We reported not long ago that Fox News was paying attention to recent stories about the marked increase in usage of the cosmetic surgery benefit by Buffalo Public Schools employees.
The folks at Fox apparently weren’t the only ones paying attention.
The local FBI office seems to have read those stories, too. A local agent recently contacted Christopher Jacobs, the Board of Education member who’s been raising questions about the more than $8 million the district spent on the benefit last year. Last week, Jacobs said, he talked with the agent.
"I think they're concerned about fraud," Jacobs said. "They're looking at issues of the significant increase in revenues generated by certain doctors and the increase in the unit cost, but I also think the increase in usage is an area they're probably going to look into."
The FBI will not comment, and several key people involved with the issue –- including the president of the teachers union and the doctor who billed the district more than $4 million last year -– said they have not been contacted by the FBI, and they know nothing about the FBI’s interest in the situation.
“I’m not concerned –- I haven’t done anything wrong,” said Dr. Kulwant Bhangoo, who billed the district for more in cosmetic surgery procedures than any other doctor last year. “All we did was provide the services to the valued members of the community, which were authorized and carefully monitored by the insurance company. We were reimbursed according to the rates set by the insurance company.”
How was he able to bill so much in a single year? In 2009, his practice had five locations. Many of the non-invasive skin procedures were done by "aestheticians," who have 600 hours of training. And the insurance company did not require a physician to be on site when the procedure was done, he said.
Since then, BlueCross/BlueShield has changed its requirements. Now, a physician's assistant or nurse practitioner must perform the procedures, Bhangoo said. The $4.3 million he billed for Buffalo Public Schools employees last year was entirely legal and within the rules set by the insurance company, he said.
"It wasn't because we were charging more [for each procedure]," he said. "That's not the case. It's more because more people are wanting the procedures. Patients today want instant results you can get with Botox. People can go in and have these treatments done during their lunch break and then carry on with the rest of their day."
The Buffalo Teachers Federation contract -- signed in 1999 and expired in 2004 -- provides "cosmetic surgery which is required and necessary as determined by the insured's physician" for teachers and their dependents who are covered under the traditional BlueCross/BlueShield plan, which is one of the plans available to them.
About 4,300 district employees and retirees -- half of those insured through the district -- opt for the traditional coverage. Employees and retirees do not pay anything out of pocket toward the premiums, according to district and union officials. Philip Rumore, president of the teachers union, says he will give up the benefit when a new contract is negotiated.
- Mary Pasciak