Disciplinary Action against
Seshagiri Rao, M.D.
Stephen Barrett, M.D.
The Texas Medical Board has charged Seshagiri Rao, M.D. with nontherapeutic prescribing, failure to secure informed conent, and fraudulent billing related to his mismanagement of five children with autism or autism spectrum disorder. The complaint (shown below) states that Rao:
- Used an inappropriate urine test to diagnose nonexistent "heavy metal toxicity."
- Inappropriately treated the patients with chelation therapy
- Pretended to insurance companies that he was treating heavy metal toxicity rather than autism.
In 2012, Rao signed a agreed order under which he was required to have his practice monitored for about two years, during which another physician will examine his records of children with autism or delayed development. He also agreed to take complete at least ten hours of approved courses in medical record keeping and autism and developmental disorders.
Rao is a board-certified pediatrician/allergist who markets himelf as an "autism specialist." This is the second time he has been in trouble. In 2006, he signed an agreed order that assessed an administrative penalty of $250. The action was based on allegations that he failed to provide properly requested medical records within 15 business days.
HEARING CONDUCTED BY THE
TEXAS STATE OFFICE OF ADMINISTRATIVE HEARINGS
SOAH DOCKET NO. 503-
LICENSE NO. G-0803
IN THE MATTER OF THE
SESHAGIRI RAO, M.D.
TEXAS MEDICAL BOARD
Filed May 19, 2010
TO THE HONORABLE TEXAS MEDICAL BOARD AND THE HONORABLE ADMINISTRATIVE LAW JUDGE TO BE ASSIGNED: COMES NOW, the Staff of the Texas Medical Board (the "Board"), and files this Complaint against Seshagiri Rao, M.D., ("Respondent"), based on Respondent's alleged violations of the Medical Practice Act ("the Act"), Title 3, Subtitle B, Texas Occupations Code, and would show the following:
The filing of this Complaint and the relief requested are necessary to protect the health and public interest of the citizens of the State of Texas, as provided in Section 151.003 of the Act.
II. LEGAL AUTHORITY AND JURISDICTION
1. Respondent is a Texas Physician and holds Texas Medical License No. G-0803, that was originally issued on August 23, 1981. Respondent's license was in full force and effect at all times material and relevant to this Complaint.
2. Respondent received notice of the Informal Settlement Conference ("ISC") and appeared at the ISC, which was conducted in accordance with §2001.054(c), GOV'T CODE and § 164.004 of the Act. All procedural rules were complied with, including but not limited to, Board Rules 182 and 187, as applicable.
3. No agreement to settle this matter has been reached by the parties.
4. All jurisdictional requirements have been satisfied.
III. FACTUAL ALLEGATIONS
Board Staff has received information and based on that information believes that Respondent has violated the Act. Based on such information and belief, Board Staff alleges:
1. Respondent saw Patient 1, Patient 2, Patient 3, Patient 4, and Patient 5 (collectively referred to as "Patients")1 during the period of 2007-2008. The Patients were all minor children.
2. Each of the Patients is autistic or has autism spectrum disorder ("ASD").
3. Respondent treated each of the Patients with chelation therapy.
4. Respondent tested each of the Patients for heavy metal toxicity.
5. Respondent billed the Patients' insurance carriers for these servIces.
1The Board will provide, under seal, a code of the names of the patients that correspond to their numbers referenced above.
Respondent's Violation of the Standard of Care
6. The acceptable standard of care in diagnosing metal toxicity is to measure serum levels of lead, mercury, arsenic or other toxic metals.
7. Respondent did not use blood serum measures in testing the Patients' for metal toxicity, but instead, he used a urine screen to test the Patients for metal toxicity.
8. Respondent violated the standard of care by using an improper test for heavy metal toxicity.
Respondent's Nontherapeutic Prescribing
9. Respondent used chelation therapy to treat the Patients' autism and ASD.
10. Chelation therapy is not a treatment for autism or ASD as it is experimental, investigational and unproven.
11. Chelation therapy has potential adverse side effects.
12. Respondent also used off-label prescribing by prescribing Namenda to the Patients as treatment for autism and ASD.
13. Namenda is approved by the Federal Drug Administration ("FDA") to treat Alzheimer's disease. The FDA has not approved Namenda as a treatment for autism or ASD.
