Stent-happy docs on notice in Maryland health care fraud debate

Mark Midei, then

For over a year, The Baltimore Sun has been following the federal investigation of Dr. Mark Midei, a Maryland cardiologist who is charged with implanting unneeded heart stents after being influenced by the stent maker, Abbott Laboratories. The Maryland legislature is now considering a ban on gifts to all physicians from medical companies.

Here’s how The Sun summarizes the latest news  in this health care fraud case: 

“St. Joseph Medical Center in Towson, Maryland, whose cardiology business is a focus of a continuing federal health care fraud investigation, has notified hundreds of its heart patients that they may have received expensive and potentially dangerous coronary implants they didn’t need.

“An internal review, begun last May at the behest of federal investigators and in response to a patient complaint, has turned up 369 patients with stents that appear to have been implanted in their arteries unnecessarily, hospital CEO Jeffrey K. Norman said in an interview yesterday. Patients began receiving letters alerting them to the finding early last month, and more notifications are expected as the review continues. Norman said:

”We take our interaction and the care of our patients with the utmost seriousness, and so we wanted to alert patients and their physicians to what we found.”

“In several cases, patients who received coronary stents at St. Joseph – purportedly to open a clogged artery to correct a severe blockage – have since learned they had only minor blockage, if any. For example:

  • One 69-year-old man was told that his artery had a 95% blockage, yet the new review suggests something closer to 10% , which is considered insignificant.
  • A 55-year-old woman who agreed to receive a stent after being told that she had a 90% blockage has since learned she had virtually no problem and that she never suffered from the heart diagnosis that has consumed her life for the past 18 months.

“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.

Mark Midei, now

“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 Midei’s employer, St. Joseph, billed government and private insurers more than $6.6 million for the procedures he performed.

“Maryland lawmakers are again considering legislation to bar gifts from companies to health care providers in the wake of allegations that Midei was “indirectly influenced” to perform unnecessary stent procedures by the device maker Abbott Laboratories.

Vermont and Massachusetts have recently enacted similar laws, considered the most restrictive in the nation, that significantly limit the items that industry sales representatives can offer to physicians, prohibiting trinkets, trips and most meals. They also require public disclosure of certain financial transactions.

“The bans drew an outcry from drug and device industry officials, who tried unsuccessfully to repeal the Massachusetts law last year, saying it hurt business. Maryland has weighed such conflict-of-interest legislation before, though it’s never gotten very far. Last year’s stent scandal involving accusations against Midei has renewed interest in the proposed law.”

♥  ♥  ♥

As a heart attack survivor who now sports a shiny stainless steel stent in my left anterior descending coronary artery (which was 99% blocked before being propped open with a bare metal stent on May 6, 2008), I have a keen (some might say obsessive) interest in All Things Cardiac, and particularly, like most patients who’ve had stents implanted, in this growing controversy around stent-happy cardiologists.

This topic began to worry heart patients and their physicians after the COURAGE* trials were published the year before my own heart attack, suggesting that for elective (non-emergency) coronary artery disease cases, stents show no benefit compared to just taking recommended heart drugs in preventing cardiac events in stable patients.

Tell that to Dr. Mehmood Patel, a 64-year old stent-happy Louisiana cardiologist who was sentenced to 10 years in federal prison, the maximum legal punishment allowed. Patel’s former employer, Our Lady of Lourdes Hospital, also paid $7.4 million to settle a class-action lawsuit brought by his former patients who had had coronary stents unnecessarily implanted.  His 11-week trial included charges of fraud involving 75 patients.

Meanwhile, back in Baltimore, Midei has subsequently been relieved of his privileges at St. Joseph Medical Center after last May’s internal investigation revealed that his stenting rates over the past two years were alarming enough to bring them under scrutiny. And St. Joseph has repaid several million dollars in federal Medicare funds it received for Midei’s procedures in order to settle pending government legal claims.

Although St. Joseph has not admitted to any wrongdoing, it did agree to pay a $22 million fine to settle charges that it paid illegal kickbacks to Dr. Midei’s medical practice in exchange for patient referrals.

A study of over 1,000 U.S. hospitals** led by Dr. Paul Chan reported in the Journal of the American Medical Association this year found that when cardiac catheterizations were done for acute indications like my own myocardial infarction (heart attack), the overwhelming majority of cases (98.6%) were performed for appropriate indications. Only 1.1% were done inappropriately (in the other cases, the benefit was uncertain).

But for elective procedures like the ones performed by Midei, however, Dr. Chan found that almost 12% of all such procedures were inappropriate, and an additional 38% were carried out for indications associated with unclear benefits.

Most of the procedures studied that were deemed to be inappropriate had been carried out on patients:

  • with no angina (54%)
  • with low-risk ischemia as determined by exercise testing (72%)
  • who were not receiving ‘maximal’ medical therapy (96%).
  • and 94% of these patients also did not have ‘high risk’ coronary anatomical findings.

