RALEIGH, N.C. (WNCN) — A Raleigh doctor has been found guilty of using low-quality, unsanitary medical equipment on patients during nasal surgeries, according to the U.S. Department of Justice.
The conviction came Friday after a three-week federal jury trial and five hours of jury deliberation.
Court documents said 59-year-old Anita Louise Jackson was found guilty of reusing devices to perform more than 1,400 surgeries for Medicare patients between 2011 and the end of 2017, according to a news release from the USDOJ.
The jury convicted Jackson of 20 counts in total:
- One count of adulterating medical devices for use on patients with intent to defraud and mislead
- Three counts of fabricating medical and healthcare records
- 10 counts of paying illegal remunerations
- Two counts of aggravated identity theft
- Three counts of mail fraud
- One count of conspiracy
The conspiracy charge comes from Jackson conspiring with her staff to commit device adulteration, to pay illegal remunerations, to make false records and to commit mail fraud, according to the USDOJ.
Who is she?
Jackson was an ear nose and throat doctor who ran Greater Carolina Ear, Nose, and Throat (GCENT), with offices in Raleigh, Lumberton and Rockingham, the release said.
Between 2011 and the end of 2017, it said Jackson preformed 1,555 balloon sinuplasty surgeries on 919 Medicare beneficiary patients. Balloon sinuplasty is an in-office surgery to treat chronic sinusitis.
Using insanitary medical equipment
According to court documents, Jackson reused single-use medical devices called Entellus XprESS devices.
The device, approved by the U.S. Food and Drug Administration, was cleared to be used in the performance of balloon sinuplasty procedures — but only on one patient, during one surgery.
After that, the FDA said device must to be discarded.
Between 2012 and 2017, court documents said Jackson obtained, at most, 36 new Entellus devices, despite being, at times, the top-paid Medicare provider of balloon sinuplasty services in the country.
The court considered this evidence that Jackson misled and did not inform her patients that they were receiving a procedure with an adulterated device.
According to court documents, the evidence also showed, and Jackson admitted on cross-examination, that she had enough money to buy every patient a new device, but chose not to do so.
“This doctor put profit ahead of patients, luring in Medicare patients with free “sinus spas” and risking infection to those patients by reusing the same single-use surgical devices on them again and again,” stated Michael Easley, U.S. Attorney.
Jackson was also convicted on 10 counts of illegally influencing her patients to receive the surgery by failing to collect the co-pay which the patients were required to pay.
According to court documents, Jackson used her employees to market the sinuplasty surgery as a “free sinus spa.”
In doing so, court documents said Jackson convinced her patients to receive a treatment they may not have needed, or may not have agreed to, if the full out-of-pocket cost to the patient was disclosed.
According to the USDOJ, the full out-of-pocket cost could be as high as $1,500 for Medicare beneficiaries, which the jury found was not disclosed to patients.
In order to get more patients, the USDOJ said she wrote-off and hid the full cost of the procedure on any bills sent to the patient.
“Dr. Jackson corrupted her integrity and violated patient trust by putting profits ahead of quality care,” said Christopher Dillard, the Special Agent in Charge of the DoD Office of the Inspector General, Defense Criminal Investigative Service (DCIS) Mid-Atlantic Field Office.
Fabricating medical records
Between 2017 and 2018, court documents said Medicare contractors performed three audits on Jackson.
The jury found that Jackson fabricated the medical records given to auditors to keep more than $1.7 million that had already been paid to her by Medicare.
They convicted her of fabricating and modifying medical records to justify the billing of balloon sinuplasty surgeries to Medicare auditors.
According to court documents, the two aggravated counts of identity theft were regarding Jackson’s use of forged patient signatures.
It said she forged her patient’s signatures on documents where they declared that they received surgeries from the her, and that they needed them.
Jackson was convicted of mail fraud after using fake medical records to deceive auditors, and to deceive a fellow physician, according to court documents.
She was also convicted for tricking a fellow ENT physician into signing a sworn statement that her medical documentation supported her prior balloon sinuplasty surgeries.
Jackson billed Medicare more than $46 million dollars for the balloon sinuplasty procedures she performed between 2014 and 2018, despite netting more than $4.79 million from those surgeries alone, according to the USDOJ.
The department said the amount does not include any sinuplasty surgeries performed on patients with private health care insurance and monies received from Medicare before that timeframe.
In court, the jury ordered Jackson to forfeit over $4.79 million.
“It is disturbing when fraudsters exploit vulnerable Medicare enrollees and defraud federal health care programs for personal gain,” said Special Agent in Charge Tamala E. Miles of U.S. Department of Health and Human Services Office of Inspector General.
Raleigh doctor faces sentencing
After the verdict, it said Jackson was taken into custody pending sentencing.
She faces a total maximum of 40 years in prison:
- 20 years maximum for mail fraud
- 10 years maximum for paying illegal remunerations
- 5 years maximum for conspiracy and making false statements
- 3 years maximum for adulteration with the intent to defraud of mislead
- A 2-year mandatory prison sentence for aggravated identity theft, consecutive to any other punishment
Jackson also faces fines exceeding $250,000.