Unnecessary Surgery, Insurance Fraud, and You

November 5, 2015 / Medical Malpractice

Have you had any surgeries in the past few years? Think back, especially if it involved your heart or circulatory system. Perhaps you had spinal fusion or a joint replacement done. Did you have any surgery done because the doctor told you that you needed it?

Often we have surgery because the doctor tells us that surgery is the only option. Few of us have the medical knowledge to ask the right questions regarding alternatives. We do what the doctor tells us to do, especially if death is mentioned.

The lure of easy insurance money, especially when it is from Medicare or Medicaid, can play a part in a surgical recommendation if the doctor is not ethical. Here in Indiana, a group of cardiologists and a hospital, Cardiology Associates of Northwest Indiana and Munster Community Hospital, are being sued for unnecessary surgeries.

Too Many Procedures, So Much Money

About a year ago, dozens of people began suing the groups listed above, alleging unnecessary procedures. In some cases, wrongful death arising from those procedures is alleged. Some say that the investigation has revealed that 75 percent of heart procedures were performed unnecessarily.

One patient, Steve Mayerak, whose second opinions revealed that his procedures and surgeries were unnecessary, commented, “I’ve had 10 angiograms, [a] defibrillator and pacemakers which I since found out I didn’t need.”

The motive for unnecessary surgery, of course, is money. A defibrillator procedure brings in about as much revenue as the cost of a medium-sized car, and is one of the most lucrative procedures a hospital can do. The three doctors involved in the suit are the top three cardiologists in Indiana when it comes to payments they get from Medicare. One of them is twentieth in the entire U.S., based on the amount of Medicare money ending up in his accounts.

To give you an idea of the numbers of medical procedures done annually in the U.S., it’s around 51.4 million in total for all procedures. Here are the annual numbers for some of the most common cardiac procedures:

• Arteriography and angiocardiography: 2.4 million
• Cardiac catheterizations: 1.0 million
• Balloon angioplasty of coronary artery/coronary atherectomy: 500,000
• Insertion of coronary artery stent: 454,000
• Coronary artery bypass graft: 395,000.

We are thankful that the overwhelming majority of doctors are honest, but, because these surgeries are so commonly done, there’s always a chance that someone dishonest will be tempted to take advantage of that and “cash in.”

Surgeries That Might Not Be Needed

Unneeded surgeries carry risks beyond the financial losses; it’s not just about the money. Anesthesia has known dangers up to and including death, especially for folks over 65. Post-operative infections are also a risk. Pain, and decreased future mobility and capacity, are also likely hazards.

Some of the most frequent unnecessary medical procedures are:

• Cardiac stents
• Pacemakers
• Cardiac catheterization
• Back surgery, including spinal fusion
• Knee and other joint replacements
• Hysterectomy
• Caesarean section (C-section).

It is speculated that unnecessary surgeries can amount to as many as 20 percent in some medical specialties. In the past 10 years, over 1,000 doctors have paid to settle or close surgical malpractice claims involving charges of unnecessary or inappropriate procedures.

By definition, unnecessary surgeries or procedures constitute medical malpractice.

When others breach their duty, we keep ours.

Our investigative team goes to work immediately to uncover the who,’ ‘what,’ ‘when,’ ‘where,’ ‘why’ and ‘how’ of medical injuries caused by malpractice. We are committed to bringing together the most qualified experts available (irrespective of cost) to uncover what happened. Your experts will come from around the world if necessary. Medical malpractice claims can be complex. Therefore, it is the proficiency of your experts that is crucial in both the investigation and litigation phases of your claim.

Mike Stephenson is a Martindale-Hubbell AV-rated attorney, the highest possible attorney peer rating. When you call Mike, you can have complete confidence that you are talking with an Indiana medical malpractice lawyer with over 30 years’ experience offering compassionate and successful representation for his clients. What is your next step toward justice? Contact the trusted advisors and proven advocates, Stephenson Rife, today using our contact form, or call 1-317-825-5200.