WHAT A HEEL: Surgeon Bilks Medicare With Bogus Surgeries
An analysis of a Medicare database The Wall Street Journal reveals that Vishal James Makker, a “handsome, 41-year-old neurosurgeon with a charming bedside manner,” had “an unusual propensity” for performing multiple spine surgeries on Medicare patients:
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.
For the past year, the Journal has been mining Medicare's claims databases to expose how some doctors potentially defraud the taxpayer-funded health program for the elderly and disabled and game its reimbursement system. The databases contain a computerized record of every bill submitted to, and paid out by, Medicare.
Analysis of the data suggests that it also could be used as a tool to help screen for potentially bad or negligent doctors by identifying suspicious patterns of care. …
Dr. Makker attributed his high rate of multiple fusions, in part, to referrals of difficult cases from other Portland-area spine surgeons who don't accept Medicare, and to failures of spinal implants from a supplier he has stopped doing business with.
In April 2006, the Oregon Medical Board issued a "complaint & notice of proposed disciplinary action" alleging that Dr. Makker performed "medically unnecessary" spinal fusions on several patients without obtaining their prior consent; didn't provide the patients with adequate follow-up care; and billed for some procedures he didn't do. Without admitting or denying wrongdoing, Dr. Makker agreed to complete a remedial training program and a billing course.
In less than nine years of practice, Dr. Makker has been sued by eight patients alleging medical malpractice, court records show, compared with an average for neurosurgeons nationwide of about one suit every two years, according to medical malpractice insurer The Doctors Company.
Spinal surgeons tell The Journal that spinal fusions “can be lucrative for surgeons and medical-device makers” and that except in cases of a spinal infection or cancer it “isn't good practice” to perform multiple fusions on the same patient.
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