By Andrew Ford Published Feb 23, 2023 by The Arizona Republic.
John Romine, 77, slowly walked to the door of Modern Vascular’s clinic in Surprise. He had an uneventful surgery there before Christmas, he said. He was supposed to have a follow-up visit on Friday.
His wife called on Wednesday to check on the appointment. Romine said she was told the clinic was “permanently closed.”
He drove over to investigate, but he found the front door was locked.
Modern Vascular appears to have shuttered the clinic following an investigation by The Arizona Republic, a complaint from the Department of Justice that quoted the newspaper story, and an email sent to staff last week from the company’s new CEO, Patrick F. Santore Jr.
Calls to the clinic were forwarded to Modern Vascular’s management company, which didn’t respond.
Santore’s email, obtained by The Republic from two sources, shows some of the Modern Vascular clinics received letters saying Medicare was “presently suspending all payments pending the outcome of the DOJ investigation.”
Medicare payments have made up a large portion of the company’s revenue, and the DOJ claimed Modern Vascular defrauded Medicare to the tune of $50 million.
“Our legal team is actively engaged with the appropriate CMS authorities and is working towards an expedient resolution to this matter,” Santore’s email said.
The Centers for Medicare and Medicaid Services declined to comment about the accuracy of Santore’s email.
Modern Vascular clinics got the letters regarding Medicare on Feb. 9, according to a statement Santore provided to The Republic on Thursday. Their payments are suspended pending the outcome of the DOJ’s lawsuit, the statement said.
“To be clear, Modern Vascular has not been sanctioned or terminated by the Medicare Program,” Santore’s statement said, “rather payments to the facilities have been temporarily placed on hold. Modern Vascular expects that the suspension will be lifted. While this is a temporary setback, Modern Vascular continues on its mission of preserving the limbs of an otherwise underserved and largely ignored patient population.”
Modern Vascular’s Tucson, Albuquerque clinics closed earlier
Modern Vascular closed clinics in Tucson and Albuquerque earlier this year. The pages for those locations were removed from the Modern Vascular website, and a recent news release from the company advertised 15 locations instead of 17. Calls on Wednesday to seven clinics listed on the site, including the one in Surprise, were forwarded to Modern Vascular’s management company.
The closed clinics in Tucson and Albuquerque were the site of wrongdoing claimed in lawsuits, which the company disputed. That included a woman who died after a heart attack in the Modern Vascular clinic in Tucson, and a patient hospitalized with a blood clot the size of a basketball after treatment in the Modern Vascular clinic in Albuquerque.
The Republic’s investigation, Blood and Money, found emergency response records showing the staff of Modern Vascular called 911 when patients were in trouble, which the company said is a common practice. One of those 911 calls involved a patient in the Tucson operating room that emergency responders found “bleeding out,” the records showed.
“Bringing attention to what was going on in those facilities is key to pushing them to act,” said Lisa McGiffert, of Patient Safety Action Network, a nonprofit working to end medical harm.
“And in this case,” McGiffert said, “they acted by retreating.”
The front door of the Tucson clinic was locked and no staff was visible inside when a reporter visited the clinic during business hours the second week of January. A notice lay on the ground that a medical waste pickup had been missed the week earlier. Christmas decorations still hung in the lobby. Calls to these clinics were also forwarded to the management company.
Modern Vascular lawsuits claim unnecessary procedures, patient harm
Founded in the Phoenix area, Modern Vascular rapidly spread across the country to at least 17 locations in 10 states. Along the way, it faced lawsuits including claims of patient harm and unnecessary procedures, almost all of which it denied in court.
At least four people lost limbs, and three of those individuals sued, as The Arizona Republic previously reported, with an updated count in USA Today. Modern Vascular faced lawsuit claims of wrongdoing in connection with two patients’ deaths. At least six patients said in lawsuits the procedures were unnecessary.
Nine of the 12 lawsuits are still open, and Modern Vascular has denied all the claims in court, as The Arizona Republic reported, with updated numbers in USA Today. One case settled under confidential terms, according to an attorney who sued a Modern Vascular doctor. Another attorney said he dismissed his lawsuit, which was related to the death of a Modern Vascular patient, because a toxicology analysis wasn’t done on the patient. An attorney involved in the third dismissed suit said he would neither confirm nor deny the case was settled.
