Fraud cases build against surgeons

The link between unnecessary surgery and alleged healthcare fraud made headlines last week in cases against a Virginia dermatologist and an orthopedic surgeon in Ohio.

A federal grand jury indicted Amir Bajoghli, M.D. on 60 counts of healthcare fraud, aggravated identity theft and obstruction of justice, the FBI announced. Bajoghli deliberately misdiagnosed patients with skin cancer and performed needless, invasive Mohs micrographic surgery on benign tissue, according to the indictment. Costs for this procedure can top $25,000, and utilization of Mohs surgery has increased four-fold nationally in less than a decade, as FierceHealthFinance previously reported.   

Bajoghli reportedly filed claims containing fraudulent skin cancer diagnoses codes and falsely certified that procedures performed were necessary. He's also accused of billing for surgeries not rendered and instructing unlicensed staff to close patients' wounds. Prosecutors say Bajoghli later billed for these services as if he himself performed or supervised them. While this alleged conduct was occurring, Bajoghli was named a "Top Doctor" by Washingtonian magazine.

Meanwhile in Ohio, a malpractice trail is underway against West Chester Hospital and its parent company related to the work of Abubakar Atiq Durrani, M.D. He reportedly told patients that unless they had spinal surgery, they ran the risk of paralysis or their heads falling off in car accidents, according to The Cincinnati Business Courier. This allegedly convinced patients to undergo millions of dollars' worth of procedures unnecessarily.  

Durrani had privileges to operate at five hospitals, according to the indictment. He apparently fled the United States for his native Pakistan after being charged with defrauding public and private health insurance programs.

A FierceHealthPayer eBook article explored how payers can manage utilization of spinal fusion surgeries, which are increasingly-used procedures involving serious patient risks, according to Doug Thompson, Health Care Service Corporation's senior director of analytics consulting. HCSC began using a statistical model to flag members likely to undergo spinal fusion and followed up with an education campaign to tell patients about treatment alternatives. This program is described in the eBook entitled "Payer Strategies for Engaging Members."  

For more:
- here's the FBI announcement
- read the Cincinnati Business Courier article
Download the free FierceHealthPayer eBook, "Payer Strategies for Engaging Members"

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