How Much Did Durham Officials Know About the Doctor, Recently Accused of Medicare Fraud, Who They Hired to Help Lead the County’s COVID Response?

Federal prosecutors this month filed a troubling, multicount indictment against a prominent ear, nose, and throat surgeon, who also served as medical and laboratory director at the Durham County Department of Public Health and was hired to lead the county’s COVID-19 response.

Here in Durham, the federal indictment raises more questions than it answers regarding Anita Jackson’s tenure as a member of the county’s public health leadership team.

Soon after the 20-count indictment was made public, Wendy Jacobs, vice chair of the Durham County Board of Commissioners, requested information about Jackson’s contract from the county’s public health department, according to an email last week from public health director Rodney Jenkins to the commissioners, which the INDY obtained.

In the January 20 email, Jenkins noted that an internal auditor “is evaluating activities that occurred during the period Dr. Jackson served as a contractor with the Department of Public Health. Additional information will be disseminated upon completion of the Internal Audit review,” he wrote.

The indictment, filed by assistant U.S. attorney William M. Gilmore in Raleigh, accuses Dr. Anita L. Jackson of fraudulently billing Medicare for more than $46 million when she treated more than 700 patients who suffered from chronic sinus problems. 

Jackson, an Ivy League–educated doctor, “was the top-paid provider of balloon sinuplasty services in the United States, despite the location of her practice outside of a major metropolitan area,” according to the 36-page indictment filed on January 4 with the U.S. District Court’s Eastern District.

Investigators say Jackson “profited substantially” by engaging “in a series of crimes, frauds, and other acts that abused the trust of both the Medicare program, and her patients.”

Federal prosecutors have accused Jackson of mail fraud, identity theft, conspiracy, and cooking the financial records at several ear, nose, and throat clinics she operated in Rockingham and Lumberton by using “cloned or templated medical records” that bilked Medicare of millions of dollars, according to the indictment.

Why was Jackson hired in the first place to lead Durham County’s COVID-19 response, and why did the Durham County Board of Health pay her more than $540,000 for two years from December 2019 to December 2021?

In his email to county commissioners, Jenkins tries to distance his administration from Jackson’s hiring.

“The original contract with Dr. Jackson was executed prior to my joining the organization,” Jenkins stated in the email. “According to staff, the previous physician resigned from working with the county, which necessitated a different contractor to cover the Medical Director services. These services were provided through a contract with the UNC School of Medicine–Infectious Disease Division. The contract totaled $124,996 for part time support over a 12-month period.”

Jenkins explained that “a contract was established with Dr. Anita Jackson to provide Medical Director services totaling $134,200 for a six-month period, with a full-time presence at the Public Health Department. The contract was renewed in six-month increments while the department recruited for a permanent Medical Director.”

Jenkins also noted that shortly after he arrived as public health director, he “evaluated potential areas of improvement and other operational efficiencies,” and, “based on best practices, recommended … establishing a full-time medical director position.”

“This would help with continuity of services and [align] with best practices for medium to large health departments where there are often complexities with providing care in densely populated areas,” he stated.

Still, were the county staffers and public health board members who hired Jackson aware of a 2005 lawsuit filed against her in Orange County Superior Court by officials with Blue Cross and Blue Shield of North Carolina (BCBSNC)?

Officials with the state’s largest health insurer accused Jackson of submitting millions of dollars in bogus claims between 2000 and 2004 through her two Lumberton practices: Greater Carolina Ear, Nose, and Throat, and Carolina Family Urgent Care.

BCBSNC officials also sued to audit Jackson’s business records, Lumberton’s paper of record, The Robesonian, reported.

According to the paper, the case was settled out of court after Jackson countersued, claiming that “for 10 months the insurance company harassed and intimidated her. She said Blue Cross never provided a fee schedule to her practices to guide her in how much she could bill for services.”

Some members of the public also wonder if Durham’s county commissioners had an oversight role, and want to know if the board approved budgeting for the position and whether her work benefited local residents.

But county leaders say they are also wondering what happened.

“The interim county manager and staff are conducting an investigation into the issues you have raised,” commissioner Jacobs told the INDY last week.

“I do not know how [the] hiring process for that position works,” Jacobs added.

Brenda Howerton, who chairs the board of commissioners, told the INDY that she and her fellow elected officials are only responsible for the hiring of the county manager, attorney, and tax assessor.

“The hiring of directors is left up to the individual [county] boards,” Howerton said. “The commissioners do not weigh in on the hiring of staff.”

Jackson certainly made for a highly attractive candidate in the state’s most diverse county where its elected leaders prioritize equity and inclusion.