Meanwhile, St. Joseph’s Hospital now claims it has revamped its internal review systems and has agreed to operate under increased federal oversight for the next five years.

Over 80 medical malpractice lawsuits have been filed so far by Midei’s former patients. Meanwhile, Midei himself has filed a $60 million lawsuit against St. Joseph Medical Center. His lawyer Stephen Snyder told The Sun:

“Midei was injured because city-based media published accounts of the allegations against him, which became known after St. Joseph began sending the warning letters to patients”.

And what do Midei’s own patients think of this scandal?

When one stent recipient, 66-year-old Peggy Lambdin, received the warning letter from St. Joseph’s indicating that her coronary artery had been less than 50% blocked when Midei implanted her stent (a blockage considered clinically meaningless and not an indication for stenting), she was unfazed, according to an interview in the Baltimore Sun:

“No one can ever tell me that I didn’t need that stent. I feel like [Dr. Midei] saved my life.”

NEWS UPDATE: July 14, 2011 – “Cardiologist’s License Ordered Revoked In Stents Case” 

Baltimore, MD  –  A Maryland state medical panel has declined to reverse a judge’s order to revoke a cardiologist’s license on accusations he performed hundreds of medically unnecessary coronary stent procedures. The Maryland Board of Physicians ruled that Dr. Mark Midei violated five provisions of the Medical Practice Act, including provisions that prohibit unprofessional conduct, making false reports, keeping inadequate records and over-utilization of health care services. The board declined to reverse the ruling, calling Midei’s violations “repeated and serious”, and   further writing that Midei “unnecessarily exposed his patients to the risk of harm” and “increased the costs of the patients’ medical care.”

The judge had ordered Midei’s medical license be revoked and not reinstated for at least two years, to which the board agreed, adding that Midei had falsified the extent of blockages of patients’ coronary arteries by reporting them as being 80% blocked, when they were actually lower – and in most cases, much lower. In some patients, he had also falsely reported that they suffered from unstable angina when in fact they did not.

The Board found that he inserted cardiac stents into arteries that weren’t clogged enough to need them — likely because of “pressure to produce.” 

The Board’s report also noted that Midei was hired to run St. Joseph’s cardiac catheterization lab at a seven-figure salary that was triple his prior earnings, adding:

“Dr. Midei testified that he understood that he was a big generator of business for the hospital, that the hospital had lost many patients to competition, and that its goal was to hold onto the stent business that it saw slipping away.”

Read more coverage of Mark Midei’s stent scandal. See also:


  • March 3, 2011 – Medical reviews at Pittsburgh’s Westmoreland Hospital have determined two cardiologists there implanted coronary stents in at least 141 patients in 2010 who may not have had enough blockage in their arteries to need a stent.  Letters to these patients do not provide a reason why the patients received the stents, but state their condition “may not have justified the placement of a coronary stent.” Hospital officials said the questionable stents were implanted by Drs. Ehab Morcos and George Bousamra, who voluntarily resigned their hospital privileges at Westmoreland on January 12, 2011 after being investigated.  The two doctors performed more than 750 of the up to 2,000 stent procedures done at Westmoreland Hospital that year.
  • June 10, 2011 – The US Department of Justice will investigate charges by a Tennessee cardiologist against another cardiologist and two hospitals. Dr. Wood Deming of Jackson is accusing Dr. Elie Hage Korban (Heart and Vascular Center of West Tennessee, Jackson) of blatant overutilization of cardiac medical services, including, but not limited to, cardiac sonography, scintigraphic stress imaging, angiography, angioplasty, and stenting” in order to defraud government insurance programs. Dr. Deming also alleges that the executives of Jackson-Madison County General Hospital and the Regional Hospital of Jackson and radiologist Dr. Joel Perchik condoned or assisted in Korban’s fraud in addition to engaging in a bilateral kickback and self-referral scheme. The US attorney’s office in Memphis will file its own complaint against Korban within the next two months.
  • July 26, 2011 – A federal jury has convicted Maryland interventional cardiologist Dr. John R. McLean, 59, on six charges of health care fraud relating to insurance claims he’d filed for stents deemed to have been placed unnecessarily, as well as for ordering unnecessary tests and making false entries in patient medical records. A statement released by the Office of the Inspector General said: “The evidence shows that Dr. McLean egregiously violated the trust of his patients and made false entries in their medical records to justify implanting unneeded cardiac stents and billing for the surgery and follow-up care.”  NEWS UPDATE, November 10, 2011: Dr. John McLean was sentenced to eight years in prison followed by three years of supervised release. McLean has also been “ordered to pay $579,070 in restitution to Medicare and other health insurance programs and to forfeit $579,070 as proceeds of the crime.”  McLean had previously resigned his hospital privileges at Peninsula Regional Medical Center in Salisbury, MD in 2007, citing visual impairment as the reason. Hospital administrators, however,  had conducted internal and external reviews leading them to conclude that McLean had implanted as many as 25 stents in patients who did not meet the clinical criteria for PCI.


