Cassim v. Bowen

Facts

Dr. M.M. Cassim was a licensed surgeon practicing in Dallas, Oregon, with forty percent of his income derived from Medicare patients. In early 1985, OMPRO initiated a routine quality review of Cassim’s surgical care and subsequently examined all surgeries he performed during a six-month period. OMPRO reviewed medical records of eighty patients and identified thirteen alleged gross and flagrant violations of professional standards. OMPRO conducted its initial investigation without consulting Cassim, the patients, attending nurses, other physicians, or the hospital’s quality assurance committee, and lacked complete medical records including some x-rays and lab data. OMPRO notified Cassim of its findings in October 1985, giving him thirty days to submit rebuttal information and offering him the opportunity to meet with OMPRO representatives. Cassim met with OMPRO’s surgical review panel, was represented by counsel, presented his defense, and introduced missing documentation. Based on this additional information, OMPRO reduced the alleged violations from thirteen to eight. OMPRO recommended to the Office of Inspector General that Cassim be excluded from Medicare for one year. OIG affirmed the findings, concluding that Cassim had performed unnecessary surgery on eight patients aged 66 to 86, placing them in high risk situations with potential for patient harm. OIG ordered exclusion for one year and publication of notice in local newspapers, while informing Cassim of his right to appeal to an administrative law judge.