Failure to Secure Informed Consent
14. Respondent failed to obtain infonned consent from the Patients' parents or other persons authorized by law to consent to treatment on the Patients' behalf before perfonning certain tests, treatments, or procedures.
15. Respondent misrepresented to the Patients' parents and guardians that the treatments provided were approved by the FDA.
Respondent's Fraudulent Billing
16. Respondent submitted billings to the Patients' insurance carriers for the chelation therapy provided to the Patients to treat autism or ASD.
17. The use of chelation therapy to treat autism or ASD was not a covered benefit under the Patients' insurance policies and, thus, was not eligible for reimbursement.
18. When Respondent submitted billings for the Patients' chelation therapy to their insurance carriers for payment, Respondent used the diagnosis of heavy metal poisoning.
19. The use of chelation therapy to treat heavy metal toxicity is a covered benefit under the Patients' insurance polices and eligible for reimbursement, provided the toxicity is confinned by blood tests.
20. Since Respondent used an improper test for heavy metal toxicity, Respondent was not entitled to receive any reimbursement for the chelation therapy services, even if he had used the chelation therapy to treat heavy metal toxicity.
21. Respondent was in actuality using the chelation therapy to treat the Patients' autism or ASD. At the same time, Respondent was billing for the chelation therapy under the pretext of treatment for the Patients' heavy metal toxicity, since chelation therapy can be a covered benefit, provided the proper tests are conducted. The Respondent's actions constituted false, fraudulent and improper billing.
22. The actions of the Respondent as specified above violated one or more of the following provisions of the Medical Practice Act. The Medical Practice Act authorizes the Board to take disciplinary action based on Respondent's:
a. violation of Section 164.051(a)(I) of the Act based on Respondent's commission of an act prohibited under Section 164.052 of the Act;
b. violation of Section 164.051(a)(3) of the Act based on Respondent's violation of a rule adopted under the Act, specifically, Board Rule 200, regarding Standards for Physicians Practicing Complementary and Alternative Medicine;
c. violation of Section 164.051(a)(6) of the Act based on Respondent's failure to practice medicine in an acceptable professional manner consistent with public health and welfare, as more specifically defined in: Board Rule 190.8(1 )(A), failure to meet the standard of care; Board Rule 190.8(1 )(B), negligence in performing medical services; Board Rule 190.8(1 )(C), failure to use proper diligence in one's professional practice; Board Rule 190.8(1)(D), failure to safeguard against complications; Board Rule 190.8( 1 )(H), failure to disclose reasonable alternative treatments to a proposed procedure or treatment; Board Rule 190.8(1 )(1), failure to obtain informed consent from the patient or other person authorized by law to consent to treatment on the patient's behalf before performing tests, treatments, or procedures, and Board Rule 190.8( 1 )(K), prescription or administration of a drug in a manner that is not in compliance with Chapter 200 of this title (relating to Standards for Physicians Practicing Complementary and Alternative Medicine);
d. violation of Section 164.052(a)(5) of the Act based upon Respondent's unprofessional or dishonorable conduct that is likely to deceive or defraud the public or injure the public as further defined by Board Rule 190.8(2)(J), providing medically unnecessary services to a patient or submitting a billing statement to a patient or a third party payer that the licensee knew or should have known was improper. "Improper" means the billing statement is false, fraudulent, misrepresents services provided, or otherwise does not meet professional standards;
e. violations of Section 164.053(a)(1) of the Act which authorizes the Board to take disciplinary action against the Respondent based on Respondent's commission of an act that violates a law of this state that is connected with Respondent's practice of medicine;
f. violations of Sections 164.053(a)(7) of the Act which authorize the Board to take disciplinary action against Respondent based on Respondent's violation of Section 311.0025 of the Texas Health & Safety Code, which provides that a hospital, treatment facility, mental health facility, or health care professional may not submit to a patient or a third party payer a bill for a treatment that the hospital, facility, or professional knows was not provided or knows was improper, unreasonable, or medically or clinically unnecessary;
g. violations of Section 164.053(a)(5) of the Act based on Respondent prescribing or administering a drug or treatment that is nontherapeutic in nature or non therapeutic in the manner the drug or treatment is administered or prescribed, and
h. violation of Section 164.053(a)(6) of the Act based on Respondent's prescribing, administering or dispensing in a manner inconsistent with public health and welfare: (A) dangerous drugs as defined by Chapter 483, Health and Safety Code; or (B) controlled substances scheduled in Chapter 481, Health and Safety Code, or the Comprehensive Drug Abuse Prevention and Control Act of 1970 (21 U.S.C. Section 801 et seq.).
