Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Dr. Anita Louise Jackson is an ENT specialist. Dr. Jackson runs several ear, nose, and throat clinics in the Raleigh, NC area. She helped several of her local health departments respond to the COVID-19 pandemic. She’s also named in a $46-million Medicare fraud scheme. 

The indictment dives into each charge in detail. We’ve summarized the 20+ counts below. 

The recycling of “single-use” balloon sinuplasty devices. 

Illegal payment and remuneration by regularly failing to charge and collect patient coinsurance obligations.  

Billing Medicare based upon fraudulent records.  

Using fabricated medical records to smokescreen Medicare audits. 

These are criminal charges. 

Dr. Jackson ranked among the nation’s most successful ENT providers in terms of revenue generated from balloon sinuplasty procedures. Her success likely struck watchdogs as strange since she mostly practiced in a rural environment. The most successful ENT practices, based on cash generated from these procedures, are often located in metropolitan regions. 

Prosecutors allege between 2014 – 2018 Jackson billed Medicare fraudulently for $46 million. $5.4 million translated into profit for Jackson and her practice. Among the alleged fraudulent charges, 1,200 correspond to balloon sinuplasty.  

The indictment describes her alleged process as follows:  

JACKSON routinely concealed from her Medicare patients the true amount that they were obligated to pay for the balloon sinuplasty services that JACKSON was billing to Medicare in their names. Characterizing these services as a “Sinus Spa,” JACKSON and her subordinates routinely led patients to believe they owed either nothing, or only a small copayment of up to $50.  

In fact, patients were obligated to pay hundreds – in some instances thousands – of dollars for the services. To induce the receipt of these services, JACKSON deceived and failed to inform the patients of their obligations, failed to collect the patient copayments, and ultimately caused the patient obligations to be written off without making genuine efforts to collect.  

By engaging in this practice, Jackson caused Medicare to pay all, or nearly all, of her balloon sinuplasty charges for her Medicare-only patients, when Medicare was, in fact, only obligated to pay 80 percent of such charges. JACKSON profited from this scheme because it enabled her to reap millions in balloon sinuplasty payments from Medicare which might not otherwise have been incurred had the true patient obligations been disclosed. 

We’ve enclosed an image below, lifted from the indictment, demonstrating a few instances of the (allegedly) fraudulent charges. 

Jackson then allegedly spoofed medical records to throw auditors off her trail – at least in the short term.  

Where to begin? 

The recycling of the single-use sinuplasty balloons is an obvious no-no. These devices, inserted into a patient’s sinus cavity, are immersed in phlegm, mucus, pus, blood, etc. To be clear – the devices used by Jackson were not cleared by the Food and Drug Administration for re-use/reprocessing. Sure, some devices can be used “off-label.” Recycling single-use devices – hard to make the case. 

To quote the indictment once again… 

JACKSON was fully informed that the devices were strictly single-use devices, and that the devices were not intended to be reprocessed or sterilized. Nevertheless, across the relevant time period, JACKSON purchased no more than 30 of these devices. She reused the devices as a routine business practice, sometimes inserting the same device into more than one patient on the same business day. JACKSON failed to inform her patients that she was reusing the devices, and instead, represented on “Pre-Op Instruction for Sinus Spa” forms that the devices were sterile. 

As for the rest: Do we really need to explain in detail why producing fraudulent medical records is bad form? 

Jackson also faces charges related to… 

Adulteration of medical devices… 

Three counts of making false statements specific to health care benefits… 

Two counts of aggravated identity theft… 

Three counts of mail fraud… 

If convicted, Jackson could spend a lot of time behind bars and see a fine of $250,000 – likely more. Prior to (and during) these alleged events, Jackson operated several successful ENT clinics.  

We’re curious as to how this all plays out in court. We’ll report updates as they emerge.  

One note: Many of these patients lived in rural, lower socioeconomic areas. It’s possible they did not have the money to pay their coinsurance. Nonetheless, Medicare mandates that these patients still be billed in good-faith. If uncollectable, so be it. But the process can’t begin with promising the patient they will only owe $50. In other words, Medicare does not want to see doctors writing off patient obligations in advance of the procedure. Medicare considers this an illegal inducement which causes over-utilization. Medicare considers this constructive remuneration to patients likely to influence the patient’s decision to receive services.  

What do you think? Let us know in the comments below… 

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.