California pain clinic with 23 locations suddenly closes

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Agast

Agast

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Abrupt closure of Lags Medical Clinics leaves patients without care or referrals

From the Lags Medical Center website:
LAGS Medical Centers is a pain management group operating throughout California, Oregon, Washington & Nevada. Since 2000, the LAGS alternative approach to pain treatments has returned patients to a healthy, active lifestyle: restoring function by minimizing pain. Dr. Lagattuta served as a Team Doctor/Physiatrist for the Chicago Bulls basketball team during their record, 72-game winning season in the Michael Jordan era. He attributes much of that success to seeing that pain can be treated by restoring movement and minimizing the use of drugs. Eventually, he developed the MAP protocol: a 3-tiered approach directly addressing pain sources from Metabolic, Anatomical and Psychological perspectives, rather than just covering up pain with opiates or pain pumps. Focusing interventional, less-invasive treatments on a patient’s pain source(s) can remove the need for pain-related emergency room visits, avoid costly surgeries and ultimately reduce the cost of care.

LAGS has grown to care, at scale, for a large base of ‘underserved’ (Medicaid/Medicare patients), who often experience challenges in accessing healthcare. Our 38 clinics are ideally equipped to serve these and many other patients across 25 counties.
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KSBY reached out to LAGS Pain Management and they said they cannot yet disclose why they closed. However, they’re giving patients a 30-day supply of their medication and referring them back to their primary doctors.// Might be a health issue.
 
willabeast said:
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KSBY reached out to LAGS Pain Management and they said they cannot yet disclose why they closed. However, they’re giving patients a 30-day supply of their medication and referring them back to their primary doctors.// Might be a health issue.
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All locations closed at the same time...smells like a government issue
 
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What could possibly go wrong with 20-30 locations prescribing controlled substances likely fairly liberally.
 
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Laryngospasm said:
What could possibly go wrong with 20-30 locations prescribing controlled substances likely fairly liberally.
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How many times over the next 30-60 days will patients ask their new pain doctor
“Why can’t you just give me what my last clinic gave me? It was working!”

response should be:
“Just go back to them then.”

“but they are closed”

“exactly”
 
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Wasn’t there an unaccredited fellowship there too? Feel bad for the incoming guys.
 
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wendalltwolf said:
Wasn’t there an unaccredited fellowship there too? Feel bad for the incoming guys.
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Maybe that’s where Piebaldi went

And her whistleblower dreams just came true
 
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I have met this guy before when I was a fellow. Didn’t train there though. Seemed like a nice guy but talked about some shady stuff he was doing. After spending a couple hours around him I hate to say I saw it coming and am not surprised this happened at all. I think have a pretty good idea of what may have happened. Not meds likely as he said they would typically not write more than norco 10 qid, but stark issues.
 
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So I am actually bearing the brunt of the backlash in my clinic as he has multiple clinics in my area.

I agree with the poster above, I don’t think it’s an opiate issue as most patients that l see from his clinic are usually below 50mme.

Taking the standard approach, willing to see their patients for consultation only.

We are clear no narcotic Rx will be written.

Offering interventional treatments, non opiate medication management.

Any other advise from those who have experience with situations like these.
 
I saw another article that said an employee mentioned a Medicare issue, so likely fraud/stark like I thought. He talked a lot about punch biopsies for small fiber neuropathy that was being done in a lab he owned. He let it slip that providers were being bonused 100 per punch biopsy and some were doing close to 20 per week. Not sure how that is not a stark violation and possibly the issue. They definitely operated a high volume practice with each person having 2-3 scribes. Who knows what else was happening
 
RM38 said:
I saw another article that said an employee mentioned a Medicare issue, so likely fraud/stark like I thought. He talked a lot about punch biopsies for small fiber neuropathy that was being done in a lab he owned. He let it slip that providers were being bonused 100 per punch biopsy and some were doing close to 20 per week. Not sure how that is not a stark violation and possibly the issue. They definitely operated a high volume practice with each person having 2-3 scribes. Who knows what else was happening
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Im sure this clinic got shut down for more reasons than kickback punch biopsies
 
painfree23 said:
Im sure this clinic got shut down for more reasons than kickback punch biopsies
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You are probably right as I can’t imagine they only pushed/went past the gray area on one thing. But with the number of clinics and docs/mid levels they had in that practice the kick backs alone could have easily reached 10mil over the course of multiple years. If they also go back after the lab fee and biopsy fee.....big time money
 
PMR2008 said:
he was pretty busy
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He only billed 12,326 99214's. I am guessing most were by the mid levels/fellows
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#1 for visits, #2 for services performed. I’m sure some mid levels earned some broken digits for this laziness. Not ordering a UDS, genetic metabolism profile, mbb, sij, interlam then tfesi (and punch bx) on the first eval is clear evidence of an inadequate H&P.
 
