Generally, when a doctor is convicted for fraud, the misdeeds are limited to a single category of fraud.  Maybe the doctor charged for procedures that weren’t performed; maybe there were kickbacks for referrals; or maybe self-referrals were involved.

But last Friday a doctor in Michigan pleaded guilty to a series of interrelated crimes so numerous and complicated that it takes a neurosurgeon—literally.  Here’s what Aria Sabit was up to.  For one thing, he persuaded patients to undergo spinal surgeries with instrumentation when they didn’t need it.  Then, instead of that surgery, he implanted cortical bone dowels.  But he billed both Medicare and commercial insurers for the surgeries that he talked the patients into rather than the ones he performed.

Meanwhile, no grass growing under his surgery booties, he persuaded a hospital where he worked to buy spinal implant devices from a physician- owned distributorship.  How did he do that?  By paying kickbacks to the surgeons, based on the surgeries they performed—the higher the volume and the complexity, the more he paid in kickbacks.

And the physician-owned distributorship was so lucrative for him that he referred patients for spine surgery when they didn’t need it at all.  When they did need surgery, he made sure the surgery that was performed was more complicated than necessary.  And, remembering his financial tie to the medical device distributorship, he made sure that the surgeries involved all the devices he could think of.