On January 5, 2022, the U.S. Department of Justice announced the indictment of Dr. Anita L. Jackson.  The indictment primarily relates to the provision of balloon sinuplasty.  According to Johns Hopkins, balloon sinuplasty is a minimally invasive treatment for chronic sinusitis and entails the placement of a small balloon through the nose to dilate the sinus openings.   

According to the indictment, Dr. Jackson was the top-paid provider of balloon sinuplasty services in the United States, although she did not practice in a major metropolitan area.  The government alleges that Dr. Jackson billed Medicare over $46 million for over 1,200 balloon sinuplasty treatments and received more than $5.4 million.  The government also alleges that Dr. Jackson engaged in several illegal acts to further her alleged scheme to defraud Medicare. 

Re-Use of Single-Use Medical Devices

The government alleges that Dr. Jackson re-used balloon sinuplasty devices despite being informed that the devices were intended to be single-use devices.  These devices were also not approved by the United States Food and Drug Administration to be reused. The government alleged that despite 1,200 balloon sinuplasty services, Dr. Jackson purchased only 30 devices over the four-year period and sometimes used the same device on the same business day.  The reuse of these devices netted Dr. Jackson hundreds of thousands of dollars in profits, according to the indictment. 

Illegal Remunerations to Patients

According to the indictment, Dr. Jackson and her staff frequently led patients to believe they owed minimal or no copayment to induce the receipt of the balloon sinuplasty services.  However, some patients actually owed hundreds or thousands of dollars for the services, according to the indictment.  The government alleges that Dr. Jackson would cause the patient obligations to be written-off without efforts to collect on the copayment amount. The government asserts that Dr. Jackson may not have performed as many balloon sinuplasty procedures had the patients’ copayment obligations been properly disclosed.

Billing Medicare Based Upon Insufficient Medical Records and Medical Record Fabrication

Dr. Jackson is also accused of billing Medicare for balloon sinuplasty services without adequately documenting and keeping documentation of the services rendered.  The indictment alleges that at times Dr. Jackson maintained no operative report for balloon sinuplasty services to justify the bill submitted.  The government also raised concern with “carbon copy” operative reports that were blank or missing signatures.  When Medicare audited Dr. Jackson, the government alleges that she fabricated, backdated, and forged records to deceive the auditors.

Dr. Jackson is charged with (1) adulteration of medical devices, (2) ten counts of paying illegal remunerations, (3) three counts for making false statements relating to health care benefits, (4) two counts of aggravated identify theft, (5) three counts of mail fraud, and (6) conspiracy.  

As the government noted, the indictment is not a guilty disposition – it contains only accusations.  If Dr. Jackson is convicted, the judge will consider the federal sentencing guidelines and other factors.  Dr. Jackson faces several years in prison if convicted.  The aggravated identify theft has a mandatory 2-year prison sentence to be served consecutive to other punishments.  She faces a maximum of 20 years in prison for mail fraud, 10 years for paying illegal remunerations, and 5 years for conspiracy and making false statements.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with white-collar criminal investigations and health care fraud investigations.  If you need assistance with such a matter, please contact us today.