Anita Louise Jackson, MD, faces up to 20 years in prison when she is sentenced later this year.
A federal jury in North Carolina has found a Raleigh physician guilty of mail fraud, conspiracy and other charges related to a $46 million scheme that re-used disposable medical devices for more than 1,400 nasal surgeries on Medicare patients, the U.S. Department of Justice says.
Anita Louise Jackson, 59, an ear, nose and throat physician who operated Greater Carolina Ear, Nose, and Throat, was convicted on all 20 counts related to the 2011-2017 scheme that fabricated bogus medical records and paid kickbacks to co-conspirators.
She was taken into custody immediately after the verdict was handed up and faces up to 20 years in prison and fines in excess of $250,000 when she is sentenced later this year.
"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," Michael Easley, U.S. Attorney for the Eastern District of North Carolina, says in a media release. "If we allow doctors to bilk Medicare to pad their profits by performing unsupported medical procedures— each and every American taxpayer eats the cost."
The three-weeks of testimony showed that Jackson preformed 1,555 balloon sinuplasty surgeries on 919 Medicare patients using "at most" 36 new, single-use Entellus XprESS devices, which cost about $1,400 each, even though Jackson was among the nation's top-paid Medicare providers of balloon sinuplasty.
The evidence showed that Jackson lied or didn't tell patients she relied on re-used devices. Jackson admitted during cross-examination that "she had sufficient money to buy every patient a new device -- but chose not to do so," DOJ says.
Jackson billed Medicare more than $46 million dollars for the balloon sinuplasty procedures between 2014 and 2018 and banked nearly $4.8 million (since forfeited) from Medicare for these surgeries.
Jackson was also convicted on 10 counts of illegally inducing her patients to receive the sinuplasty surgery, by failing to collect the patients' co-pays. Jackson and her staff marketed the sinuplasty surgery as a free "sinus spa" to lure in prospective patients. She wrote-off or hid the up to $1,500 patient portion of the costs of the procedure on any bills sent to the patient after their visit to GCENT.
Jackson was also convicted of three counts of making false statements relating to healthcare benefits, two counts of aggravated identity theft, and three counts of mail fraud after modifying medical records to hide about $1.7 million in Medicare payments from auditors.
“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.”
Michael Easley, U.S. Attorney, Eastern District of North Carolina,
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
Jackson preformed 1,555 sinuplasty surgeries on 919 Medicare patients using 'at most' 36 new, single-use Entellus XprESS devices even though she was among the top-paid Medicare providers for the procedure.
The ENT lied or didn't tell patients she relied on re-used devices and admitted during cross-examination that 'she had sufficient money to buy every patient a new device -- but chose not to do so,' DOJ says.
Jackson and her staff marketed the sinuplasty surgery as a free 'sinus spa' to lure in prospective patients and wrote-off or hid the up to $1,500 patient portion of the costs of the procedure on any bills sent to patients.