As thousands of valley residents await lab test results that could signal their early deaths, the FBI and IRS have launched Medicare fraud investigations into the health care center that has put more than 40,000 people at risk of hepatitis and HIV infections.
Rep. Jon Porter, R-Nev., confirmed Thursday that the investigations focus on allegations the Endoscopy Center of Southern Nevada billed Medicare for visits of more than 30 minutes when doctors spent less than half that amount of time with a patient.
"We are talking with the GAO (General Accounting Office) about the possibility of a report detailing just how large this problem is in the country," Porter said.
Porter said he learned of the probes during a Feb. 29 briefing in Las Vegas with Dr. Lawrence Sands, chief health officer for the Southern Nevada Health District. Porter said Sands told him investigators found that the clinic engaged in the overbilling on a "substantial number" of occasions.
Sands was unavailable for comment Thursday, as were investigators for the two federal agencies.
News of the investigations came as a former doctor at the clinic run by Dr. Dipak Desai revealed to the Review-Journal that he and other physicians were ordered to perform unnecessary biopsies to run up patient charges and to bill for up to 40 minute "patient consults" while spending about 5 minutes with each patient.
A biopsy is the removal of a sample of tissue from the body for examination under a microscope to assist in diagnosis.
The former doctor at the Desai clinic said biopsies were performed during colonoscopies and upper gastroenterological examinations. He said they posed little risk and were just little "snips."
But the head of emergency services at University Medical Center, Dr. Dale Carrison, said that while the procedures are generally safe, they are not without risk. The primary risk of a biopsy of a colon is perforation of the colon which can dramatically increase the chance of abdominal infection, he said.
The primary risk of biopsies of the stomach, he said, is bleeding. "It does happen," Carrison said.
Porter said that it might be necessary to introduce legislation that would make ambulatory care centers, also known as outpatient or same-day surgery centers, subject to stricter patient care regulations, similar to those that hospitals follow.
"We want to determine whether additional legislation is necessary (for patient safety)," he said.
The doctor, who worked at the Desai clinic from 1997-2000, alleged that at that time the unnecessary biopsies, coupled with the fabricated lengthy patient examinations, could add more than $300 to a bill.
The physician, who asked for anonymity because he fears "retaliation" from Desai, said he left the clinic in 2000 because he "was so depressed."
"It was so unethical," he said. "I couldn't live with myself."
He said he didn't speak up at the time because he needed a job.
Some time after he cut ties with Desai, the doctor was interviewed by the FBI, he said.
Desai remains unavailable to the media.
The former physician at Desai's 700 Shadow Lane facility said Desai literally ordered physicians to perform biopsies.
"When I wouldn't do it, I would get reprimanded," the physician said. "Desai dictated everything there."
The physician, a former Air Force officer who is retired and living in Summerlin, said he did not see the unsanitary conditions described by federal and state officials. Health professionals at the center were found to have reused syringes on infected patients and contaminated vials of medicine that were shared among patients.
Six patients have tested positive for hepatitis C. Five of those were treated on Sept. 21; the other patient was treated on July 25.
Health officials have sent letters to 40,000 of the clinic's patients, urging them to get tested for hepatitis C and B and HIV, the virus that causes AIDS. Hepatitis is a potentially deadly blood-borne disease that attacks the liver.
The former doctor at the clinic said Desai continually stressed the need to make more money.
"He would tell us to do two biopsies rather than one," he said. "It just destroyed me to do that when it wasn't necessary."
The physician said doctors remained with Desai because "they had bills to pay."
"There are still some good doctors with him," he said. "They just care about money too much."