23. This case involves one or more violations to multiple patients and increased potential to harm to the public. Respondent has previously been the subject of disciplinary action by the Board.
IV. APPLICABLE STATUTUES AND RULES FOR THE CONTESTED CASE PROCEEDING
The following statutes, rules, and agency policy are applicable to the conduct of the contested case:
I. Section 1 64.007(a) of the Act requires that the Board adopt procedures governing formal disposition of a contested case before the SOAH.
2. 22 TEX. ADMIN. CODE, Chapter 187 sets forth the procedures adopted by the Board under the requirement of Section 164.007(a) of the Act.
3. 1 TEX. ADMIN. CODE, CHAPTER 155 sets forth the rules of procedure adopted by SOAH for contested case proceedings.
4. 1 TEX. ADMIN. CODE, CHAPTER 155.507, requires the issuance of a Proposal for Decision (PFD) containing Findings of Fact and Conclusions of Law. Page 5 of9
5. Section 164.007(a) of the Act, Board Rule 187.37(d)(2) and, Board Rule 190 et. seq., provide the Board with the sole and exclusive authority to detennine the , charges on the merits, to impose sanctions for violation of the Act or a Board rule, and to issue a Final Order.
V. NOTICE TO RESPONDENT
IF YOU DO NOT FILE A WRITTEN ANSWER TO THIS NOTICE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS WITHING 20 DAYS OF THE DATE NOTICE OF ADJUDICATIVE HEARING WAS MAILED, A DEFAULT ORDER MAY BE ENTERED AGAINST YOU, WHICH MAY INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION OF YOUR LICENSE. IF YOU FILE A WRITTEN ANSWER, BUT THEN FAIL TO ATTEND THE HEARING, A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU, WHICH MAY ALSO INCLUDE THE DENIAL OF LICENSURE OR ANY OR ALL OF THE REQUESTED SANCTIONS INCLUDING THE REVOCATION OF YOUR LICENSE. A COPY OF ANY RESPONSE YOU FILE WITH THE STATE OFFICE OF ADMINISTRATIVE HEARINGS SHALL ALSO BE PROVIDED TO THE HEARINGS COORDINATOR OF THE TEXAS MEDICAL BOARD.
IF YOU FAIL TO ATTEND THE HEARING, THE ADMINSTRATIVE LAW JUDGE MAY PROCEED WITH THE HEARING AND ALL THE FACTUAL ALLEGATIONS LISTED IN THIS NOTICE CAN BE DEEMED ADMITTED, AND THE RELIEF SOUGHT IN THIS NOTICE MIGHT BE GRANTED.
WHEREFORE, PREMISES CONSIDERED, Board Staff requests that an administrative law judge employed by the State Office of Administrative Hearings conduct a contested case hearing on the merits of the Complaint, and issue a Proposal for Decision ("PFD") containing Findings of Fact and Conclusions of Law necessary to support a determination that Respondent violated the Act as set forth in this Complaint.
TEXAS MEDICAL BOARD
Elaine Snow, Staff Attorney
Texas State Bar No. 18809200
Telephone: (512) 305-7088
FAX # (512) 305-7007
333 Guadalupe, Tower 3, Suite 610
Austin, Texas 78701
Filed with the Texas Medical Board on May 19, 2010.
Mari Robinson, J.D.
Texas Medical Board
This page was revised on September 15, 2013,