Some doctors' arrests and license violations go undetected

DURHAM, N.C. (WTVD) -- A man reached out to the ABC11 I-Team after his mother's insurance recommended a doctor with pending sexual assault and battery charges. Now the man is urging others to do their homework before selecting a physician.

The man wanted to stay anonymous but said in January his mother's insurance, United Healthcare, recommended a new primary care doctor for her after she moved to Durham.

"When you see the doctor's name printed on the official letter you kind of take it as a badge of approval, you kind of accept it or interpret it as that doctor has passed the basic quality threshold to be included in the AARP / United network," he told ABC11.

However, a quick search uncovered the recommended physician, Dr. Oscar Cornelio-Flores, was recently arrested in November.

"I was taken quite aback. Why would a trusted company overlook a pending investigation in a relatively serious nature investigation for a physician?" the man said.

Cornelio-Flores was initially charged in November for sexually assaulting a female patient, according to the Durham Police Department. A spokesperson for the department said there are now three victims with pending sexual charges against Cornelio-Flores.

Cornelio-Flores' employer, Avance Care, told ABC11 he was placed on leave in November and was officially terminated on Jan. 1.

Yet, United Healthcare issued a letter recommending Cornelio-Flores on Jan. 27.

"With more than 48,000 physicians in our network in North Carolina, we are dependent on collaboration with providers to ensure the accuracy of our provider directories. Our provider agreements require practices to alert us within 10 days of a physician being arrested or terminated," a spokesperson for United Healthcare told ABC11 in an email.

The spokesperson said the provider did not notify them of Cornelio-Flores' arrest until March.

"Since learning of his arrest, we have taken swift action to remove him from our network and our provider directory," the spokesperson stated.

Cornelio-Flores' former employer, Avance Care, did not respond to why there was a nearly four month gap in notification.

"My fear was other senior citizens, especially these are for Medicare advantage beneficiaries, a lot of them are not tech savvy, people of that generation tend to trust the health system, trust the insurance companies to a certain extent so how many of them unfortunately went ahead with the recommendation?" the man told ABC11.

The I-Team did reach out to Cornelio-Flores but he did not provide a statement.

This situation isn't the only example of a doctor slipping through the cracks.

Earlier this year an audit found the North Carolina Department of Health and Human Services (NCDHHS) failed to ensure that only qualified providers were a part of the state's Medicaid program.

"As a result, there was an increased risk that providers whose actions posed a threat to patient safety were enrolled in Medicaid and could receive millions of dollars in improper payments from the State," the February audit stated.

NCDHHS did not identify or remove providers who had their licenses suspended or limitations placed on it, according to the audit. This included providers who had sexual misconduct against women, a felony conviction, substance abuse and unprofessional conduct.

The audit also mentioning more than 30,000 flags raised in NCDHHS' site for background checks that were not reviewed.

NCDHHS said in response to the audit that it already began implementing the recommended changes and is making the issues a "top priority."

"We take every instance of an unqualified provider very seriously and any overpayment is unacceptable," the department stated in its response.

The North Carolina auditor estimated 2,400 individuals were placed at an increased risk and the error cost the state around $1.64 million.

I always hate to see the taxpayers' money misused but more than that that anybody's vulnerability was escalated into what could have been a huge problem," said Nancy Ruffner, a patient's advocate with Navigate NC.

Ruffner helps patients find providers and helps patients have a voice when concerns arise.

"What we see often is a low healthcare literacy coupled with too much trust. Who would even think to question? A lot of people this is not on their radar. We're very patriarchal in our healthcare where we just do what people tell us to do and never question," Ruffner said.

She urges people to look into providers before choosing them.

"The process for that is really, really important for protecting the patient," Ruffner said.

She suggests patients go to the state medical board first and check if the provider is licensed. When searching on consumer sites like HealthGrades, Ruffner recommends cross checking with professional organizations and the licensing board.

"Get the name but start noising around maybe they are also associated with Rex or WakeMed and you can at least have the satisfaction that two credential personnel teams should have passed, they should have passed through two sets of eyes," she said.

She also advises patient to continue to question even after selecting a doctor.

The man who initially reached out to the ABC11 I-Team said he is hoping others will learn to vet even recommended physicians.

"As we get more direct access for consumers and patients to medical and healthcare knowledge I would encourage everyone to do your own research. If everyone would do their own research before you buy a car...you owe it to yourself and your loved ones to do the same level of due diligence to make sure you are getting the best provider out there to avoid some of these potential pitfalls," the man said.