Profits and Unnecessary Surgery

This morning the Wall St. Journal profiled a surgeon on the front page. The story was disturbing on a number of levels, not the least of which concerned allegations of unnnecessary spinal surgeries and gaming the Medicare system to make profits. These are just some of the allegations leveled against neurosurgeon Dr. Vishal James Makker of Portland Oregon.
The Wall St. Journal relates the stories of several patients who submitted to numerous spinal surgeries in the short span of a few years. In one instance, Makker had performed surgery on Ronald Johnson’s spine six times in the last two years. Makker’s critics, including some patients who’ve sued him for malpractice, assert that the repeat surgeries are performed because of the profit margins and not any medical benefit further surgery might provide.
According to the WSJ article, “A Medicare database analyzed by The Wall Street Journal reveals that Dr. Makker has had an unusual propensity for performing such multiple surgeries on the spine. The data show that in 2008 and 2009, Dr. Makker performed spinal fusions on 61 Medicare patients. In 16 of those cases, he performed a total of 24 additional fusions. That gave him an overall rate of 39 additional fusions per 100 initial fusions, the highest rate in the nation among surgeons who performed spinal fusions on 20 or more Medicare patients during those two years.”
Makker has been the target of an FBI investigation which was later dropped. The Journal couldn’t provide the reason for the investigation or the circumstances under which it was dropped however, the article intimated that some of Makker’s Medicare billing behavior showed signs of fraud.
“Several years ago, the Federal Bureau of Investigation began asking questions about Dr. Makker, according to two people interviewed by FBI agents. Dr. Makker says the FBI agents were part of an investigation related to billing issues by the U.S. attorney in Portland. He says his criminal defense attorney, Stephen Houze, was recently notified by the U.S. attorney in writing that the investigation had been abandoned for lack of evidence. The FBI declined to comment.
Over about three years, from early 2008 through early this year, he billed Medicare more than $5.4 million for all his work, but was paid only $597,510, for a payment rate of 11%, according to a person familiar with his billings. An analysis of a 5% sample of the Medicare billing of 3,247 spine surgeons in 2008 shows the average surgeon was paid 21% of the sums submitted. Law-enforcement officials who specialize in Medicare fraud say lower rates of payment can be red flags for fraud.”
Because information about doctors such as Dr. Makker is generally not well known by the public, the Wall St. Journal story is especially important and informative. The healthcare culture is too often a closed system in which information about erring doctors is kept secret and out of the view of the public. This can be a serious public safety concern.