Raleigh doctor charged with fraud after billing Medicare $46 million for sinus care
A Raleigh doctor with practices across central North Carolina faces a federal indictment accusing her of profiting from millions of dollars in Medicare fraud, the U.S. Attorney for the Eastern District of North Carolina announced.
Dr. Anita Louise Jackson, 58, who helped direct Durham’s pandemic response as medical and laboratory director for the Durham County Department of Public Health, is accused of fraudulently billing Medicare for over $46 million for services to patients at her practice, Greater Carolina Ear, Nose and Throat.
Federal prosecutors charge her with adulteration of medical devices, paying illegal remunerations, making and using materially false healthcare documents, mail fraud, conspiracy and aggravated identity theft, according to a news release from U.S. Attorney Michael Easley announcing the indictments.
If convicted on all charges, Jackson could face up to 37 years in prison, the announcement said. She also faces fines exceeding $250,000.
The indictment alleges Jackson offered over 1,200 sinus infection treatments to more than 700 patients between 2014 and 2018, for which her practice received over $5.4 million and billed Medicare millions more.
Jackson “profited substantially” from this, and her practice was the highest-paid provider for this in the U.S. for portions of this time period, despite being located mostly in small, rural areas, the indictment states. The practice has locations in Raleigh as well as in the towns of Lumberton and Rockingham.
The indictment accuses Jackson of engaging in a series of crimes and frauds that deceived the Medicare program and her patients.
Jackson has worked in otolaryngology, a medical specialty focused on the ears, nose and throat, for over 20 years and is licensed to practice medicine in several North Carolina hospitals, according to a profile on findatopdoc.com.
Jackson was not available to talk to The News & Observer by phone, a receptionist at her practice said Friday afternoon.
According to her LinkedIn profile, Jackson was a research professor at the UNC Eshelman School of Pharmacy beginning in May 2017. The university told The N&O on Friday evening she has not been a faculty member since July 2019.
Jackson joined the Durham County health department in December 2020. A county spokesperson confirmed to ABC 11, which first reported the indictment, that Jackson no longer works for the county.
Accusations of fraud
Jackson offered balloon sinusplasty services, a non-invasive procedure for patients with sinus infections in which surgeons inflate a small balloon placed through the nose to improve sinus air flow.
According to the indictment, Jackson “netted hundreds of thousands of dollars in profits” from re-using balloon devices that are only authorized by the federal Food and Drug Administration for single use. Instead of being discarded, devices inserted into the nose of a patient were reused on several other patients without their knowledge.
The doctor and her employees hid the actual costs of sinus treatments from her patients and had them pay less, in turn making “Medicare to pay all, or nearly all, of her balloon sinusplasty charges for her Medicare-only patients, when Medicare was, in fact, only obligated to pay 80 percent of such charges,” the indictment states.
Federal investigators also accuse Jackson of falsifying medical records to prevent Medicare auditors from recouping Medicare proceeds and of billing Medicare for services with missing or duplicated documentation.
Jackson has been accused of fraudulent medical billing before, in March 2005.
Blue Cross and Blue Shield of North Carolina sued her then after Jackson denied audit requests when the insurer alleged that Greater Carolina Ear, Nose and Throat overcharged millions of dollars for services through fraudulent medical claims from 2000 to 2004.
The doctor and insurer settled out of court for an undisclosed amount in 2009, The Robesonian reported that year.
This story was originally published January 7, 2022 at 3:54 PM with the headline "Raleigh doctor charged with fraud after billing Medicare $46 million for sinus care."
