Md. Case: An Issue of Medical Judgment or Criminal Fraud?


On September 1, 2010, John R. McLean, a former cardiologist based in Salisbury, Md., was indicted by a federal grand jury for health care fraud and for making false statements to Medicare and Medicaid.

McLean is charged with performing operations to insert stents – devices to treat coronary disease – in the arteries of patients who did not need them according to accepted medical practice, and then falsifying their medical records to make it appear that they did need them. He lost his hospital privileges in 2007 after a hospital probe of his practices involving stents.

Medicare, Medicaid, and private insurance won’t pay for a stent unless the patient has been diagnosed with a 70 percent or greater blockage of the artery. The indictment alleges that McLean inserted stents in patients with significantly less blockage but falsely stated that they were at the 70 percent level or above. Stents and the follow-up appointments and tests can be lucrative for a cardiologist, and the indictment says that McLean benefited from unnecessary stents to the tune of $519,000.

Prosecutors say it’s all about McLean receiving cash that he wasn’t entitled to.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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