Someone who has stolen money from a bank certainly should never be hired to work in one. While this blog’s opening sentence has a ring of “no kidding” to it, we couldn’t think of a more apt comparison to a situation that recently came to our attention. Last week, ProPublica published an article entitled “Doctors With Histories of Big Malpractice Settlements Work for Insurers, Deciding If They’ll Pay for Care”. We wouldn’t blame you if your eyebrows are raised.
Collectively written by Patrick Rucker of The Capitol Forum and David Armstrong and Doris Burke of ProPublica, the article reveals that at least a dozen doctors were hired by major insurance companies after being disciplined by state medical boards or making multiple or outsized malpractice payments.
Florida doctor sued for malpractice becomes health insurance company medical director.
The ProPublica article highlights the tragic story of Loretta Murphy. She went into the hospital for a common gallbladder surgery in 2009. It was performed by Air Force surgeon, Dr. Pachavit Kasemsap. Sadly, Murphy’s aorta was somehow severed during the procedure. As a result, she never left the hospital and passed way just before her 40th birthday. She left behind a husband, Shawn and two daughters, aged 17 and 13.
For months, Shawn Murphy fought Kasemsap in a Brevard County, Florida circuit court. Several other families had also complained that their loved ones suffered under the same doctor’s care. According to the Florida malpractice payment database, Kasemsap has settled five malpractice cases for a total of $3 million. That includes $1 million paid to the Murphy family.
Kasemsap last practiced medicine in December of 2012.
One would think that the former physician would never be permitted within the medical industry again. In spite of his many malpractice cases, Kasemsap somehow was able to secure a job as a medical director for a health insurance company. As Rucker, Armstrong and Burke alert, that gives him the power to impact the lives of far more patients than he would ever have seen in the operating room.
As explained by the writers, medical directors like Kasemsap can, without ever seeing a patient, overrule the judgment of the doctor who did and deny payment for a recommended procedure, test or medicine. “Patients and their physicians complain that insurance company doctors routinely, and wrongly, deny payment for critical lifesaving treatments because they are expensive,” the article notes.
There are many implications when former doctors become medical directors.
Rucker, Armstrong and Burke make clear that it is certainly not uncommon for states to require medical directors to be licensed physicians. However, it is up to insurers to determine which medical professionals are fit for the job. Since Kasemsap left his clinical practice after multiple accusations of negligence, it appears unconscionable that he can make insurance claim decisions. He isn’t the only disgraced doctor to be placed in such a position either.
ProPublica and The Capitol Forum researched insurers and their hiring choices. Unable to find any comprehensive database of doctors working for insurance companies or any public listings by the insurers who employ them, the team identified medical directors through regulatory filings, LinkedIn profiles, lawsuits and interviews with insurance industry insiders.
Together, they identified 12 insurance company doctors with either a history of multiple malpractice payments, a single payment in excess of $1 million or a disciplinary action by a state medical board.