This Week In Blunders – July 5-11
“The glorification of profit … is harming both care and health. Health care should not be an engine for excessive private gain.” – Donald M. Berwick
If there’s an award for the most despicable medical billing fraud, I nominate Dr. Sanjeev Kumar, 45, a Mayo-trained gynecologic oncologist who ran the Poplar Avenue Clinic in Memphis.
Typically, medical billing fraud involves schemes like billing for services that were never rendered or upcoding for more expensive treatments than patients received.
Not Kumar. He found a way to reuse single-use medical devices in thousands of hysteroscopies and then billed private and government insurers as if he’d used new ones.
This is a stressful, highly personal, in-office procedure for detecting cancer. A scope and a grasper is inserted into the vagina, pushed through the cervix, and into the uterus for a biopsy, and then snip, snip.
Kumar did more than 15,000 of these procedures between September of 2019 and April of 2024. But he only purchased about 200 hysteroscopes.
“Thousands of women were subjected to hysteroscopies with biopsy using the dirty devices,” prosecutors said.
He billed more than $41 million for this service and netted more than $4.8 million from Medicare and Medicaid alone.
On Wednesday, Kumar was sentenced to 20 years in prison. Restitution will be determined in a hearing scheduled for Oct. 2. The FBI is looking for victims. The personal-injury lawyers are circling.
