's no wonder that our healthcare costs are ballooning beyond reason! I'm of the mind that the reason law enforcement doesn't go after these thieves is because they know both the legal and medical professions are mammouthly corrupt! But, we should go after these white collar thieves who are breaking the backs of the taxpayers and pushing people over the brink into bankruptcy! This is why we must CHANGE and move to a non-profit Universal Healthcare system that focuse, first, on Wellness Education, Diet, Fitness and Disease Prevention - and provides the highest quality healthcare for all! Our Armed Forces on military bases all over America (and throughout the world) and the Veteran's Administration is able to do run a very efficient healthcare system (of course there are some problems, but no system is perfect). We're Americans - we can do this! All we have to do is take the best ideas from Canada, England, France and other countries doing healthcare better than us - then, come up with a truly new All-American model! This is what the American people need and want - the challenge will be in getting through the political process and pass the lawyer's and medical lobbyists who want a corrupt system they can exploit for greed! I am convinced though it may cost more up front to change the system - in the long run it will cost less by keeping more people healthy and extending their lives - and we'll save a ton a piece in unnecessary suffering and stress (which is the foudation of every illness, disease and disorder)! Besides, Universal Healcare (including Mental Healthcare) is just the right thing to do! what they left out is wrote on November 24, 2008 11:59 AM: The ICD9 code that is used to bill for pulse oximetry is a code that is used across the country and is normal. Many MANY doctors use it. Dr. Leon is not doing anything wrong. Once again, Jane Ann rears her ugly head to continue the drama. They weren't able to convict Noel... but Jane Ann tries to convict them in the court of public opinion. bah humbug Homer Wood wrote on November 24, 2008 09:05 AM: This is another disgusting example of the broken trust between a doctor and their patient. Jane Ann Morrison keeps us informed again. Thanks The Eyes of Vegas wrote on November 24, 2008 08:13 AM: Wow, after over a decade of these shenanigans, this is only now coming to light? Compared to some of the surgeons (Thomas, Kabins, Venger, Thalgott, McNulty), yes, Leon is a small fish. But these "pain management" and "disogram" guys have also gotten ridiculously wealthy playing the personal injury(Awand/Vannah/Eglet) scam. Take a look at Drs. Lemper, Kraft, Oliveri, Kozmary, Prater, and Iglikowski too. This is organized crime. This isn't the only billing scam wrote on November 24, 2008 08:00 AM: Take a look at the lawyers. where are the indictments? wrote on November 24, 2008 07:22 AM: Also, the feds need to take a good hard look at US Judge Quackenbush. your kidding, right? wrote on November 24, 2008 07:20 AM: To Craig, don't get to excited that our DA or local law enforcement will do anything. How many people past and present from metro have their hands in the HOA matter? Also, see the report on klastv about Kenny Guinn's son using metro to do his bidding. Read All Comments