I had a desk full of referrals yesterday and today. Sure, mme weren’t the highest but combo LA benzo in the mix in more than a couple in there. All the referrals were for taking over opioid rx.
ounch biopsy was common complaint for patients who went there. Also waiting hours to see a video screen mid level for Med refill
 
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I would not accept a single one of those patients. A local Shots for pills clinic closed right when I started practice and I vetted the referrals carefully (or so I thought). The only one of those patients still standing is a Workers Comp guy because he just went where he was sent. Anyone else willing to wait hours for their script knows they’re participating in something shady and they’re here for it. They slip up eventually and you end up firing them.
 
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gaseous_clay said:
I must’ve missed this boat. Who is piebaldi?
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It’s a pretty big boat. I guess she deleted her whistleblower thread for legal reasons.

forums.studentdoctor.net

Co-fellow fired

Hey all, Wanting some thoughts on this. My co-fellow was recently fired. I don't know what's going to be done in terms of finding a replacement or not. So now my call suddenly increased ridiculously from every 3 weeks to every other week. I am not ok with this. I didn't sign up for this. I...
forums.studentdoctor.net forums.studentdoctor.net

forums.studentdoctor.net

Tail coverage

Let me state my previous thought in a different manner: You have a moral obligation to report this to the state medical board.
forums.studentdoctor.net forums.studentdoctor.net
 
Agast said:
I would not accept a single one of those patients. A local Shots for pills clinic closed right when I started practice and I vetted the referrals carefully (or so I thought). The only one of those patients still standing is a Workers Comp guy because he just went where he was sent. Anyone else willing to wait hours for their script knows they’re participating in something shady and they’re here for it. They slip up eventually and you end up firing them.
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It illustrates what a slippery slope pain management can be. Clinics seem to be almost all legit pts or 100% secondary gain pts.

I think once people compromise themselves and see how easy it is to scam the system and live the high life, why bother with the slog of challenging pain cases and actually practicing medicine?
 
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Agast said:
It’s a pretty big boat. I guess she deleted her whistleblower thread for legal reasons.

forums.studentdoctor.net

Co-fellow fired

Hey all, Wanting some thoughts on this. My co-fellow was recently fired. I don't know what's going to be done in terms of finding a replacement or not. So now my call suddenly increased ridiculously from every 3 weeks to every other week. I am not ok with this. I didn't sign up for this. I...
forums.studentdoctor.net forums.studentdoctor.net

forums.studentdoctor.net

Tail coverage

Let me state my previous thought in a different manner: You have a moral obligation to report this to the state medical board.
forums.studentdoctor.net forums.studentdoctor.net
Click to expand...
Reading these threads gave me a headache. Glad I missed that boat.
 
lobelsteve said:
Single payor. Salary cap. Tort reform. End precert/PA.

Lots of ways to fix and streamline a system.
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You are going to take some **** for suggesting what you have but that very well may be the best way to fix this broken system. Just look at the absolute monsters our current system has created.
 
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NJPAIN said:
You are going to take some **** for suggesting what you have but that very well may be the best way to fix this broken system. Just look at the absolute monsters our current system has created.
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Just opening a conversation. I have a salary cap. I believe dollars for docs has helped. There is a local Ortho getting $6 million from industry. I would never send him anyone. He is just too dirty IMO.
 
hyperalgesia said:
I thought crybaby = piebaldi?
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giphy.gif
 
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It’s a public health issue,local authorities and hospital systems should be encouraged to step up and help. That doesn’t necessarily mean taking over all the prescribing, but helping with detox and Suboxone referrals would be useful.
 
SeniorWrangler said:
It’s a public health issue,local authorities and hospital systems should be encouraged to step up and help. That doesn’t necessarily mean taking over all the prescribing, but helping with detox and Suboxone referrals would be useful.
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I suggest doing what you do on Halloween when you don’t want to be bothered with trick or treaters. Leave a bowl of Suboxone on the doorstep and hope it lasts long enough that you don’t get egged.
 
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NJPAIN said:
You are going to take some **** for suggesting what you have but that very well may be the best way to fix this broken system. Just look at the absolute monsters our current system has created.
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My only objection to some type of socialized system is that it tends to interfere with the free market.

If I have cash and I want cutting edge private treatment, the government can't use it's monopolistic leverage to suppress that option. That's what Medicare does now.
 
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hyperalgesia said:
My only objection to some type of socialized system is that it tends to interfere with the free market.

