Mariah Martinez was 10-years-old when she started suffering debilitating headaches, reported The Atlantic. Worried, her parents sent her to a respected pediatric neurologist who would help — or so they thought. The doctor, Yasser Awaad, gave Martinez an electroencephalogram, known as an EEG, which charts electrical activity in the brain. At the end of the test, he concluded that she was suffering from a type of epilepsy known as atypical partial absence seizures.
In response to the diagnosis, Martinez went on Lamictal, a common anti-seizure medication. However, her headaches only seemed to get worse. Martinez was given an additional ten EEGs over the next few years, and Awaad claimed that almost all were abnormal. The headaches were getting so bad that Martinez’s Lamictal dose was increased to incredibly high levels, making her tired and unable to function normally.
It was when Awaad left his practice that Martinez went to a new doctor, and the results were shocking. He said that she had no EEG abnormality and doubted that she ever had atypical partial absence seizures, as they do not cause the type of headaches Martinez described. Rather, the doctor believed that Awaad had purposely misdiagnosed Martinez to make more money. He received money for every EEG test administered.
A decade later and Awaad is being put on trial after over a hundred former patients claimed that he falsely told them they had epilepsy. But, unfortunately, misdiagnoses fraud is not uncommon — in fact, some estimate that at least ten percent of all Medicare claims are inaccurate, though Harvard professor Malcolm Sparrow added that this could be because of doctor error as well as fraud.
The problem is not just found in Medicare and pediatric units; for example, nearly 400 people underwent unnecessary heart procedures that was suggested by and added to the coffers of a hospital in London, Kentucky. The victims sued the hospital and doctor in 2013.
A Texas doctor even gave his patients, who suffered from arthritis, chemotherapy treatments so that he could fund his “lavish” and “opulent lifestyle,” per CNN.
Similarly, in 2015, a doctor named Farid Fata was sentenced to 45 years in prison for administering unnecessary chemotherapy to over 550 patients.
Sparrow has said that the problem lies with the fact that doctors are paid on a fee-for-service basis. This means that the more bills they send to insurance companies, the more they earn.
“I don’t want a doctor who is richer for treating me more or richer for treating me less,” he said. “I want a doctor who is on a salary.”
But many worry that the growth of tests and procedures — necessary and not — is only growing. A Wall Street Journal report found that while ten years ago, health-care fraud used to be almost entirely related to doctor neglect or the doctor not providing accurate care, a new type of suit is growing: the medical-necessity cases. These bring doctors to court over whether they administered too many tests or procedures.
To reduce the risk of being swindled, doctors have emphasized the importance of getting a second opinion for serious diagnoses and any major procedure.