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Unnecessary Heart Surgeries Leads to Medicare Fraud Conviction

A Tallahassee Florida surgeon is behind bars after being convicted of performing medically unnecessary cardiac angioplasties. On December 18, Moses deGraft-Johnson pled guilty to 55 counts of healthcare fraud and criminal conspiracy. He also pled to a count of aggravated identity theft.

Prosecutors and regulators are still trying to sort out how many patients were harmed by deGraft-Johnson. Over a several year period he performed hundreds of angioplasties and even billed for some that were never done.

Prosecutors say his scheme netted him $29 million dollars, much of it from Medicare.

Court records show that Moses deGraft-Johnson operated the Heart and Vascular Institute of North Florida.

Medicare rules require physicians to certify that all services billed to the program were actually performed and were medically necessary. Medicare and most private insurance only reimburse services that were medically necessary and actually rendered.   Doctors can’t over treat patients or perform unnecessary services simply to pad their bills. This is especially true when the procedure in question is invasive and could put the patient at further risk.

Healthcare Fraud – Billing for Services Not Performed

deGraft-Johnson’s fraud scheme wasn’t limited to performing unnecessary angioplasties. He is also accused of billing for some services that were never performed.

Prosecutors say he was outside the United States at times yet his billing records suggesting he was in Florida performing angioplasties.

Prosecutors also claim he was recruiting patients from underserved communities. To feed his greed, he would recruit patients from nursing homes, churches and outreach organizations. Although prosecutors have not identified those entities by name, similar medical necessity and false billing fraud cases involve recruitment efforts among the elderly, homeless and addicts. Fraudsters find it easier to steal their Medicare or Medicaid information and bill for services not performed.

deGraft Johnson Is Behind Bars

deGraft-Johnson reign of terror ended with his arrest in February.  His lawyers argued that he should be released on bail. Prosecutors disagreed and claimed that he had ties to the nation of Ghana and was a flight risk. They found three drivers licenses in his name and believed he had lied about his assets.

In a bizarre twist, they claim deGraft Johnson was planning on running for the presidency of Ghana!

After losing an appeal of his detention order, deGraft-Johnson pled guilty on December 18th, one week before Christmas. He is expected to be sentenced in April 2021. He faces over 500 years in prison.

As part of his plea deal, he agreed to help regulators identify all of his victims. Authorities fear there are hundreds of people who may have received false information about their cardiac condition. Finding them and ensuring they receive proper screening and care will be a daunting (and expensive) task.

He has also agreed to help pay restitution to his victims. Authorities believe the money he made from the scheme was spent on luxury vehicles; jewelry; and homes in Manhattan, Southampton, New York, Miami, and the Houston area. They also believe he has property in Ghana.

Medically necessity cases are tough to prove. Some cases, like those involving unnecessary testing, carry little risk of physical harm. The only victims are taxpayers who foot the bill for Medicare and Medicaid. The risks to patients were much higher in this case, particularly where deGraft – Johnson performed invasive procedures on patients who didn’t need them.

Invasive procedures such as angioplasties carry significant risks. Angioplasty involves inserting a catheter into the heart. Anytime you stick something into a person’s heart there are risks. The risks from angioplasty procedures include:

  • bleeding, clotting, or bruising at the point of insertion.
  • scar tissue or blood clots forming in the stent.
  • an irregular heartbeat, or arrhythmia.
  • damage to a blood vessel, heart valve, or artery.
  • heart attacks
  • kidney damage, especially in people who have preexisting kidney problems
  • an infection

In a prepared statement, a Health and Human Services spokesperson said, “deGraft-Johnson’s unscrupulous behavior placed the lives of his many patients at risk while siphoning funds from vital health care programs for personal gain.. We will continue to work with our law enforcement partners to hold accountable health care professionals who prioritize greed over critical patient care.”

The case was jointly prosecuted by law enforcement officials from Health and Human Services, the State of Florida, FBI, IRS Department of Commerce and ATF.

Whistleblower Rewards for Healthcare Fraud

Prosecutors haven’t said how deGraft – Johnson was caught. Since he pleaded guilty before trial, we probably will never know. In most cases, these fraud schemes are first discovered by insiders who have firsthand knowledge of the scheme or scam.

Typical Medicare and Medicaid fraud whistleblowers include billing clerks, office managers, other doctors and nurses. No one likes seeing Medicare fraud , especially honest healthcare workers who have chosen to make a career out of helping others.

Under the federal False Claims Act, whistleblowers with inside knowledge of healthcare billing fraud can earn a reward of between 15% and 30% of whatever the government collects from the wrongdoer. Cases involving Medicaid, Medicare and Tricare are all eligible for rewards.

Approximately 30 states have their own whistleblower reward programs for the state funded portion of Medicaid meaning in these states, two rewards are possible. (Florida where deGraft – Johnson practiced is one of those states.)

The federal and state False Claims Act all contain powerful anti-retaliation provisions that can pay you double damages and attorneys fees. This is in addition to any reward you may receive.

To obtain a reward, you need an attorney to help you file a sealed case in court. Sealed means secret. Your case will remain confidential while investigated by authorities. Ultimately the government or your lawyer will be able to prosecute the case once the investigation is complete. In some instance authorities may ask the court to dismiss the case.

See Something? Say Something.

If you are a healthcare worker with inside information about fraud involving a government funded healthcare program, you may be entitled to a large cash reward. We can help you obtain a reward and stop the fraud. Calling our hotline will put you in contact with a whistleblower lawyer who can help you assess your case and file for a reward.  Medicaid Fraud Hotline: 888.742.7248 or REPORT ONLINE AND CLAIM A REWARD

Patient? Healthcare professional not interested in a reward or wanting to remain completely anonymous? Contact 1-800-MEDICARE. (There are no rewards for reporting directly to 1-800-MEDICARE.)

Medicaid Fraud Hotline: 888.742.7248 or Report Online
and claim reward