* Boden WE, O’Rourke RA, Teo KK, et al. “Optimal medical therapy with or without PCI for stable coronary disease”.  New England Journal of Medicine 2007; DOI:10.1056/NEJMe070829.

** “Appropriateness of Percutaneous Coronary Intervention”. Journal of the American Medical Association,  2011;306(1):53-61.

11 thoughts on “Stent-happy docs on notice in Maryland health care fraud debate

  1. Holy crap!

    What happened to the “do no harm” part of this man’s oath? Scumbag.

    This is so outrageous… if I was a Maryland prosecutor, I’d try charging this guy with assault, reckless endangerment and possibly even attempted murder.

    Did any of these patients die of complications related to these unnecessary surgeries?


    • To my knowledge, no. Midei was eventually fired by St. Joseph, has not yet been charged with a crime, and, according to the Baltimore Business Journal, none of the patients identified in the hospital’s investigation have died.

      But the hospital’s own investigation has led to class-action and individual lawsuits filed against Midei, the firing of former St. Joseph CEO John K. Tolmie and two other hospital executives, a federal government investigation into St. Joseph’s cardiac business, and a state inquiry into the possible violation of patient safety regulations. And because of the procedure’s $15,000 average price tag, it gets special attention from insurers and regulators in search of health care fraud.


      • The hospital administrators were never fired! And it was published this summer that there were no ties between the adminstrators and Midei. Do not state your supposed facts without proof.


        • Chris, I’m assuming you might be related to former St. Joe’s CEO John Tolmie, reported by The Baltimore Business Journal first as having “resigned in May 2009 amid a federal investigation of the hospital” and subsequently (July 29, 2011) “fired amid a federal investigation into the stent procedures”. I’ve been unable to find the sources you mention from this summer – please forward them and I’ll be happy to change the word ‘fired‘ to ‘resigned‘.


  2. This guy did my sister’s stent procedure. We were told at the time he was “the best”. Little did we know at the time that his skill was due to doing so many unnecessary procedures. He should be in jail, as should the hospital administrators who allowed him to operate.


  3. Theres apparently a pro-stent website set up by Midei (his lawyers? his relatives?) where his supporters can go online and write nice things about what a great guy he is.


  4. how does one find out if DR Ehab Morcos was getting kickbacks, incentives or whatever at westmoreland hospital in greensburg PA for placing in unnecessary heart stents ????


    • Hi Terri – Though Drs. Morcos and Bousamra are no longer on Westmoreland’s staff, they are still members of the Westmoreland County Cardiology medical practice. After Westmoreland’s internal review, letters were sent to all patients identified by the reviewers as having potentially unnecessary stents implanted. The names of both doctors were then turned over to the Office of the Inspector General in the Department of Health and Human Services. If you were one of the stent patients who received a warning letter from Westmoreland, you can contact the Inspector General’s office, Westmoreland hospital, or Dr. Morcos directly for more information.


  5. There is the potential for any surgeon to do procedures that are not medically necessary, weather its inserting hip replacements, doing simple arthroscopic procedures, or anything else.

    Of course all supply companies want the doctors to use their products or prescribe their drugs. Most doctors are honest enough not to be lead by temptation, and they actually do whats in the best interest of their patients.

    Cardiac stenting is a wonderful procedure for those that need it. I have seen some patients need the same artery stented 17 times because they had a high restenosis rate. Their only other option would have been bypass surgery and if their stents closed imagine what would happen to grafts. It is a common fact that stenting keeps people from having major heart attacks and also keeps people from needing bypass surgeries.

    We are a lucky society that we have the medical technology available to us, and a few dishonest greedy doctors should not cast the whole profession in a bad light. Everyone has the right to a second opinion. My father right now has been told he has to have 2 bilateral fem pop bypasses because his stents are closed. You can bet he will be getting a second opinion before I let anyone cut on him, I am grateful we have this option. It would be our fault if we didnt exercise the right to get that second opinion.

    Is what Im saying here making any sense? If people want to omit fraud from the medical industry maybe laws should be passed that everyone get that second opinion before any procedure or surgery is done.. maybe then hospitals wouldnt be settling after the fact and thus no police dog activity would be needed to stop fraud……2 certified medical opinions required….. then one doctor would have less chance to do things not needed, and we in the medical profession can continue saving lives and doing the things we got into the field to do…… care for people…

    just a thought


    • Hello Chris and thanks for your comments here. Nobody would argue that stents aren’t appropriate for some patients (including me – I had a stent implanted in a fully occluded left anterior descending coronary artery that resulted in heart attack in 2008). But many recent well-designed clinical studies conclude that even though drug therapy alone can reduce the risk of heart attack and death in people with stable coronary artery disease just as well as more expensive invasive procedures, many cardiologists continue to use interventions like propping open blocked arteries with costly stents instead of first trying medication as current guidelines recommend. For more on this, read “You Can Lead a Cardiologist to Water But, Apparently, You Can’t Make Him Drink”.


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