Attorneys who represented the company in the past didn’t respond to recent requests for comment. But the company’s founder previously touted his company’s good works.
“We do a lot of amazing work,” Yuri Gampel previously told a reporter. “We save limbs every single day in all of our clinics.”
The Republic’s investigation was quoted in a Department of Justice complaint accusing Modern Vascular of fraud, saying the company placed “enormous pressure” on their staff to perform invasive procedures: “As Modern Vascular Corporate’s Chief Medical Officer Steve Berkowitz told a reporter for the Arizona Republic, ‘If you run a pizza joint and you’re not selling enough pizzas, you’re not going to stay in business.’”
The Republic’s investigation and the DOJ complaint spotlighted the company’s practice of engaging referring doctors as investors. The DOJ said the company made illegal payments to prompt other doctors to send them patients, allowing Modern Vascular to bill federal health care programs for claims that were “tainted by kickbacks and should not have been paid.”
The Republic’s investigation also revealed the checkered past of Modern Vascular’s top-billing doctor, Scott Brannan.
Brannan couldn’t be reached recently for comment, but previously spoke to a Republic reporter for more than 16 hours, detailing his rise from a trailer park home to national prominence. He chronicled his time in prison for a role in a marijuana-smuggling operation and his use of steroids. He shared his secret to success at his craft – an “irrational expectation of perfection.”
“I keep going when other people would sometimes stop,” he said.
Lawsuits claimed at least four people were hurt under Brannan’s care, as The Arizona Republic previously reported, with an updated count in USA Today. Brannan denied the claims in court. Two of the cases are ongoing. One case was settled, Brannan said, and one was dismissed.
At a previous clinic where Brannan worked, one of his patients died, according to court documents and testimony before the Arizona Medical Board. To head off a malpractice claim, Brannan said in a deposition, he paid the patient’s daughter in installments totaling $10,000.
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Statement from Modern Vascular CEO Patrick Santore
Some of Brannan’s past problems were revealed through advisory letters he was issued by the state medical board. The Republic obtained a trove of these letters, exposing hundreds of Arizona doctors with a problematic past. That includes: removing a patient’s ovaries without consent, showing up to work intoxicated, and failing to treat a patient exposed to gonorrhea.
The letters are public by law, but the state medical board pointed to a statute and a governor’s executive order which the board says prevents it from posting the letters online, where patients could access them easily.
While patient advocates, including McGiffert, supported the public’s access to these documents online, Arizona policymakers were largely silent.
Asked about the letters, Gov. Katie Hobbs said: “We’re reviewing practices across all the state agencies and my administration intends to operate with transparency. And so we’re gonna make sure that’s being done.”
The Republic asked each legislator who sits on House and Senate health and human services committees whether they’ll take action to make these letters more accessible. Only Rep. Patricia Contreras (D-Phoenix) responded.
“I think the public should probably have easier access to the information, the good and the bad, but I really need to find out what their reasoning is behind it,” she told the Republic. She said she’d explore the issue and consult all sides.
Seven of those lawmakers, including Contreras, were publicly endorsed in the last election by the political action committee of the Arizona Medical Association, which speaks up for doctors and backed the law to keep advisory letters off the internet.
“In making endorsements for the 2022 State General Election, ArMPAC’s Board of Directors carefully reviewed candidates’ positions, analyzed their voting records on key issues important to public health, and in some cases, conducted candidate interviews,” Shelby Job, spokesperson for the Arizona Medical Association, wrote in an email. “Candidates were then endorsed based on their willingness to listen to and support issues important to Arizona’s physicians and patients.”
Hobbs and all but one of those lawmakers have taken money from the Arizona Medical Political Action Committee – which bills itself as “supporting physician-friendly candidates.” Since 2020, the PAC gave a total of $6,725 to the legislators. Hobbs took their money during earlier elections.
Contreras pushed back when asked about the contribution, which records show was $150.
“You’re wanting to insinuate that we’re being motivated by this,” she said, “and at least in my situation, that is not the case at all.”
Rep. Amish Shah (D-Phoenix) was the only member of the House health and human services committee who didn’t get money from the PAC.
But in 2021 Shah, a doctor himself, gave $125 to the PAC.
Sarah Lapidus contributed to this story.