Doctor guilty of using 'unsanitary' surgical devices, other charges in Medicare fraud case: DOJ

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Saturday, January 28, 2023
Raleigh doctor indicted in $46 million Medicare fraud case
A doctor who helped lead the COVID-19 response for the Durham County Health Department has been indicted by a federal grand jury after an investigation of her private practice.

RALEIGH, N.C. -- A North Carolina doctor was found guilty of re-using "unsanitary" equipment meant for one-time use on unsuspecting patients during surgeries, the Justice Department said Friday.

The U.S. Attorney's Office said Anita Louise Jackson of Raleigh was also convicted on charges of adulterating medical devices for use on patients with the intent to defraud and mislead, fabricating medical and healthcare records, paying illegal remunerations, mail fraud, and conspiracy.

Jackson, who operated Greater Carolina Ear, Nose, and Throat, with offices in Raleigh, Lumberton and Rockingham, was convicted on 20 counts after a three-week federal jury trial.

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Authorities said she used equipment to perform balloon sinuplasty, an in-office surgery to treat chronic sinusitis, during more than 1,400 surgeries for Medicare patients between 2011 and 2017. Jackson used a device called the Entellus XprESS which is approved by the FDA for use on one patient, during one surgery and then was to be discarded.

The numbers simply didn't add up -- despite performing the procedure more than a thousand times, Jackson received at most only 36 new Entellus devices between 2012 and 2017, officials said.

"This doctor put profit ahead of patients, luring in Medicare patients with free "sinus spas" and risking infection to those patients by reusing the same single-use surgical devices on them again and again," said Michael Easley, U.S. Attorney for the Eastern District of North Carolina. "If we allow doctors to bilk Medicare to pad their profits by performing unsupported medical procedures -- each and every American taxpayer eats the cost. But the harm is most felt by the victim-patients who deserved better, and the elderly Americans on Medicare who are entitled to quality care. Jackson's blatant disregard for her patients' health has led to her conviction on multiple federal charges."

Evidence during an investigation showed that Jackson misled and did not inform her patients that they were receiving a procedure with an adulterated device and that during cross-examination, she stated that she had enough money to purchase new devices for each patient but chose not to do so.

Federal prosecutors also said between 2014 and 2018, Jackson used her practices to bill Medicare more than $46 million for the balloon sinuplasty procedures and netted more than $4.79 Million from Medicare for these surgeries alone.

"The FDA continues in its commitment to aggressively pursue those who deviate from required standards of use for medical devices," said Special Agent in Charge Justin C. Fielder, FDA Office of Criminal Investigations Miami Field Office. "We will remain vigilant in our efforts to protect consumers from potentially dangerous products."

Jackson was also convicted on 10 counts of illegally inducing her patients to receive the sinuplasty surgery by failing to collect co-payments. In doing so, Jackson induced her patients to come to the office for a "free" sinus spa and to get treatments they may not have needed or may not have agreed to if the full out-of-pocket cost to the patient had been disclosed.

She also wrote off or otherwise hid, the full cost of the procedure on any bills sent to the patient after their visits, which could be as high as $1,500 for Medicare beneficiaries, officials said.

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Jackson was also convicted of three counts of making false statements relating to health care benefits, two counts of aggravated identity theft, and three counts of mail fraud.

"It is disturbing when fraudsters exploit vulnerable Medicare enrollees and defraud federal health care programs for personal gain," said Special Agent in Charge Tamala E. Miles of the U.S. Department of Health and Human Services Office of Inspector General.

Jackson faces a maximum prison term of 20 years for mail fraud, 10 years for paying illegal remunerations, five years for conspiracy and making false statements, and three years for adulteration with the intent to defraud or mislead. Aggravated identity theft carries a two-year mandatory prison sentence, consecutive to any other punishment.

Jackson also faces fines exceeding $250,000, and the jury ordered forfeiture of $4,794,039.31.

There's still a federal civil case pending against Jackson as well.

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