Maryland strips Midei of medical license for PCI overutilization

The Maryland State Board of Physicians has revoked the medical license of interventional cardiologist Mark G. Midei, MD, due to his “repeated and serious” violations of the Medical Practice Act, including “unnecessary stent insertions,” and the falsification of patients’ medical records—both of which the board deemed “indefensible.”

The charges, which were initially filed on July 20, 2010, related to his treatment of five patients in whom he inserted cardiac stents.

The prosecutors accused him of violating five provisions of the Act, including unprofessional conduct in the practice of medicine; willfully making a false report or record in the practice of medicine; the gross overutilization of healthcare services; violations of the standard of quality care; and failure to keep adequate medical records. The oral exceptions hearing was held on June 22 before the Maryland board.

Specifically, the board concluded that he failed to “deal honestly with patients and colleagues when he falsely reported that three patients suffered from unstable angina and all patients suffered occlusions of 80 percent. He made intentional, non-accidental and non-advertent false reports that exaggerated the degree of coronary stenosis and reported non-existent unstable angina in order to justify the placement of a stent.” They also concluded that he placed six unneeded stents in four patients.

Based on the board's decision, Midei claimed he remembered incidents of unstable angina in these patients that were not recorded in the medical records, which the board did not find “credible” because these three cases were “among thousands” that he saw annually, three years previously. Midei testified to the board that he saw 1,500 to 2,500 patients annually for such diagnosis and possible intervention.

The board also noted that it is not reviewing the propriety of the peer-review investigation, taking place at St. Joseph’s Medical Center, where Midei practiced. The board noted it was only concerned with the five patients directly related to the case.

Though Midei argued that he did not directly profit per stent inserted, the board said it gave that defense “little weight” because he acknowledged that he was a “big generator of business for the hospital,” which was losing many patients to its competition. The hospital purportedly received $10,000 to $15,000 for each stent inserted.

In addition to the board’s investigation and decision, there are several class actions suits related to Midei’s alleged overstenting. Also, this situation and others like it have caused many state boards to call for more oversight or improvement to the current peer-review process.