Writing in Bloomberg this month, David Armstrong chronicles how Mehmood Patel—who once bragged of being the nation's busiest cardiologist—ended up behind bars after being convicted of 51 counts of billing for placing unnecessary stents in patients.

According to the attorneys who argued the case, Patel's case marked the first time a cardiologist was convicted in the United States based only on charges of billing for medical unnecessary procedures. It was a watershed case for the federal government and was followed by convictions for two other cardiologists and investigations in at least six states.

• The New Yorker: How often are stents overused?

Background on Mehmood Patel

Patel graduated at the top of his class from Baroda Medical College in India and later trained in New York. In 1977, he accepted the job as the chief of cardiology at a hospital in Lafayette, La.

Fifteen years later, in 1992, Patel placed the first stent in Lafayette history.

In 2000, he leased an 18-wheel truck and turned it into mobile cardiac catheterization lab, where he charged both physician and facility fees for implanting stents. Later, he opened a $1.2 million permanent cath lab and brought in a local doctor as an investor who referred patients to him.

According to Armstrong, the Patel operation "was like none other in the region." He treated half the cardiology patients in Lafayette, according to his business manager, and had between 6,000 and 7,000 patients in his care at a time.

By 2003, Patel was making $6 million a year from cardiology consultations, his cath lab, and stent surgeries at local hospitals. Each stent implantation earned Patel up to $2,600, and he could thread one into an artery in fewer than 15 minutes.

• Earlier this week: Cardiologists will stop calling stents 'inappropriate'

The case against Patel

Federal investigators opened a case against Patel in May 2003 after colleagues provided evidence that Patel was placing unnecessary stents in patients.  (The hospitals where Patel worked also launched their own investigations into the cardiologist.)

During the 2008 trial against Patel, prosecutors used expert witnesses, patient heart scans, and clinical standards to defeat the defense of a doctor who said he had used his best medical judgment. Patel argues that he never implanted an unwarranted stent or hurt a patient. 

The investigators found that a video had been made of every artery that Patel had stented. Prosecutors decided to show those videos to the jury and call in experts to explain the footage. Those experts report that Patel was stenting patients with fatty buildup of less than 50% in their arterial passages, much lower than 70% threshold. In some cases, the patients had no buildup.

"It is something we had never done," says FBI special agent Troy Chenevert.  He compares the stenting videos to those of bank robberies or "the bribe paid to the politician."

Patel spent 19 days on the stand defending himself against 91 counts of unnecessarily stenting implants, arguing that the videos showed that he never places stents in patients with less than 70% buildup.

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In the end, the jury found Patel guilty on 51 of the counts and was sentenced to 10 years behind bars, which he began in December 2012. In an unusual move, the judge ordered Patel to pay for his incarceration: $2,158.77 a month.

A last impact

According to Armstrong, some of Patel's patients subsequently suffered heart attacks and strokes and required remedial surgery, while others needed regular blood transfusions from injuries sustained during stenting.

In one case, a patient was needlessly stented just before he was to receive a lifesaving kidney transplant, without being told that the stent would preclude him from receiving organ donations. He died.

Three hundred plaintiffs sued Patel and two Lafayette hospitals, including the two families who say that Patel's actions led to the death of their loved ones. Those 300 plaintiffs shared a $15.1 million class-action settlement (Armstrong, Bloomberg, 10/24).