A Heartbeat Away from Prison

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A pacemaker is a small device implanted into a patient’s chest that controls abnormal heart rhythms. A former cardiologist from London, Kentucky apparently enjoyed implanting pacemakers, especially when he received reimbursement for his claims from federal healthcare and private insurance programs. (I’m sure it made his heart happy to receive a steady stream of income, even though he was committing healthcare fraud by billing Medicare, Medicaid and private insurers for unneeded pacemaker operations.)

Pacemakers are great for people who need a temporary fix that treats slow heartbeats following a heart attack. Other times, it’s permanent for individuals who consistently have a slow heartbeat or need treatment for heart failure. Even though it’s a fairly simple, low risk operation, no one likes to have an operation that they don’t need for a condition they don’t have. Today’s fraudster performed more than 230 unneeded pacemaker operations over four years on patients who did not have a heart problem. (He stuck Medicaid, Medicare and multiple private insurers with the bill.)

 The medically unnecessary operations were justified as “sinus node dysfunctions,” which are not fatal. (Another good reason for getting a second opinion before consenting to surgery.) During the doctor’s 14-day trial, several patients testified that they were pressured into having the pacemaker surgery because otherwise, they might die.

Incidentally, around the same time, the hospital where the cardiologist worked was undergoing an investigation for questionable practices. Additional research shows that hundreds of patients filed lawsuits against the hospital, its cardiologists and billing agency, claiming they had received unjustified heart procedures. The owner of the hospital system at that time agreed to pay $16.5 million to settle allegations of a fraud scheme involving unnecessary procedures. (That makes things a bit clearer, doesn’t it?)

The London, Kentucky cardiologist was found guilty on one count of healthcare fraud and is one heartbeat away from a maximum of 10 years behind prison bars. He’s the second cardiologist from the London, Kentucky hospital who could be facing jail time for healthcare fraud stemming from the massive number of lawsuits filed. (The first cardiologist convicted got 30 months in prison.)

The cardiologist’s defense attorneys agued in court that the cardiac procedures he performed were appropriate and done in good faith. (Of course, that’s why more than 300 people filed lawsuits.) While the doctor was terminated in June 2013, his license is still valid and he continues to practice in Louisville, Kentucky. (Today’s fraud case gives you a solid reason as to why healthcare insurance is so expensive. You can thank this guy for contributing to that problem.)

Today’s “Fraud of the Day” is based on an article entitled, Heart doctor committed fraud by implanting unneeded pacemakers, jury rules,” published by Lexington Herald Leader on HartfordBusiness.com on April 16, 2018.

A heart doctor defrauded health insurance programs by performing unneeded procedures to implant pacemakers at the hospital in London, a federal jury has ruled.

The jury convicted Anis Chalhoub on one count of health fraud last week.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.