Accident victim’s medical bills raise questions about anesthesiologist

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.

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/