Federal report on stent procedures finds potential fraud

Investigators question whether doctor's relationship with stent maker encouraged unnecessary medical procedures

December 06, 2010|By Tricia Bishop, The Baltimore Sun

While Dr. Mark Midei was allegedly implanting unnecessary cardiac stents in hundreds of patients at a Towson hospital, stent manufacturer Abbott Laboratories was paying for crab and barbecue feasts at his Monkton home and building a business strategy around the Maryland cardiologist's high output, according to a federal report being released today.

Abbott, a $30 billion-a-year, Chicago-based pharmaceutical firm, ranked Midei among its top-volume doctors in the Northeast and made plying him with research money and "VIP trips" part of its business plan in late 2008 — about the time Midei's usage of Abbott-brand stents soared, the report said.

The 170-page document contains the findings of a months-long investigation by the U.S. Senate Committee on Finance into allegations of inappropriate and potentially harmful cardiac procedures performed by Midei at St. Joseph Medical Center. It calls the case "a clear example of potential fraud, waste and abuse," noting that St. Joseph billed government and private insurers more than $6.6 million for the procedures.

Committee Chairman Sen. Max Baucus also raised concerns in a statement that "this could be a sign of a larger national trend of wasteful medical device use." Similar allegations have been made against cardiologists in at least three other states and elsewhere in Maryland.

"Hospital patients expect their care to be based on medical need, not profits," the Montana Democrat said. "This report sets forth alarming evidence that patients at St. Joseph's Medical Center received unnecessary and potentially harmful stent implants time and again — a pattern that is shocking, disturbing and shameful.

"Doctors should not be performing invasive medical procedures patients don't need, and taxpayers certainly shouldn't be paying for these wasteful and improper implantations."

The Senate report includes dozens of e-mails, letters and other documents, subpoenaed by the committee, that reveal a cozy and sometimes lucrative relationship between Midei, St. Joseph and Abbott. In one exchange, Abbott officials congratulated Midei for implanting 30 stents in one day, calling it a record and describing the physician as "one of the highest implantors [sic] thus far."

Investigators for the Senate Finance Committee, which has long been concerned about inappropriate relationships between pharmaceutical companies and physicians, said their investigation raises questions about "whether or not Abbott Laboratories indirectly encouraged Dr. Midei to intensify his use of stents, with unfortunate results."

Abbott declined to answer questions Friday, but issued a statement saying, "Dr. Midei has been a highly regarded physician in his field, with whom Abbott had consulted in the past. Our affiliation with Dr. Midei ended early this year."

St. Joseph said it had not seen the report and declined to answer questions Friday, while Midei's attorney, Stephen L. Snyder, dismissed it, saying simply: "Big deal."

Among other details in the Senate report:

• Abbott paid for social events at Midei's home, including a "beers and crabs" dinner and a whole-pig barbeque for employees of the St. Joseph cardiac lab. A company official also lauded an Abbott saleswoman for her business relationship with Midei, calling it the strongest the official has seen in 15 years.

• Abbott officials enlisted Midei as a paid consultant after he was forced out of St. Joseph, calling it the right thing to do because "he helped us so many times over the years." The company paid him more than $30,000 to market its "Xience V" stent in Japan, after the media climate in the United States became "too hot."

• The company noted an "ugly" decline in the volume of stent procedures at hospitals throughout the Baltimore region after the allegations against Midei became public, including a 46 percent drop at St. Joseph.

• One Abbott official suggested that local connections or the "Philly mob" should intervene to silence Baltimore Sun columnist Jay Hancock for his coverage of the scandal, saying "someone needs to take this writer outside and kick his ass!"

The report does not offer recommendations or outline a next step, though some safety measures have already been added through recent legislation, Baucus said.

"Aggressive new tools, like improved screening of medical providers and increased oversight, [were included] in the new health care reform law to root out fraud, waste and abuse like this," Baucus said.

The U.S. Senate committee, which oversees the taxpayer-funded Medicare and Medicaid programs, launched the investigation in February after a story in The Sun about Midei's questionable procedures. The inquiry focused on Midei, St. Joseph and Abbott, which manufactures the stents that Midei typically used during his last year of work at the hospital, which ended in May 2009.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.