If I have cash and I want cutting edge private treatment, the government can't use it's monopolistic leverage to suppress that option. That's what Medicare does now.
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That’s why maybe a limited public system and private option makes economic sense. Everyone gets their Lipitor, immunizations and screening colonoscopies for free, and you pay if you want premium access, brand name drugs, or, dare I say it, pain treatment… everyone gets a baseline level of support - enough to keep their bodies working, and you pay free market rates for anything beyond that. Not so simple when it comes down to the nuts and bolts but I’ve heard some countries have good results with such a setup.
 
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The write-up from their web site about the bulls and Jordan reeks with BS. All it lacks is the word “holistic “.
 
callmeanesthesia said:
That’s why maybe a limited public system and private option makes economic sense. Everyone gets their Lipitor, immunizations and screening colonoscopies for free, and you pay if you want premium access, brand name drugs, or, dare I say it, pain treatment… everyone gets a baseline level of support - enough to keep their bodies working, and you pay free market rates for anything beyond that. Not so simple when it comes down to the nuts and bolts but I’ve heard some countries have good results with such a setup.
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Maybe we just reform Medicaid and eliminate enrollment requirements... But it would never fly because people want MediCARE.

But people who already have Medicare would never allow their benefits to be curtailed to accommodate all.

So basically, I think the whole topic is thrown around only as a political pawn.
 
I have another 30 referrals sitting in my desk for when I get back...
Time to order a rubber stamp?
 
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callmeanesthesia said:
That’s why maybe a limited public system and private option makes economic sense. Everyone gets their Lipitor, immunizations and screening colonoscopies for free, and you pay if you want premium access, brand name drugs, or, dare I say it, pain treatment… everyone gets a baseline level of support - enough to keep their bodies working, and you pay free market rates for anything beyond that. Not so simple when it comes down to the nuts and bolts but I’ve heard some countries have good results with such a setup.
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In general, I like this setup. The only problem is people are greedy @$$holes and politicians will do whatever they can to pander to their voters. I guarantee that if this system was in place, the moment some kid dies because the mean government wouldn't authorize his/her $100K-per-day-not-that-efffective cancer treatment, politicians would fall over themselves trying to figure out a way to "expand coverage" to "save the kids".

Also, from what I understand, this is the situation in Canada. They are having trouble retaining good doctors in the public system because every doctor who can is trying to get those private patients.
 
NJPAIN said:
I suggest doing what you do on Halloween when you don’t want to be bothered with trick or treaters. Leave a bowl of Suboxone on the doorstep and hope it lasts long enough that you don’t get egged.
Click to expand...
You're joking but I like this idea. I would even consider making suboxone OTC with dosing amounts limited by the pharmacy to 16mg/day over the course of a month or so. I find that the vast majority of pts suffering from addiction don't really abuse it other than to prevent withdrawal. There seems to be a ceiling effect and the euphoric effects tend to dissipate after a couple of weeks.
 
Don’t know what happened in this instance, so not commenting specifically. But in my area they shut down a provider who was writing outrageous amounts of narcotics. There was absolutely no plan, the dea high fives one another and moves on. No treatment for the addicted, it’s left to the local physicians.

I haven’t taken these patients and the pcps in the area are super pissed at the pain docs who won’t take them.
 
I can guess why they should be. these are orphan patients who no "provider" wants, but were most likely being treated by one of their own. and now that they have responsibility, they aren't sure what to do with them, so they wonder about referral to a pain doctor, who might not have started opioids in the first place.



the problem is that the term "pain doctor" is a misnomer.

at best, you and I are "pain managers". the true pain "eliminators" are the candymen on the street corner dealing fentanyl.
 
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Ducttape said:
I can guess why they should be. these are orphan patients who no "provider" wants, but were most likely being treated by one of their own. and now that they have responsibility, they aren't sure what to do with them, so they wonder about referral to a pain doctor, who might not have started opioids in the first place.



the problem is that the term "pain doctor" is a misnomer.

at best, you and I are "pain managers". the true pain "eliminators" are the candymen on the street corner dealing fentanyl.
Click to expand...

Anyone who calls themselves a pain doctor these days is asking for it. I used to think it was a curse, but the beauty of "physiatrist" is that no one knows what it is or what to expect.
 
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paindoctor2014 said:
Don’t know what happened in this instance, so not commenting specifically. But in my area they shut down a provider who was writing outrageous amounts of narcotics. There was absolutely no plan, the dea high fives one another and moves on. No treatment for the addicted, it’s left to the local physicians.

I haven’t taken these patients and the pcps in the area are super pissed at the pain docs who won’t take them.
Click to expand...

i had 70 referrals sitting on my desk today faxed in garbage records from PCPs and some phone calls asking why I refused some referrals...
 
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