California Doctor Facing Fraud Allegations for Incentivizing Expensive Procedures

A California doctor responsible for the pain management treatment of thousands of patients has been accused of committing malpractice and insurance fraud by the State Department of Justice (DOJ). Doctor Francis Lagattuta, the head physician and practice owner of the Lags Medical Centers chain, is being investigated alongside his practice.

The DOJ investigation is based on claims that Dr. Lagattuta encouraged employees to perform unnecessary treatments so the chain would receive larger insurance payments. Here’s what you need to know about the allegations against Dr. Lagattuta and Lags Medical Centers and how you can avoid getting harmed by similar unscrupulous healthcare professionals.

Patients at Lags Medical Centers Suffered Unnecessary and Painful Procedures

Lags Medical locations were responsible for helping more than 20,000 people access pain management treatment. The majority of the chain’s patients were people with government-funded insurance that covered treatment for debilitatingly painful conditions. That’s where the potential for fraud came in.

According to former Lags Medical employees, Dr. Lagattuta gave bonuses to employees for treating more than 32 patients a day. Furthermore, employees testified that they received even higher bonuses if they performed procedures that carried especially high compensation rates at government insurance programs. These procedures included injections, punch biopsies, and nerve ablations, all of which are painful to the patient.

This potentially increased the rate at which Lags Medical employees performed these tests significantly. According to state records, the chain performed one of every six nerve ablations performed in California between 2015 and 2020.

The company also performed more than double the most expensive drug tests than the next closest competitor, which was a lab company specializing in testing patients. Dr. Lagatutta received $5.4 million for these drug tests between 2017 and 2019 from Medicare alone. The DOJ believes these actions demonstrate that Dr. Lagattuta encouraged his staff to perform insurance fraud.

Furthermore, this fraud also involved malpractice. Over-treating patients and subjecting them to superfluous, painful procedures is a direct violation of medical ethics. This behavior neglects the patient’s best interests, actively harming them to make more profit for the provider. Should the DOJ’s allegations hold up in court, then Dr. Lagattuta’s actions have harmed thousands of California citizens already suffering from severe pain.

Why Healthcare Professionals May Commit Insurance Fraud

Unfortunately, stories like the Lags scandal are too familiar. While doctors and other healthcare professionals are supposed to “do no harm,” they are only human. Some people simply care more about their own wallets than the health of other people.

That’s why some healthcare professionals like Dr. Lagattuta over-treat patients. A person with government insurance presents an opportunity to unscrupulous doctors. Medicare and CalMed cover even large bills more readily than private insurance programs. An unethical doctor might subject a patient to unnecessary medication or painful procedures because their insurance will pay them for it.

Even medical workers who care about their patients may still fall into the trap of insurance fraud and malpractice if they work for an unethical hospital. For instance, many brand-name prescriptions have excessively high price tags compared to identical generic meds. However, hospitals that give patients the brand-name drug when they come to the hospital can charge the patient’s insurance much more than it could for the generic. This lines the hospital’s pockets, so the administration may push individual nurses and physicians to stick to brand-name options.

What to Do If You Suspect Your Doctor’s Defrauding You

If you think your healthcare team might be trying to over-treat you for insurance fraud reasons, you need to act. The longer you accept over-treatment, the more likely it is that you’ll suffer unnecessary, potentially life-threatening side effects.

Furthermore, you’ll be forced to pay unnecessary deductibles and potentially miss out on treatment that could actually help your health. Here’s how to approach potential insurance fraud and medical malpractice the right way.

Request Your Medical Records

As soon as you’re concerned about your medical care, you should request copies of your medical records. These documents are critical for two reasons. First, they explain the treatment you’ve received so far and the purpose behind it, which is helpful for understanding your care team’s intentions.

Second, your medical records give you documents you can show to other professionals. If you’re worried about being over-treated, you can take your medical records to another doctor and ask their opinions about your treatment.

Get Expert Opinions

Asking for second opinions is the next step in the process. Once you have your records, you should get in touch with unbiased third parties to discuss what they contain. You should consider reaching out to both an unaffiliated healthcare professional and a medical malpractice attorney.

The healthcare worker can advise you on whether the treatments were necessary or useful. They can also point out whether there were less painful and expensive options or medications with fewer side effects that you could have been prescribed. Meanwhile, the malpractice lawyer can help you understand whether what you’ve suffered is grounds for a lawsuit.

Take Legal Action

If the experts you talk to agree that you’ve been over-treated, then it’s time to take legal action. Insurance companies, ethics boards, and the California court system frown on insurance fraud and medical malpractice. Your malpractice attorney can guide you through the process of filing any complaints and lawsuits necessary to hold the healthcare professionals who harmed you accountable for their actions.

Stand Up to Medical Insurance Fraud and Malpractice in California

Just because you’re receiving treatment on your doctor’s orders doesn’t mean you’re getting the proper treatment. California’s current insurance systems incentivize unscrupulous healthcare professionals to overtreat people. If you think you’re facing over-treatment, you could be at risk of serious financial and medical harm.

The best way to approach potential insurance fraud and medical malpractice is to speak with an experienced malpractice lawyer. The expert team at the Law Offices of Michael Oran, APC, can help you understand your treatment and determine if you’re facing malpractice. Schedule a consultation today to learn how they can help you.

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