Catena v. Commonwealth, State Board of Medical Education & Licensure

411 A.2d 869, 49 Pa. Commw. 542, 1980 Pa. Commw. LEXIS 1212
CourtCommonwealth Court of Pennsylvania
DecidedFebruary 29, 1980
DocketAppeal, No. 574 C.D. 1979
StatusPublished
Cited by11 cases

This text of 411 A.2d 869 (Catena v. Commonwealth, State Board of Medical Education & Licensure) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Catena v. Commonwealth, State Board of Medical Education & Licensure, 411 A.2d 869, 49 Pa. Commw. 542, 1980 Pa. Commw. LEXIS 1212 (Pa. Ct. App. 1980).

Opinions

Opinion by

Judge MacPhail,

William P. Catena, M.D. (Petitioner) appeals an order of the State Board of Medical Education and Licensure (Board) suspending his license to practico medicine for six months and placing him on probation with conditions for a period of three years.

Petitioner was charged by the Board under Section 15 of the Medical Practice Act of 1974 (Act), Act of July 20, 1974, P.L. 551, as amended, 63 P.S. §421.15, based on two separate allegations of. misconduct. [544]*544First, Petitioner was convicted and sentenced in federal court for knowingly presenting to an agency of the federal government claims for reimbursement under Medicare for medical services supplied, which claims were false, fictitious and fraudulent.1 Second, Petitioner treated two Pennsylvania State Troopers, who were working as undercover narcotics agents, for weight control. During the course of treatment, Petitioner prescribed quantities of Schedule II drugs2 designed to suppress their appetites, but failed to conduct adequate physical examinations, monitor the treatment, or maintain proper medical records for them.

The hearing examiner found that the conviction for Medicare fraud constituted a violation of Sections 15(a) (2)3 and 15(a) (8)4 of the Act and that the inadequate care given the troopers constituted a violation of Section 15(a)(8). An order was entered suspending Petitioner’s license for six months and placing him on probation for three years. By the terms of the probation, the Petitioner would be precluded from treat[545]*545ing patients for obesity or cosmetic weight loss. Upon Petitioner’s application for review, the Board affirmed the hearing examiner’s order on February 14, 1979. This appeal followed.

Petitioner argues before this Court that (1) conviction for Medicare fraud does not constitute a misleading, deceptive, untrue or fraudulent representation in violation of Section 15(a)(2) of the Act, nor does it establish unprofessional conduct in violation of Section 15(a)(8) of the Act, (2) the discipline imposed by the Board as a result of the findings based on Medicare fraud is so harsh in light of Petitioner’s medical competence and attainment as to be an abuse of discretion, and (3) the finding of a violation of Section 15(a) (8) of the Act based on the treatment of the troopers is not supported by substantial evidence.

Section 15(a)(2)

Petitioner argues first, that although fraud in billing patients would be within Section 15(a)(2), fraud in billing a third party payor is outside the doctor-patient relationship and, therefore, outside the practice of medicine as defined in Section 15(a)(2).

While Petitioner admits that billing patients is included within the scope of “practice of medicine,” there are no Pennsylvania cases that so hold. Other jurisdictions, however, have determined that submission of fraudulent bills constitutes fraud in the practice of medicine. Matanky v. Board of Medical Examiners, 79 Cal. App. 3d 293, 144 Cal. Rptr. 826 (1978); Kaplan v. Department of Registration and Education, 46 Ill. App. 3d 968, 361 N.E.2d 626 (1977); Wassermann v. Board of Regents, 11 N.Y.2d 173, 182 N.E.2d 264, 227 N.Y.S.2d 649 (1962). We also note that this Court stated in State Dental Council and Examining Board v. Friedman, 27 Pa. Commonwealth Ct. 546, 367 A.2d 363 (1976) that Section 3(i) of The Dental Law, [546]*546Act of May 1,1933, P.L. 216, as amended, 63 P.S. §122 (i), empowered the State Dental Board to maintain the standards of the dental profession, which standards deal with “all aspects of professional conduct.” Id. at 551, 367 A.2d at 366. In view of the similarities between the two professions, it would be illogical to assume that the legislature intended for the standards relating to dentists to be more inclusive than those relating to physicians. We hold, therefore, that billing patients is within the scope of the term “practice of medicine” as used in Section 15(a)(2).

Petitioner urges, however, that when a physician bills a third party payor the activity is outside the doctor-patient relationship and, therefore, outside the practice of medicine. Petitioner relies on cases decided under the prior law, which was contained at Section 12 of the Medical Practice Act of June 3, 1911, P.L. 639, as amended, formerly 63 P.S. §410, repealed by the Act of July 20,1974, P.L. 551. That section provided, inter alia, that a license to practice medicine could be revoked for “grossly unethical conduct.” Cases interpreting this phrase limited its application to “ ‘those breaches of the trust, confidence and reliance, necessarily attendant upon the intimate relationship of physician and patient, which amount to gross abuses of the standards of professional conduct generally recognized as essential to the proper practice of medicine and surgery.’ ” Pennsylvania State Board of Medical Education and Licensure v. Ferry, 172 Pa. Superior Ct. 372, 378, 94 A.2d 121, 124 (1953). See also, State Board of Osteopathic Examiners of Pennsylvania v. Berberian, 200 Pa. Superior Ct. 533, 190 A.2d 330 (1963).

Petitioner’s reliance on these cases is misplaced. First, the former statute contained grounds for discipline other than “grossly unethical conduct,” including “any form of pretense which might induce persons [547]*547to become a prey to professional exploitation.” It is obvious that because other grounds for discipline existed in the law, the cases cited do not hold that a physician could never be disciplined for conduct outside the doctor-patient relationship. Therefore, a finding that fraudulent billing of a third party payor is within the scope of Section 15(a)(2) would not be inconsistent with the cases cited.

Second, it seems clear to us that billing third party payors is within the doctor-patient relationship when a patient becomes the tool of a physician’s fraud. The mere substitution of victims does not take the activity outside the scope of Section 15(a)(2). If Petitioner’s logic were to be accepted, a doctor could not be disciplined for fraud in billing a child’s parents for services rendered to the child because the parents are outside the doctor-patient relationship. Such a result is patently absurd and Petitioner’s argument must be rejected.

We conclude that Petitioner’s narrow reading of the phrase “practice of medicine ’ ’ is not supported by the former statute or the cases decided thereunder, nor is it in accord with a fair reading of Section 15(a) (2) and the Board’s duty to protect the citizens of this Commonwealth. Friedman, supra at 550, 367 A.2d at 366. See also, Miller v. State Dental Council and Examining Board, 39 Pa. Commonwealth Ct.

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Bluebook (online)
411 A.2d 869, 49 Pa. Commw. 542, 1980 Pa. Commw. LEXIS 1212, Counsel Stack Legal Research, https://law.counselstack.com/opinion/catena-v-commonwealth-state-board-of-medical-education-licensure-pacommwct-1980.