Insurers Hiring Doctors With Histories of Malpractice to Decide if Care Will Be Covered

An investigation by ProPublica and The Capitol Forum has revealed a troubling trend of health insurance companies hiring medical directors who have a history of medical malpractice.

Journalists looked at regulatory filings, interviews, lawsuits and LinkedIn pages. They cross-referenced what they found with malpractice databases and actions by state licensing boards in 17 states. They found 12 insurance company doctors who had questionable records. These records include numerous malpractice payments or disciplinary actions by state medical boards.

One medical director’s history of malpractice involves settlements with 11 patients. These patients had urology surgeries that led to incontinence. One doctor was reprimanded for deceptive and dishonest behavior. Another doctor agreed to a $1.8 million settlement of a medical malpractice case where an allegedly delayed diagnosis of cancer led to a patient’s death.

These doctors were in positions to make decisions about whether care would be covered by the insurance company. Their past histories raise questions about conflicts of interest and whether insurance companies are doing a thorough job vetting people for medical director positions.

A particularly alarming example of this trend is Dr. Pachavit Kasemsap, a medical director at Cigna. He is a former Air Force surgeon who settled five medical malpractice cases for a total of $3 million. In one of these cases, the family of Loretta Murphy received $1 million after her death. Kasemsap is alleged to have cut her aorta during gallbladder surgery. This resulted in Murphy’s death.

In another case, a patient claimed Kasemsap stapled her vagina to her rectum. Kasemsap denied this, along with the claims in the other five cases.

Despite this history, Cigna hired Kasemsap and has placed him in an oversight position. This decision is particularly concerning because Cigna may have known about Kasemsap’s history. He was featured in a news story about dangerous doctors.

While patients can typically research the backgrounds of their physicians, including any malpractice payments or sanctions, such scrutiny is not possible for insurance company medical directors. These individuals can significantly impact patients’ access to care. Unfortunately, their histories and qualifications remain largely unknown to patients.