Insurance Fraud NEWS
Kentucky heart doc implants useless pacemakers
April 16, 2018, London, KY
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.
Chalhoub was charged with performing heart procedures that were not medically necessary and then having bills submitted for the surgeries to Medicare, Medicaid and private insurance carriers between March 2007 and July 2011.
Chalhoub implanted about 230 pacemakers while working at Saint Joseph London between 2007 and 2011, according to a news release from U.S. Attorney Robert M. Duncan Jr.
Evidence showed dozens of the procedures were not medically necessary, the release said.
Several patients testified that Chalhoub pressured them into having pacemakers implanted, telling some they might die without the procedure even though the diagnosis he gave was for a non-fatal condition, the government said.
However, Chalhoub continues to maintain his treatment decisions were appropriate, said his attorney, J. Guthrie True.
The evidence showed different doctors can reach different medical decisions in good faith, True said.
Defense attorneys will ask U.S. District Judge Gregory F. Van Tatenhove to set aside the jury verdict and acquit Chalhoub.
If Van Tatenhove upholds the verdict, Chalhoub could appeal.
The charge against Chalhoub grew out of the government’s larger investigation of practices at Saint Joseph London, according to a court document.
The hospital and doctors who worked there were accused in lawsuits of performing hundreds of unjustified heart procedures before a January 2014 settlement with the federal government.
Saint Joseph Health Systems, which owned the hospital at the time, agreed in that deal to pay $16.5 million to settle allegations of a scheme to rake in money through unnecessary procedures.
Saint Joseph Health Systems merged with Jewish Hospital and St. Mary's HealthCare in 2012 to form KentuckyOne Health.
Defense attorneys argued in court documents that the cardiac procedures Chalhoub performed were appropriate and that he acted in good faith.
“Prosecutors, judges, and juries are poorly suited to second-guess medical decision making,” defense attorneys said in one motion.
Prosecutors, however, said that Chalhoub knowingly implanted pacemakers in patients who didn’t need them.
Saint Joseph London terminated Chalhoub in June 2013, but his license is still valid and he continues to practice. He has an office in Louisville, according to the Kentucky Board of Medical Licensure.
More than 300 people filed lawsuits over alleged improper heart procedures at Saint Joseph London, said Hans Poppe, a Louisville attorney involved in the cases.
Some cases were dismissed, but ultimately, about 180 people reached confidential settlements with doctors and the hospital, Poppe said.
In one case that went to trial, a jury in Laurel County returned a $21.2 million verdict for Kevin Wells, a Corbin truck driver who alleged Chalhoub put a pacemaker in him that was not needed.
Chalhoub told Wells in September 2010 that a test showed a 60 percent blockage in one of his arteries, but other doctors later told Wells the blockage was only 10 percent and he didn’t need a pacemaker, Poppe said.
The defendants in the case, Saint Joseph London and Denver-based Catholic Health Initiatives, have appealed the verdict.
Another doctor who once worked at Saint Joseph London, Sandesh R. Patil, pleaded guilty in 2013 to lying about the severity of a patient’s condition to make sure the government would pay for a heart procedure. He was sentenced to 30 months in prison.
The maximum sentence for Chalhoub would be 10 years. He is to be sentenced in August.
Source: Lexington Herald Leader