Cardiologist Suspended for Alleged Misclassification of Pacemaker Procedures
Jammu and Kashmir authorities ordered an inquiry and suspended an interventional cardiologist on Saturday over allegations that he recorded 103 advanced pacemaker procedures under an Ayushman Bharat PMJAY category that did not cover them, allowing patients to claim government insurance benefits.
Dr Syed Maqbool, an associate professor at Government Medical College in Anantnag, allegedly recorded “left bundle branch area pacing” (LBBAP) procedures as dual-chamber pacemaker implantations under Ayushman Bharat, according to an internal health and medical education department report. The report stated that the medical college’s laboratory records showed patients underwent LBBAP, an advanced technique, rather than conventional dual-chamber pacemaker implantation.
Technical Report Raises Questions About Medical Necessity
The government cited a technical report attributed to Sher-i-Kashmir Institute of Medical Sciences (SKIMS) in Srinagar, which said 27 of 55 patients had “normal ventricular function,” making surgery “completely unindicated.” However, senior SKIMS officials distanced themselves from that assessment, stating that the administration had no role in preparing it. They said the government had privately sought opinions from cardiologists who are now retired.
Dr Maqbool rejected the allegations. “We replied to every allegation with documentary evidence. Matter is under consideration and we have full faith in the system,” he said. According to sources, Maqbool’s detailed rebuttal was not included in the report. The health secretary who ordered the inquiry did not respond to calls.
Medical Debate Over Advanced Pacing Technique
The suspension has triggered a wider medical debate over LBBAP, a newer pacing technique that places a lead near the heart’s conduction system. Doctors said Maqbool selected LBBAP because it can offer better clinical outcomes than conventional dual-chamber pacing. They noted that Ayushman Bharat did not cover LBBAP, forcing doctors to use the dual-chamber category so patients could access insurance support.
Under that arrangement, Ayushman Bharat covered part of the cost while patients paid private suppliers directly for specialised LBBAP hardware and equipment. Without it, patients would have had to bear the full cost, doctors explained.
Dr Khalil Kanjwal, a Michigan-based senior electrophysiologist, wrote on social media that LBBAP should be performed in all patients needing a dual-chamber pacemaker. “There are many benefits of this pacing and no harm compared to septal pacing,” he said. “I do these procedures routinely and all of our patients who come to my lab for a dual chamber pacemaker receive a left bundle pacemaker.”
The case highlights the tension between advancing medical practices and rigid insurance coverage categories, with implications for patient access to innovative treatments.
