Brown dismisses Reddy test allegations
Ewart Brown has dismissed allegations that a doctor at his medical clinic has ordered excessive, medically unnecessary tests for patients in order to profit the business.
Mahesh Reddy was arrested by detectives after an early-morning raid at his home in May and has since launched a civil claim for damages against the Bermuda Police Service.
The investigation into Dr Reddy, chief medical officer at Dr Brown's Bermuda Healthcare Services, is understood to centre on accusations that he ordered MRI and CT scans to be carried out at the clinic for his patients when they did not need them and then billed insurance companies for the procedures.
Bermuda Police Service has not commented on the reason for Dr Reddy's arrest, other than to say it was “in connection with an ongoing financial investigation”.
Dr Reddy, who has since been bailed, says in an affidavit to support his civil claim that he was quizzed about alleged fraudulent activity in relation to ordering excessive tests.
Dr Brown, the former Premier, confirmed to The Royal Gazette that Dr Reddy regularly ordered more tests than the other doctors who make referrals for diagnostic imaging scans to Bermuda Healthcare Service but said that wasn't a criminal offence and wasn't a matter for police.
“I know that he orders more,” he said. “Some months he is the highest. He has more referrals to MRI and CT than anyone else of the 50-something doctors who refer patients. He makes very good use of the diagnostic imaging available to him. Dr Reddy is considered one of the best doctors in Bermuda and even his detractors will admit that.
“I haven't heard [concerns about Dr Reddy's referrals] from the insurance companies, I haven't heard it from patients and I haven't seen it from my work overseeing the practice. Why would the police be concerned with medical tests? What do they know?”
Asked what he believed was the real focus of the police inquiry, he replied: “Me. They believe that Dr Reddy has some information, that if pressed hard enough, he will reveal. That's all I can think that they believe.”
Ricky Brathwaite, Bermuda Health Council's programme manager for health economics, told this newspaper there was currently nothing in law to stop a physician ordering as many tests as they saw fit.
But new regulations recently tabled in the House of Assembly — and then temporarily withdrawn for further consultation — would give the health council powers to monitor referrals in cases where the doctor making the referral financially benefits from the tests. Such referrals are described as self-referrals or financially vested referrals.
Dr Brathwaite, in an interview about the regulations, said: “There's nothing in the [proposed] legislation that says a physician can't refer and a patient can't have a test. This is actually about choice. “If we can create standards and we can also ensure transparency about things like financially vested referrals, [we] at least give a patient an option and allow them to be more informed about the choices that they make and when and where they receive their healthcare and let everyone compete on quality.”
The regulations would require physicians to seek permission from the health council when making self-referrals and give the quango power to impose penalties if the regulations were breached.
A register of interests would be established showing the financial interests of healthcare providers and insurers would be given permission to require doctors to prove financially vested referrals were necessary.
Tabling the regulations, health minister Jeanne Atherden said there had been “increased utilisation of some procedures without medical justification” in the “profit-led” healthcare industry.
“While it is clear that some self-referrals are appropriate and improve access for patients, close monitoring of utilisation and referral patterns have made it evident that some unchecked self-referrals can lead to unnecessary use of some procedures, which is not good for patients and increases healthcare costs.”
Dr Brathwaite said numerous overseas studies have shown that doctors order more tests when they own the testing facilities and other jurisdictions have introduced measures to deal with that.
He has been assessing health claims data for the past year-and-a-half to determine an “ordering rate” for physicians in Bermuda, i.e. which ones order the most tests.
The results are likely to be made public soon, though not by individual doctor. Mr Brathwaite said: “We don't use it as a way to target someone and say ‘I know what you're doing'. We use it as a guide for discussion.
“So if we see that on average there's one or two physicians who may be 50 per cent over the average, then we have a conversation and say ‘hey, this is what the data shows. Can you tell us a little more about your practice or what things have been going on?'.”
He added: “We are not talking about a lot of people within the community who are doing this. There's been a couple of instances where red flags have been raised. Our first instinct is not to ask whether the test that you ordered was right for your patients. We just look at the trend and say ‘okay, well it seems like you are ordering more than people in your class of physician. Is there something that's going on?'.”
Dr Brathwaite confirmed that conversations had been held with a small number of doctors and the health council had also been asked by insurers to “facilitate discussions” with physicians regarding high ordering rates. “We've looked at the numbers, so we've had the conversations,” he said.
Dr Brown said the health council had “never” approached him to discuss excessive ordering of tests at Bermuda Healthcare Services and he did not believe they had talked with Dr Reddy.
He said the insurance companies sometimes queried whether studies were necessary and “we comply with that and we answer that”.
“They are not complaining,” he added. “My question really is: where is this coming from? What or who is driving this focus?”
The former Progressive Labour Party leader agreed studies have shown doctors order more tests when they profit from the tests, but added: “More tests do not equate to unnecessary tests.”
His clinic voluntarily engaged in the American College of Radiology's diagnostic screening programme, he said, and every study ordered at Bermuda Healthcare Services and his other clinic, Brown-Darrell, was screened by experts at Lahey Hospital in Massachusetts to ensure it was necessary.
Dr Brown said he believed parts of the draft Bermuda Health Council Amendment Act 2016, which would also introduce regulations for “high risk health technology”, were specifically targeting his business, as his clinics were the only ones other than King Edward VII Memorial Hospital to have MRI and CT scanners and X-ray machines.
“There are some people in Bermuda who have decided our practice is too successful and therefore they are trying to undermine it, dismantle it, so it can go the way of many black-owned businesses,” he alleged.
Though he insisted he couldn't pinpoint who was out to ruin him, he said their impetus was both his status as a successful black man and his political past.
This newspaper revealed in July that a police inquiry into allegations of corruption made by disgraced financier David Bolden against Dr Brown in 2011 had so far cost police $2.2 million.
Dr Brown said the inquiry appeared to now be focusing on his business. “I don't think Dr Reddy's arrest had anything to do with Dr Reddy. Just because I'm paranoid, doesn't mean they are not out to get me.”
Dr Brathwaite, responding generally to criticism from doctors about the proposed regulations, said he was aware of historical issues in Bermuda and examples of opportunities being taken away from businesses “on racial lines” in the past.
But he said the regulations were not politically or racially driven in any way and arose from the need to bring down health costs and improve patient knowledge of their choices.
“I can tell you a hundred per cent that that has nothing to do with the legislation, nothing to do with the way we do business here,” he said.
According to Dr Brathwaite, a committee is “refining” the proposed legislation. The Bill and the accompanying regulations are expected to be retabled in Parliament in November.
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