Doctors’ Pay Is a Focus of UCI Inquiry

Federal investigators have subpoenaed records relating to five UCI Medical Center doctors involved with the Orange hospital’s failed liver transplant program, including their compensation agreements, according to a source familiar with the case.

The subpoena was issued as part of an unfolding criminal investigation by the FBI and the Department of Health and Human Services that is focusing, at least in part, on whether there was fraudulent billing of government healthcare programs, including Medicare and Medi-Cal, said the source, who spoke on the condition of anonymity because of the sensitive nature of the matter.

Named in the Department of Justice subpoena were Dr. Sean Cao and Dr. David Imagawa, the former and current managers of transplantation; Dr. Marquis Hart and Dr. Ajai Khanna, two UC San Diego surgeons who worked at UCI on a contract basis; and Dr. Muhammad Sheikh, a former nephrologist in the program, according to the source.

The liver program was closed in November after The Times reported that 32 patients on its waiting list died in 2004 and 2005, even as the hospital rejected scores of viable organs, at times because it did not have surgeons to perform the operations.

Toward the end of the program’s existence, UCI was almost exclusively dependent on patients with government-funded insurance. By 2004, private insurance companies had begun steering liver transplant patients to other facilities in the region. Records show that all seven of the patients who received transplants at UCI in 2005 were covered by Medicaid, Medicare or the Department of Veterans Affairs.

Spokespeople for the FBI and U.S. attorney’s office declined to comment. UCI referred calls to a lawyer for the UC system, Jeff Blair, who also declined to comment. UCI refused a request under the state records act to release a copy of the subpoena.

Imagawa said last week that he had not seen the subpoena and did not know he was named in it. His lawyer, Dennis K. Ames of Santa Ana, did not return calls seeking comment. Cao, who left UCI two years ago, said he didn’t “know much about it.” His lawyer, Margaret Holm of Santa Ana, declined to comment.

Hart referred calls to Bob Rose, a San Diego lawyer who said he no longer represents Hart. Hart did not respond to further requests for comment. Khanna and Sheikh did not return calls.

The existence of the FBI investigation was reported this month, but its focus had remained unclear. No one has been charged.

During a court hearing last week involving lawsuits over the liver program, Holm, who is also representing the UC system, said the investigation also appeared to deal with a July 2004 meeting in Chicago at which UCI officials persuaded the United Network for Organ Sharing to drop plans to close the program because of concerns over poor performance and understaffing.

UCI officials at the meeting included Hart, medical school Dean Thomas Cesario, then-medical center Chief Executive Ralph Cygan and transplant administrator Gail McGory. They told representatives of the network, which oversees organ donations under a contract with the federal government, that the hospital had recruited Hart to serve as a full-time transplant surgeon and supervise the program. A UC internal investigation found the statements were “not wholly accurate” -- in fact, Hart served UCI only on a part-time basis and remained based at UC San Diego.