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
- Cardiac catheterization
- Back surgery, including spinal fusion
- Knee and other joint replacements
- 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.
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