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By filing a civil RICO suit against a Missouri cardiologist, the AHPSettlement Trust last week took its most aggressive action so far in anongoing campaign to eliminate alleged fraud in the massive $3.75 billionsettlement of the fen-phen diet drug cases. Attorneys Richard L. Scheff, Susan L. Burke and Scott A. Coffina ofMontgomery, McCracken, Walker & Rhoads filed the suit against Dr. LindaCrouse of Kansas City, Mo., alleging that she defrauded the trust by”certifying that thousands of [fen-phen] claimants had serious valvularheart disease when either she knew that they did not or had noreasonable basis for certifying that they did.” Crouse was first targeted by the trust last year when a team of lawyersfrom Wolf, Block, Schorr and Solis-Cohen successfully moved to block paymentof all claims connected with two law firms and two of the doctors theyhad used. U.S. District Judge Harvey Bartle III of the Eastern District of Pennsylvania said he was forced to issue aninjunction because the settlement funds were set aside for “rightfulclaimants who suffered from Fen-Phen and not as a pot of gold forlawyers, physicians and non-qualifying claimants.” Some of the harshest criticism in Bartle’s November 2002 opinion waslevied on Crouse, who was paid $725,000 by two New York law firms –Napoli, Kaiser, Bern & Associates and Hariton & D’Angelo — for reading725 echocardiograms, and $2 million from other law firms for similarwork. “When considering the thousands of echocardiograms that Dr. Crouseinterpreted during the period that she worked for the Hariton and Napolifirms, her practice resembled a mass production operation that wouldhave been the envy of Henry Ford,” Bartle wrote. Bartle found that Crouse had improperly relied on law firm employees toinstruct her staff on how to interpret the echocardiograms and that she”spent little time actually reviewing and approving the results.” He also found that Crouse “never met with the claimants, never reviewedtheir medical records, and largely relied on the law firms to providethe medical history,” despite clear requirements that the cardiologistherself was responsible for attesting to the accuracy of the informationon the claims forms. Bartle later granted a request by the trust to begin auditing all claimsfor so-called “matrix” benefits in which class members who sufferedactual injuries as a result of ingesting the diet drugs are paid varyingamounts depending on the severity of their heart valve conditions. Prior to that ruling, the settlement called for audits of just 15percent of claims. Now, in the RICO suit, the trust is picking up where last year’sinjunction hearings left off, asking that Crouse be hit with trebleddamages for the fraudulent claims she allegedly certified. The suit alleges that Crouse “acted in a grossly negligent, outrageous,wanton and reckless fashion when she certified to the trust thatthousands of claimants had [heart valve damage] without taking theanalytical steps required to make such a determination.” Crouse’s “actions and inactions,” the suit says, have cost the trust”millions of dollars” that were paid to claimants who don’t suffer fromheart valve problems. The suit alleges that on thousands of occasions during a three-yearperiod, Crouse departed from normal practices and professional standardsby failing to complete the steps required to reach a reasonable medicaldetermination of the existence of valvular heart disease, or VHD. “Altogether, Dr. Crouse signed more than 2,500 certification forms, eachtime swearing under oath that the claimant suffered from VHD that couldnot be attributed at least in part to the presence of other factors,”Scheff said. Crouse’s lawyer, Patricia A. Sexton of Polsinelli Shalton & Welte inKansas City, Mo., could not be reached for comment Friday. Under the 1999 settlement agreement, cardiologists and cardiothoracicsurgeons were required to undertake specific procedures in order tocertify the existence of VHD before signing off on the court-approvedcertification form, known as the Green Form. The steps include the use of an echocardiogram, the taking of a claimant’smedical history in order to rule out potential causes of VHD other thanthe use of fen-phen, and others. The RICO suit alleges that, contrary to normal practices andprofessional standards, Crouse signed off on Green Forms withoutspending the time required to properly conduct and interpret theechocardiogram, to meet or examine the claimant, to take a medicalhistory, or to review medical records. “In almost all cases, [Crouse] never even met the person whose medicalcondition she was certifying,” the suit alleges. The suit accuses Crouse of abusing her position as a prominentcardiologist with an impressive r�sum�. According to the suit, Crouse isa fellow of the American College of Cardiology and the American HeartAssociation, board certified in Internal Medicine and in CardiovascularDiseases, and serves as director of the Echocardiographic Laboratory atthe Shawnee Mission Medical Center Regional Cardiovascular Institute andthe Women’s Cardiovascular Center. “Dr. Crouse is the type of cardiologist on whom the parties to thesettlement agreement and the trust intended to rely to ensure that onlypersons actually suffering from VHD who had ingested the diet drugsrecovered the substantial sums available,” the suit says. “Instead of abiding by her professional responsibilities, Dr. Crouseintentionally defrauded the trust by designing and operating a GreenForm mass production assembly line that generated hundreds of GreenForms per week,” the suit alleges. The suit says Crouse “signed these Green Forms either knowing that manyof her representations were false or knowing that she was acting withreckless disregard as to the truth of the representations.” In one instance, the suit alleges, Crouse signed an echocardiogramreport attesting to VHD “a mere 16 seconds after the echocardiogramended.” On other occasions, the suit says, she signed reports less than one ortwo minutes after the echocardiogram ended. In a single two-day period, the suit says, Crouse signed 163 Green Formscertifying VHD. Over a 10-month period, the suit says, Crouse and heroffice “generated as many as 500 Green Forms per week for just one lawfirm.” The suit says Crouse’s “willingness to falsify” VHD certifications madeher popular among plaintiffs’ lawyers who began “travelling to KansasCity, Missouri, with claimants from all over the country or, more often,merely with echocardiogram tapes.” Between March 2000 and May 2003, the suit says, Crouse was “engaged bymore that 25 law firms to sign Green Forms certifying to the existenceof VHD in their clients.” For her work on behalf of only two of the 25 or more law firms, the suitsays, Crouse earned “more than $3.2 million in fewer than 11 months.” The suit says Crouse “exploited the 15-percent audit limit” by falselycertifying VHD in “hundreds, if not thousands of Green Forms.” The suit also accuses Crouse of training workers in her medical practice”to take echocardiograms and measurements in a way that would make itdifficult, if not impossible, for the trust to detect that the GreenForm diagnosis lacked any reasonable medical support for a VHDcertification.” The RICO suit, captioned Castle v. Crouse, 03-cv-5252, has been assignedto Bartle as a case related to the fen-phen settlement.

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