in Houston, Texas
Doctor sanctioned for unnecessary procedures practicing in South Texas
Tuesday, Mar 29, 2011, 11:22AM CST
By Mark Lisheron
scalpel

A doctor currently practicing in South Texas, who was banned from the Medicaid and Medicare programs for nine years, lost nine patients who died after he performed elective surgery on them in 2008 and 2009.

The doctor, whose name is protected by federal privacy laws, is part of what is a groundbreaking examination of fraud in our federal health care system by the Wall Street Journal. In February the Journal broke a story of the roundup of 114 people in nine cities including Houston and Dallas involved in various schemes to defraud Medicare of  $240 million.

The federal investigation, the largest of its kind in history, was spurred by the Journal’s study of Medicare claims databases and a legal fight with the federal government over how much of the information concerning Medicare and Medicaid patients may be kept from the public.

Agreeing to privacy restrictions, the Journal was able to determine that the surgeon who currently works in five South Texas hospitals had a death rate for patients upon whom he performed elective surgery almost eight times greater than the national average.

The inspector general for New Jersey’s Department of Health banned this doctor from billing Medicare and Medicaid for procedures on seven patients that were unnecessary and inappropriate. In one of the cases, a misdiagnosis contributed to the patient’s death, the inspector general wrote in a letter to the doctor. New Jersey barred him from practicing for a time.

The Journal story centers on Vishal James Makker, a Portland neurosurgeon who performs 300 to 500 spinal surgeries a year, who has billed Medicare for more than $5.4 million over the past three years and been sued for medical malpractice eight times over the past decade.

Makker, who attended medical school at the University of Texas Health Science Center in San Antonio, has the highest rate in the nation for performing multiple spinal surgeries on the same patients.

His payment for all of that Medicare billing, $597,510, is a rate just a bit more than half that of the average for surgeons billing Medicare for the same work. Medicare fraud experts referred to in the story said low reimbursement rates are a warning to them of possible fraud.

Makker, who agreed to an exchange of e-mails and text messages with reporters, defended both the volume and the repetition of the spinal work for which he has billed the government. He considers himself a neurosurgeon of last resort.

The "main reason that I have had so many repeat surgeries" on patients, he wrote, is "honestly, I am the dumping ground for Medicare patients, especially the difficult ones that everyone knows are going to be difficult to fix with one or even two surgeries."
 
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Contact Mark Lisheron at 512-299-2318 or mark@texaswatchdog.org.

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Photo of a scalpel by flickr user aesop, used via a Creative Commons license.
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