Sweeping changes in works to curb abuse of foreign doctor program

Published Monday, Dec. 10, 2007 | 10 p.m.

Updated Tuesday, Jan. 1, 2008 | 12:16 p.m.

Two U.S. senators, including Majority Leader Harry Reid, called Thursday for an investigation into abuses of a federal program that provides doctors to communities lacking adequate medical care.

In a letter to the Homeland Security secretary, Democratic Sens. Reid of Nevada and Kent Conrad of North Dakota cited reports by the Las Vegas Sun that employers in Nevada are exploiting the program and preventing the foreign doctors from working in needy areas, as required under their visas.

The senators asked Homeland Security Secretary Michael Chertoff to “take the necessary steps to correct any abuses found.”

Also Thursday, Nevada Health Division officials announced that they will make sweeping changes and conduct a thorough examination of the program to prevent abuses.

Those actions include:

• Creating an Internet-based system where physicians can make confidential or anonymous complaints.

• Establishing an auditing process that will include unannounced site visits to ensure physicians are working in underserved areas.

• Analyzing best practices in other states.

The foreign physicians are working in Nevada through the J-1 visa waiver program, which includes the Conrad State 30 program — created by Conrad to supply doctors to medically needy regions of the country. The programs, which are overseen at the federal and state level, allow foreign medical school graduates — nicknamed “J-1 doctors” for the visas they hold when they come to the United States for their residency — to stay in the country as long as they commit to practice full time, for at least three years, in areas the government has designated as having too few doctors.

The Sun reported claims that at least four employers — Dr. Nutan Parikh, Dr. Rachakonda D. Prabhu, Dr. Abdul Siddiqui and Dr. Sherif Abdou — have been ordering their physicians away from the underserved areas to treat more affluent patients in hospitals and other clinics. The four employers are also accused of working the J-1 doctors to the point of exhaustion, which can be harmful to patients. Siddiqui’s J-1 doctors also claim he modified their contracts against their will, resulting in months without a salary.

Employers can exploit the physicians and abuse the system because they also sponsor visas for the J-1 doctors, who are reluctant to complain for fear of being fired and forced to leave the country.

The Sun’s report was published Sunday and response from state and federal lawmakers has been swift. Assemblywoman Sheila Leslie, D-Reno, put the subject on the agenda of the Health Care Committee, which starts meeting this month, and Assembly Speaker Barbara Buckley, D-Las Vegas, said the state must proactively audit the clinics.

Dr. Ikram Khan, a retired surgeon who sits on a state committee that reviews agreements between J-1 doctors and employers, has been trying to reform the system. He said he was encouraged to hear that Congress and the state are taking action to investigate the problems.

“This is the first time it has come to light,” Khan said. “Having said that, let’s give them a chance to find solutions.”

Ultimately, he added, the “buck stops at the federal level” and the states can follow through. One of the most important reforms is to provide federal money to states so they can oversee the program, he said.

The J-1 visa waiver program is overseen by multiple agencies, including the U.S. Citizenship and Immigration Department, the U.S. Labor Department and the Nevada Health Division. Republican Rep. Jon Porter said any agency involved in the program has the responsibility to get involved.

“We’re going to make sure we can mobilize the correct agencies to make sure this type of abuse does not happen,” he said.

Porter added that anyone found guilty of wrongdoing must be held accountable, and that he will ensure the J-1 doctors are fully protected.

The Sun found that federal and state oversight of the J-1 program was inadequate. Reid and Conrad also requested that the Homeland Security Department report its findings to Congress and recommend legislative changes to prevent abuses and improve oversight.

“The J-1 visa waiver program was intended to bring professional medical care to communities where it is badly needed,” Reid and Conrad wrote. “We believe it is crucial that oversight mechanisms be in place to protect against abuses of this important program.”