TWO WHISTLEBLOWERS SHINE A LIGHT ON AN ELABORATE BACK SURGERY SCHEME TO DEFRAUD TAXPAYERS AND PRIVATE INSURERS WHILE RISKING PATIENTS' HEALTH WITH UNNECESSARY SPINAL FUSION SURGERIES, ON "WHISTLEBLOWER," FRIDAY, JUNE 21
"The Billion-Dollar Back Surgery Scam: Patients in Pain and Peril" - In 2011 Mark Sersansie began a new sales job with a medical supply company in California, but he soon began to suspect that not everything with the company was as it seemed. After teaming up with Bill Reynolds, a former DEA agent turned insurance fraud investigator, the pair realized that they may be looking at one of the most complex - and dangerous - schemes to defraud workers' compensation insurance in California state history.
Host Alex Ferrer uncovers the secrets of the billion-dollar back surgery scheme, on WHISTLEBLOWER, Friday, June 21 (8:00-9:00 PM, ET/PT) on the CBS Television Network.
At the center of the scheme were doctors who were being paid large kickbacks to steer patients into spinal fusion surgery at specific hospitals, including many cases where the procedures were medically unnecessary. They did this to take advantage of a former provision in California's workers' compensation law that allowed hospitals to "pass through" to insurance carriers the entire cost of medical hardware used in spinal surgeries. The pass-through provision placed no dollar limits on the cost of the hardware, which allowed hospitals to invoice and obtain reimbursement from insurance carriers for deceptively inflated amounts.
One of the distributors of the spinal hardware devised a plan to make even more money by manufacturing its own surgical screws, called pedicles, using non-FDA approved materials. Once implanted, the counterfeit hardware could potentially leach toxic substances and cause dangerous infections. Reynolds and Sersansie learned that hundreds - maybe even thousands - of patients may have been implanted with this counterfeit hardware. The pair filed a whistleblower lawsuit in 2012.
WHISTLEBLOWER is produced by CBS News Productions and CBS Television Studios. Alex Ferrer is the host. Susan Zirinsky is the senior executive producer. Anthony Batson, Alex Ferrer and Ted Eccles are the executive producers. Peter Bull is the senior producer. Alicia Tejada is the senior coordinating producer. Resa Matthews is the producer. Sara Holmberg is the field producer. Marcus Balsam, Gary Winter, Libby Fabricatore, Pascal Akesson, Michelle Harris, James Taylor are the editors.