Doctor performed needless surgeries on Michigan patients to defraud insurers, feds say
A former Michigan doctor has been charged with health care fraud after prosecutors say he performed medically unnecessary procedures and billed patients incorrectly in order to defraud health insurers, according to a Feb. 2 news release.
Daniel Castro, 70, worked at a Battle Creek clinic from 2015 to 2017 as an otolaryngologist, or an ear, nose and throat specialist, according to the release from the U.S. Attorney’s Office in the Western District of Michigan.
Prosecutors say Castro performed functional endoscopic sinus surgeries on patients who did not need them, according to their scans, medical history and symptoms.
Castro does not currently have an attorney listed.
According to the medical school at The University of Texas, these surgeries are reserved for those with chronic inflammation in the nose and sinuses “that persists despite aggressive medical treatment.”
Court documents say Castro routinely diagnosed his patients with chronic pansinusitis, or inflammation of the sinuses, in order to justify performing the “lucrative” FESS. The doctor would not share the often “completely normal” findings of CT scans before surgery, therefore allowing patients to go through with a surgery they did not need.
In most cases, Castro would give the patient a “conservative” medical treatment for their condition, but would not wait to see if it would work before scheduling and performing the surgery, according to an indictment.
According to the indictment, the more surgeries Castro performed, the higher his compensation would be.
Additionally, Castro is accused of falsifying his records to bill patients and their insurers, including Medicaid and Medicare, for services they did not receive. In some cases, prosecutors say Castro billed patients for a more complex surgery that he did not do in order to defraud insurers for his own financial gain.
He also created fake office consultation notes to justify the medical procedures he performed that his patients did not need, prosecutors said.
Castro, who now lives in Texas, is charged with 34 counts of health care fraud and eight counts of making false statements relating to medical matters.
If he is convicted, Castro faces up to 10 years in prison for each fraud charge and up to five years in prison for each false statement charge.
This story was originally published February 2, 2022 at 6:27 PM with the headline "Doctor performed needless surgeries on Michigan patients to defraud insurers, feds say."
