Exploring Ethics: Real-World Applications and Case Studies

As part of studying the subject of ethics, we had to write what I learned in ethics class essay. The article that I chose to write about is a Huntington Beach doctor getting indicted in a 135-million-dollar Medicare fraud scheme. Dr. Nagesh Shetty who is 74 years old was one of the seven healthcare professionals that were accused and charged in this scheme. Dr. Shetty has had a history of legal and disciplinary actions when it comes to healthcare. For example, in 1994 Dr. Shetty got in trouble federally for 28 counts of mail fraud with an insurance company that was based out of Minnesota. This case was later dropped by the state of California. In 1996 he was sentenced to 21 months in prison (federal) and was fined $40,000 for filing a false income tax return form, as well as, failed to report $400,000 in his income over a course of three years in the 1980s. While Dr. Shetty was in prison in 1998, he was charged federally for allegedly defrauding private and military health insurance. In the year 2000, Dr. Shetty was again convicted of 26 counts of mail fraud and was sentenced to serve two years in prison, and three years of parole. Dr. Shetty was also ordered to pay restitution, this included $28,000 to the U.S. Treasury and was ordered to pay more than $19,000 to Blue Cross Blue Shield. During this court process, The California Medical Board chose to revoke Dr. Shetty’s license. Not only was it revoked in the state of California, but it was revoked in the state of Washington and New York. The year of 2009, Dr. Shetty was reinstated after undergoing a probation period and completing an ethics course and a clinical training program. He also underwent monitoring and was unable to solo practice, as well as, supervising PA’s and billing matters. In 2016, he was accused of repeated negligence and failure to maintain accurate and adequate records involving a patient. This disciplinary order was effective April 26.

The ethical issues that are within this case are that this individual has no moral standard when it comes to his patients or the hospital he works for. You could even go to the length that he has no moral standard of how he should be acting. He was very selfish in what he was doing, and you could tell after reading this article that he was very money hungry and didn’t care about hurting anyone else but himself. You could also state that he was showing his patients, employer and insurance companies’ negligence by trying to get as much money out of them as he could. I believe that the biggest ethical issue that was violated in this article/case was honesty and trustworthiness. Dr. Shetty displayed no form of honesty and was having his patients go through “medically unnecessary” treatments and testing. This really damages the trust a patient has in a physician because you are making them go through unneeded treatments. You could also go the length of saying this is a form of malpractice on the physicians behalf.

The legal issues that were present within this article/case were fraud. I feel this was the biggest issue within this case not only because it was stated within the article/case, but because he was lying to the insurance companies about what the patients truly needed, and in return was able to get a great amount of money out of it. Not only did he have fraudulent mailing issues, but he was also hit for tax and insurance fraud. Altogether I think this is the biggest issue that sticks out when it comes to the legal issues.

When it comes to this case, in particular, it’s hard to determine which ethical theory this case/article resembles due to the simple fact that this doctor has no moral standards whatsoever. But if I were to say what this doctor needs to understand is Normative ethics and some of nonconsequential ethics. The reason that I chose to go with Normative ethics is that this theory talks about how one “ought to act” and I don’t believe Dr. Shetty knows “how to act” based on numerous cases against him. I do also believe that since he went through an ethics class to get his license reinstated, he should know what is right and what is wrong. So, the simple fact that he is getting charged again means that he doesn’t understand ethics, doesn’t have an idea of what is right and wrong, as well as, how one ought to act when taking care of patients and dealing with their health. The reason why I chose Nonconsequential ethics is because this states that “the nonconsequentialist believes right or wrong depends on the intention, not the outcome.” I chose this one for one specific aspect of the article/case and it’s based solely on the unnecessary medical cardiac treatments and testing. I believe that if he were doing these based solely on the fact that he cared about the individual’s health and not the money aspect he’d be in good shape because he was caring about that individual’s health. But since he did this with the intent of getting more money from Medicare shows that his actions were in the wrong and he wasn’t looking out for the patients’ health, but more towards his own needs. In my personal opinion, I believe that he should’ve referred back to the code of ethics at that facility to remind himself that what he is doing is wrong, and that it’s not only damaging the hospital, patient and him, but the reputation of the other doctors at that facility, as well as, around the city/nation.

Policy

Here at this facility, we pride ourselves on patient trust and satisfaction. So, we will be reinforcing and enforcing our code of conduct. This policy that we will be implementing is composed of background checks and a screening process (upon being hired) and quarterly ethical training. The purpose of this policy will be to avoid hiring people with problematic behavior and individuals with ethical behavior. If, however, we do decide to hire someone with a history of problems we will then focus on showing and teaching them how to help keep our hospital safe, as well as, maintain the trust between the physician, staff, and the patient. These individuals whether or not they are physicians or staff will have to report back to administration with a mandatory ethical checklist. Also, if they miss an ethical training, they have to get it made up immediately. If they don’t, they won’t be able to work until it’s done. If they are found guilty of treating the patients and/or staff unethically, they will be terminated immediately, and depending on the severity of the issue, law enforcement will be involved.

Reflective Conclusion

I think the most meaningful concept that I learned is Normative ethics. This is the most important to me because it’s how one “ought to act” and I feel as if you know how you’re supposed to act in the healthcare profession, then you’ll be just fine. Not only that, it basically falls into everything else as well. Of course, there are going to be some instances where just because you’re acting the way you’re supposed to, issues won’t arise. But again, I believe Normative ethics is the most meaningful concept I learned. My perspective for healthcare ethics has changed in a sense because it seems as though they are mainly based around past events that have happened in that clinic or around the world. I also feel as if you as an individual has to have a great understanding of ethics yourself because the healthcare system prides itself on quality care and ethics. My understanding of the laws has changed because I feel as if they were made based around ethics, and how you should be acting. Also, just like I stated above, I believe the laws are influenced or made based off of what has happened previously at that clinic, or in the nation.

References

• Pozgar, G. D. (2020). Legal and ethical issues for health professionals (fifth). Burlington, MA: Jones & Bartlett Learning.
• Sclafani, J. (2019, September 20). H.B. doctor indicted in $135-million Medicare fraud scheme.