Not Appropriate! Florida healthcare fraud case highlights inappropriateness in care

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The latest research around practice patterns and appropriateness in care came shortly after a criminal case in Florida at the tail end of last year in which the owner of an outpatient catheterization lab pled guilty to committing healthcare fraud, conspiracy to committing healthcare fraud and aggravated theft—all of this to the tune of $29 million.

Moses de-Graft Johnson, MD, was behind Thorvasc PA, which operated as the Heart and Vascular Institute of North Florida, according to the U.S. Attorney’s Office Northern District of Florida.

Atherectomies figured at the heart of the case.

As part of his plea Dec. 18, 2020, deGraft-Johnson acknowledged engaging in a wide-ranging and consistent pattern of performing angiography procedures—one on each leg—on hundreds of his patients, whether they were indicated or not, the U.S. Attorney’s Office reported in a statement.

“When his patients returned for follow-up office visits, deGraft-Johnson submitted fraudulent claims to their insurance companies stating he performed atherectomies during the appointments,” according to the statement. “Using this scheme, deGraft-Johnson admits he falsely claimed to have performed over 3,000 of these surgical procedures to clear blockages in arteries in as many as 845 of his patients’ legs.”

The fraud to which deGraft-Johnson pled guilty funded an exorbitant lifestyle, according to details revealed by the prosecutors.

“Over the course of almost four years, beginning in late 2015 or early 2016 until his arrest in February 2020, deGraft-Johnson did significant harm to hundreds of patients living in the Tallahassee area,” the U.S. Attorney’s Office statement explained.

“Many of these innocent victims underwent unnecessary and invasive surgical procedures, while others were victimized through medical records reflecting procedures he did not perform—erroneous and misleading records that could cause doctors in the future to determine a mistaken course of medical treatment for many patients.”

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