01/30/2023    Allen Jacobs, DPM

AZ Podiatrist Pulls His Investment in Modern Vascular (Randall Brower, DPM)

The potential abuse of patients by Modern Vascular
as suggested by the DOJ is neither surprising or
shocking. The article citing the DOJ accusations
against Modern Vascular notes the 90% referral role
here in St Louis. The DOJ further alleges that the
business model of Modern Vascular does not protect
the investors under safe harbor statutes.

I declined to invest after listening to their
description of this business model. The St Louis
facility now claims (I am told by local podiatry
investors) it has a profit distribution for local
investors of $1,000,000 following a relatively
short period of operation here.

There is a distinction between legal and ethical.
How could a writer to PM News claim 20 referrals a
month to this facility? Podiatrists (and other
referring practitioners) will rationalize their
participation by claiming they are not intervention
radiologists, cardiologists, or vascular surgeons.
They will maintain their concern for patients with
potential PAD. They will rightfully note that
ultimately, the decision to perform unnecessary
procedures was that of the cardiologist, vascular
surgeon, or radiologist. After all, when a PCP
refers a patient with a bunion, the decision to
proceed with surgery is that of the podiatrist AND
patient.

What is insulting to me is the suggestion that
those who invested were unaware of this abuse,
while cashing in. PAD intervention such as
angioplasty or stem ting is the new area of abuse.
The excessive and unnecessary use of such
procedures in the treatment of coronary artery
disease is well documented. Thus, our
interventional and vascular colleagues have moved
on to the lower extremities. They market referrals
from podiatrists by constantly “ lecturing “ at our
seminars. It is the new frontier of fraud and
abuse.

I have personally had patients who have been
subjected to in my opinion questionable procedures
at Modern Vascular here in St Louis. Oh I can hear
it now. “you are a podiatrist. Not a vascular
surgeon. Not a cardiologist. Not a radiologist.
What do you know”. Well, I know what I know.

The acceptance of legal but not ethical is rampant
in medicine, including podiatry. We have
podiatrists in St Louis who perform arthroscopic
cutting of the interosseous ligament and then
implant a “stent “ in the sinus tarsi. Who
routinely take uncomplicated toenail correction,
removal of protruding K wires, and simple wart
excisions to the surgery centers they own. Office
owned “laboratories” process toenail specimens on
every patient yet seldom actively treat
onychomycosis.

Everyone knows what is occurring. BUT, because they
are sharing in profit, the abuse of patients is
accepted as legal if not ethical, or as “part of
the art of medical practice“. The fraud and abuse
continue unchallenged as there is money to be made.
It is the Sergeant Shultz “I see nothing”.

The next time you complain about decreased
payments, increased regulatory burden, frequent
audits, consider that perhaps you reap what you
sow. The decision not to act is a decision. The
acceptance of that profit sharing check is tacit
approval of the illicit actions generating that
check. Do not however suggest that you were as said
in Casablanca, “Shocked. Shocked to find that there
was gambling going on in there.”

Allen Jacobs, DPM, St. Louis, MO

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