Houston-based medical center institutions agreed to jointly pay $15 million to settle allegations for improperly billing Medicare for concurrent surgeries in violation of teaching physician and informed consent regulations.
Baylor St. Luke’s Medical Center (BSLMC), a joint venture between national hospital chain CommonSpirit Health and Baylor College of Medicine (BCM), along with Surgical Associates of Texas P.A. (SAT), employed three heart surgeons who “engaged in a regular practice of running two operating rooms at once … delegating key aspects of extremely complicated and risky heart surgeries to unqualified medical residents,” the DOJ alleged in a press release Monday.
The case resolved claims brought under the qui tam provisions of the False Claims Act by an unnamed whistleblower. The whistleblower will receive more than $3 million of the settlement total.
The details: From June 2013 to December 2020, the surgeons ran two operating rooms at once and failed to attend the surgical “timeout,” when the entire surgical team paused to identify key risks and prevent surgical errors, the DOJ alleged.
The surgeons allegedly conducted a second, or occasionally third, operation without designating a backup surgeon and falsely claimed on medical records they were physically present for the entire operation, the DOJ said.
The DOJ added medical staff did not inform patients the surgeon would be leaving the room to perform another operation. The $15 million recovery is the largest settlement to date involving concurrent billing claims, the agency noted.
“This record settlement demonstrates our steadfast commitment to protecting Medicare beneficiaries and working with our law enforcement partners to utilize all the tools in our arsenal to hold accountable those who steal from Medicare and other federal healthcare programs,” said Jason Meadows, special agent in charge of the U.S. Department of Health and Human Services’ Office of Inspector General, in the release.
Company response: In an emailed statement, BSLMC said the DOJ settlement resolves “a documentation and billing matter involving compliance and billing requirements set forth by the Centers for Medicare and Medicaid Services (CMS)” and that the hospital “remains committed to complying with all CMS regulations.”
In a separate emailed statement, BCM said it “did not engage in conduct that violates any applicable federal law or regulation” and that “no patients were harmed.”
SAT could not be reached for comment. The three companies agreed to settle without admitting liability.
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