THE BURNED OVER DISTRICT

The good people of Munster, Indiana are finding out that maybe they shouldn't have said that to their cardiologist. Investigators have determined that Dr. Arvind Ghandi sold cardiological procedures to his patients like a car salesman selling options.

Mrs. Davidson is now one of 293 patients around Munster, Ind., who have filed lawsuits against Dr. Gandhi and two other doctors in his practice claiming that they performed needless procedures.

The Indiana state Medicaid program has started an investigation, and one doctor not named in the litigation said he had received a subpoena from the United States attorney’s office and provided the medical charts of several former patients of Dr. Gandhi and his colleagues that he has since treated. Lawyers for Dr. Gandhi and his practice, Cardiology Associates of Northwest Indiana, said they had not received any subpoenas, and the doctors denied any wrongdoing.

In recent years, federal officials have brought several prominent cases against cardiologists and hospitals, accusing them of performing unnecessary procedures like inserting stents into coronary arteries. While medical professionals say there is no indication that cardiology has more unnecessary procedures than, say, orthopedics, they do note that the specialty has come under increased scrutiny by regulators because the procedures tend to be reimbursed by Medicare and private insurance at significantly higher levels than those in many other specialties.

“Cardiology, whether we like it or not, is generally a big moneymaker for hospitals,” said Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic and the former president of the American College of Cardiology. “We are still a fee-for-service system, and that creates, in my view, misaligned incentives among some physicians to do more procedures and among some institutions, particularly in areas where there is not tight medical supervision, to turn a blind eye and enjoy the high revenue stream.”

While there are various industry and federal guidelines describing when it is appropriate for a patient to undergo certain procedures — Medicare, for instance, says a patient’s arteries must be 70 percent blocked to justify the use of a stent — in the real world, interpretations vary. In extreme cases, physicians have been accused of falsifying medical records, saying arteries were more blocked than they really were.

Looks like Ol' Doc Gupta was more interested in getting rich than getting his patients healthy. And even if he had kept it above board he would have done so.