07/02/2024
HEALTH CARE
3 surgeons guilty in Medicare scam
Heart doctors said to have left trainees to perform operations
By PRAVEENA SOMASUNDARAM
The Washington Post
For seven years, heart surgeons at a Texas medical center allegedly ran multiple operating rooms at once and left complex parts of procedures to their “unqualified” trainees before submitting false claims to Medicare, according to a federal settlement reached with their employers this month.
Three physicians left operating rooms during procedures — including open heart surgeries — and falsely said on medical records that they were present the whole time to collect Medicare reimbursements, the June 13 settlement agreement says. On some occasions, the surgeons allegedly oversaw three operations at once.
The settlement with Baylor St. Luke’s Medical Center — where the doctors worked — Baylor College of Medicine and Surgical Associates of Texas is the largest ever to involve simultaneous surgeries, the Justice Department said in a statement. A whistleblower who reported the surgeons in 2019 will receive about $3 million from the $15 million settlement.
‘Gambled’
“In this case, doctors gambled with their patients’ care, during complicated open-heart surgeries no less, compromising quality of care over quantity and then falsely billed Medicare for reimbursement of services they improperly delegated,” Douglas Williams, special agent in charge of the FBI’s Houston field office, said in the statement. “We hope today’s civil settlement announcement represents accountability for doctors and hospitals everywhere.”
In statements to The Washington Post on Wednesday, St. Luke’s, Baylor College of Medicine and Surgical Associates of Texas said the settlement agreement is not an admission of liability in the case.
Surgical Associates of Texas said the case had been settled to “avoid the costs related to a lengthy legal dispute.” In its statement, St. Luke’s said it “remained committed to complying” with Medicare and Medicaid regulations.
Robert Corrigan Jr., an attorney for Baylor College of Medicine, said in a statement that it was “important to note that no patients were harmed,” adding that the school disputed it had violated federal law.
While the federal investigation focused on three doctors, the complaint alleges that at least 10 other cardiovascular surgeons at Baylor engaged in varying levels of surgery overlaps “as a standard practice.”
From 2013 through 2020, the three surgeons reported by the whistleblower “engaged in hundreds of incidents of brazen lies and misleading,” according to a complaint filed in 2022. More than 80% of their procedures — including heart valve repairs and coronary artery bypass grafts — were overlapping, meaning they could not have been present for them the entire time, the complaint says. Patients were not aware that the surgeons would be performing multiple surgeries at once, the settlement says.
Millions of dollars
Each of those procedures garnered an average of $50,000 to $75,000 in Medicare reimbursements, and the surgeons personally received about four times as much compensation as the average for other Houston-based surgeons in their field, the complaint states. Combined, the complaint says, the overlapping surgeries increased the hospital’s revenue by about $150 million between 2013 and 2019.
On patient consent forms, only the attending physician’s name was typically listed as the doctor performing the operation. As a result, “none of the patients operated on were told that a resident or fellow would be operating on them without a certified surgeon in the room, or that the patient’s doctor of choice would be multitasking between several other surgeries at the same time as theirs,” the complaint says.
Alamdar Hamdani, the U.S. attorney for the Southern District of Texas, said the surgeons’ patients had entrusted them “with their lives” in procedures “where one missed cut is the difference between life and death.”
