What the indicment says McLean did wrong
It is possible to argue about whether an artery that is 40 percent blocked by plaque needs a stent. The medical consensus is that it does not, but presuambly clincians can have a debate. What you can't do is stent an insignificantly blocked artery and then tell Medicare it was 80 percent or 90 percent, as McLean is alleged to have done. If the allegations are true, they amount to defrauding Medicare and are one reason health costs are so high.
On or about September 8, 2005, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health care benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient HK to state that the lesion in Patient HK’s LAD was 80 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 80 percent.
On or about November 2, 2005, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health care benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient WF to state that the lesion in Patient WF’s LAD was 80 to 90 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 80 to 90 percent.
On or about December 12, 2005, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health care benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient SD to state that the lesion in Patient SD’s RCA was 80 to 90 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 80 to 90 percent.
On or about March 29, 2006, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health care benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient PS to state that the lesion in Patient PS’s LAD was 80 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 80 percent.
On or about June 19, 2006, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health care benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient HW to state that the lesion in Patient HW’s Ramus was 90 to 95 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 90 to 95 percent.
On or about July 24, 2006, in the District of Maryland, the defendant, JOHN R. MCLEAN, in a matter involving a health care benefit program, did knowingly and willfully make a materially false, fictitious and fraudulent statement and representation, and make and use any materially false writing and document knowing the same to contain any materially false, fictitious, and fraudulent statement and entry, in connection with the delivery of and payment for health benefits, items and services; that is, defendant MCLEAN caused an entry in the Medical Record of Patient AW to state that the lesion in Patient AW’s LAD was 80 to 90 percent, well knowing that the Medical Record contained a materially false, fictitious and fraudulent statement and entry, in that the lesion was substantially less than 80 to 90 percent.
Comments
Since Jay never seems to actually do any home work, I thought I'd do it for him:
from TheHeart.org
"If you only look at angiograms, you can always find flaws, should you dilate that lesion or that lesion," Dr William O'Neill (University of Miami Miller School of Medicine, FL) explained. "We took a different approach, we looked at the patient as a whole and reviewed the clinical history and strategy for doing these procedures, and our conclusion was that there might have been one or two questionable cases, but the vast majority of the cases he did were very appropriate treatment of the patients, and his catheter technique, his angiographic technique, his stent technique is flawless. At the end, I concluded that he really was a good operator and there was really no reason to have an emergency suspension of his privileges."
O'Neill reviewed cases for Midei's legal team and was reimbursed for his work.
Posted by: Tom | September 2, 2010 6:39 AM