Before joining Durham County’s public health leadership team, and leading its COVID-19 response, Jackson graduated from the Chicago College of Medicine at the University of Illinois. Prior to obtaining a medical degree, Jackson earned an undergraduate degree in molecular biology from Princeton and master’s degrees in biology from Stanford University and Harvard University’s T.H. Chan School of Public Health, where she was the highest-ranking student award winner and recipient of the school’s Albert Schweitzer Award, according to her LinkedIn page.

Jackson states on the LinkedIn page that, as North Carolina’s first African American woman certified as an ear, nose, and throat surgeon, she “is a subject matter expert on COVID testing, [especially] in children and historically marginalized populations.”

Early last year, Jackson created a STEM pilot program that trains high school students as COVID testers

Jackson’s achievements and expertise did not go unrecognized. On September 17, 2020, Governor Roy Cooper appointed her to the North Carolina Department of Health and Human Services’ (DHHS) regulatory NC Medical Care Commission.

Last week, NC DHHS spokesperson Bailey Pennington said in an email to the INDY that the agency is aware of the federal grand jury indictment of Jackson and that she resigned from the NC Medical Care Commission on January 11.

At the heart of the federal jury indictment is a surgical procedure known as a “balloon sinuplasty.”

Gilmore states in the indictment that the procedure relies on a plastic, “single-use” device, known as an Entellus XprESS, that routinely comes into contact with “blood, phlegm, pus, and mucous secretions when inserted into the sinuses.”

Gilmore claims that the devices Jackson used “were not approved or cleared by the United States Food and Drug Administration (FDA) to be reprocessed or reused” but that Jackson nevertheless “reused the devices as a routine business practice, sometimes inserting the same device into more than one patient on the same business day.”

“Jackson,” Gilmore added, “failed to inform her patients that she was reusing the devices, and instead, represented on ‘Pre-Op Instruction for Sinus Spa’ forms that the devices were sterile.”

The indictment accuses Jackson of netting thousands of dollars from the unsanitary practice and states that between January 2014 and December 2018, the physician “purchased no more than 30” of the devices that she reused on “hundreds of patients.”

“Jackson billed Medicare alone for more than 1,200 incidents of balloon sinuplasty services to more than 700 patients, using the Entellus XprESS,” and “received more than $5.4 Million for the services,” according to the indictment.

The federal prosecutor states that Jackson relied on her staff, who had no specialized training in microbiology or the reprocessing of medical devices, to carry out procedures that reused the devices. Staffers, between uses, “scrubbed the outside of the device with soap and tap water in a sink near the procedure chair,” with no specialized tools to “clean or scrub the interior, hollow portions, and unreachable crevices of the device,” the filing reads.

Gilmore states that Jackson’s staff did not attempt to open or disassemble the device or its inflation device accessory.

“After a tap water rinse, the devices were placed into cleaning agents for several minutes,” according to the indictment. “After soaking in the cleaning agents, the devices were placed on a non-sterile ‘chuck pad’ on a table near the procedure chair to dry. In some instances, multiple devices would be left to dry in this non-sterile environment, while Jackson saw patients in the nearby procedure chair.”

The staff, Gilmore added, “carried out these procedures under Jackson’s supervision.”

Gilmore said that from “time to time, Jackson’s ‘layperson staff’ would look at the devices and tell her they should no longer be used.”

“The staff based these conclusions upon, among other things, the fact that the plastic of the device had become discolored with age and use, or that the balloon slide mechanism was no longer sliding properly,” Gilmore states. “Staff had no way to inspect the interior portions of the device to even conduct a lay-person examination for buildup of filth.”

The charges of fraud stem from allegations that Jackson charged her patients who underwent the procedure a co-pay of $50, but their out-of-pocket costs should have ranged from hundreds to more than a thousand dollars.

Jackson has been accused of passing along the costs to Medicare and then altering financial records during audits in 2016 and 2017 with template records of patient files “and boilerplate language that was insufficient, standing alone, to justify billed claims,” according to the indictment.

Jackson is also accused of “knowingly and willfully” making and using “materially false writings and documents, to wit, patient medical records, knowing the same to contain materially false, fictitious, and fraudulent statements and entries including, but not limited to, backdated and altered entries that did not exist,” according to a 2018 audit of Jackson’s practice that Gilmore cites.

Jackson’s attorney, Charles A. Bonner of Sausalito, California was not immediately available for comment following attempts to reach his office by phone and email. 

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Follow Durham Staff Writer Thomasi McDonald on Twitter or send an email to tmcdonald@indyweek.com.