An ENT doctor in the US has been sentenced to 25 years in prison and ordered to repay $4.7m to Medicare after being found guilty of 20 criminal charges, including endangering patients’ health by reusing improperly cleaned, single-use surgical devices, stealing their identities, and defrauding Medicare.
Dr Anita Jackson performed nearly 1 500 balloon sinuplasty surgeries on more than 900 Medicare patients at her three North Carolina practices from 2011 to 2018, becoming the top-paid Medicare provider of the procedure in the US at points during this time.
However, between 2012 and 2017, she bought just 36 single-use dilation tools needed to perform such surgeries, despite billing Medicare for hundreds of balloon sinuplasty services, reports Medscape.
It was found that instead of providing a new device for each patient, Jackson reused them on multiple patients without their knowledge or consent, sometimes only washing the instruments with soap and tap water between procedures.
During a three-week trial Jackson admitted she could have purchased new devices for every procedure.
US attorney Michael Easley said that by repeatedly risking infection in the name of profit, her “blatant disregard” for her patients’ well-being led to her conviction on multiple federal charges.
Jackson advertised endoscopic chronic sinusitis treatment as a “free sinus spa” service, leading patients to believe that Medicare covered the service in full or for just a small coinsurance payment.
However, Medicare only covers the procedure at 80%. By not disclosing Medicare beneficiaries’ out-of-pocket costs, up to $1 500, authorities said the scheme allowed Jackson to collect millions from Medicare that she might not have if patients had been aware of the true costs.
She did not create office visit records or operative reports for some patients and also fabricated medical records to deceive Medicare auditors, including backdating documents and forging patient signatures.
Medscape article – Doctor Gets 25 Years in Federal Prison For Fraud, Using Dirty Surgical Devices
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