03/27/2019 - US Expert Witnesses Different Conclusions From The Same Data In Dallas Forest Park Medical Center Case

Jurors in the Forest Park Medical Center kickback and bribery trial in Dallas have received differing conclusions from the same medical billing and claims data for certain surgeries at tthe forefront of the case.

An expert witness for the defense told jurors Monday and Tuesday that her analysis of the data shows that surgeries Dr. Michael Rimlawi and Dr. Douglas Won performed at Forest Park fluctuated over the years and revealed no clear patterns.

But a government expert told the jury earlier in the trial that her analysis revealed that the doctors' surgeries at Forest Park generally tracked with the amount of marketing money the hospital paid them. Prosecutors allege bribes and kickbacks paid to the doctors were
disguised as marketing payments. The more money Forest Park paid the doctors,
the more surgeries they performed at the hospital between 2009 and 2012, the government argued.

What the data really means doctors cannot be compensated based on the volume or value of patient referrals to a certain health care facility. Defense attorneys argue that their clients were paid under legitimate "co-marketing agreements" designed to increase business for the hospital as well as its referring doctors. They say the marketing agreements complied with federal law because monthly payments were fixed and not tied
to any surgeries, and no quotas were set for the number of surgeries. The trial is in its sixth week, and lawyers for some of the nine defendants on trial, including Won and Rimlawi, continued this week to call witnesses.

The defendants are accused of paying and accepting bribes and kickbacks from Forest Park in exchange for the referral of patients. Three of them are high-profile surgeons in the Dallas area who prosecutors say earned the most money from the bribery scheme.
The federal indictment alleges that Won was paid $5.9 million, Rimlawi was paid $4.5 million, and Dr. Nick Nicholson was paid $3.6 million.

A total of 21 people were charged in 2016 in the alleged $200 million health care scheme. Many have pleaded guilty, some of whom testified for the government during the trial. The government alleges that Forest Park paid $40 million in bribes and kickbacks to doctors, recruiters and others from 2009 to 2012 for drumming up patients for the now-defunct hospital.

On Tuesday, Charlotte Kohler completed two days of testimony for Rimlawi and Won, which included some testy exchanges she had with Assistant U.S. Attorney Katherine Pfeifle.

Kohler, an accountant who owns a Maryland-based health care consulting company, took
issue with the government's summary charts, saying Pfeifle was "confusing different
data points and using them to your benefit."

Scott Thomas, an attorney for Nicholson, a bariatric surgeon, noted that while Kohler explained exactly how she crunched the government's claims data, the government did not provide similar information about its analysis to the jury.

"We don't know how it was created, right?" Scott asked.

"That's correct," Kohler said.

Kohler said she's worked as a compliance officer for five different hospital systems and
charged almost $180,000 for her employment.

She told jurors that Won, a spine specialist, performed just 29 percent of his surgeries
at Forest Park from 2009 to 2012. And she called his surgeries "sporadic" at the various hospitals where he has privileges.

"I don't see any consistency," Kohler told the jury about Won's surgeries.
"I don't see any pattern of volume ... you just see it go up and down. Almost appears to be random." Dueling data

Kohler also testified that her data analysis shows Nicholson and Won charged the same fee
for their surgeries regardless of the locaation they performed the procedures.

When asked about the noticeable decline in surgeries at Forest Park in 2013, Kohler said she was told it was due to "financial difficulties" Forest Park was experiencing that led to staff cuts, a lack of supplies and other budget reductions. As a result, doctors took their surgeries elsewhere in 2013, she said.

Under cross-examination by Pfeifle, Kohler conceded that she didn't try to independently
confirm that claim. Defense attorneys Chris Lewis and Thomas Mesereau also said during the trial that Forest Park's financial problems beginning in 2013 led to reduced surgeries there.

Kohler claimed the earlier 2012 spike in surgeries at Forest Park were due to
the hospital becoming in-network in 2011.