Heart surgeons settle for $15 million over alleged concurrent surgeries, Medicare billing violations
HOUSTON - Three heart surgeons have agreed to pay $15 million to resolve claims they billed for concurrent heart surgeries in violation of Medicare teaching physician and informed consent regulations, officials said.
According to a release, Baylor St. Lukes Medical Center (BSLMC), Baylor College of Medicine (BCM), and Surgical Associates of Texas P.A. (SAT) are involved in the settlement.
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The release stated that BCM employes teaching physicians and residents who perform services at BSLMC, including including Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. SAT is a medical practice group affiliated with various cardiothoracic surgeons, including Dr. David Ott, 77, Houston.
Officials said the investigation began back on August 7, 2019, upon the filing of a sealed qui tam lawsuit, also known as a whistleblower complaint.
The whistleblower alleged Coselli, Lamelas and Ott, three heart surgeons who performed at St. Luke's, engaged in regular practice of running two operating rooms at once and delegating key aspects of extremely complicated and risky surgeries to unqualified medical residents.
The heart surgeries at issue are some of the most complicated coronary artery bypass grafts, valve repairs, and aortic repair procedures. The surgeries typically involve opening a patients' chest and placing the patient on the bypass machine for some portion of time.
Officials stated that Medicare regulations dictate when teaching physicians can leave the operating room for any operation, no matter how complex.
The settlement resolves allegations that from June 3, 2013, to Dec. 21, 2020, Ott, Coselli and Lamelas violated these rules in various respects. Surgeons often ran two operating rooms at once and failed to attend the surgical "timeout"— a critical moment where the entire team would pause and identify key risks to prevent surgical errors, according to the allegations.
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Additionally, surgeons would allegedly enter a second or occasionally a third operation without designating a backup surgeon. At times, the surgeons allegedly hid these activities by falsely attesting on medical records they were physically present for the "entire" operation. In addition, medical staff did not inform patients the surgeon would be leaving the room to perform another operation.
"Patients entrusted these surgeons with their lives - submitting to operations where one missed cut is the difference between life and death," said U.S. Attorney Alamdar S. Hamdani. "Allegedly, the patients were unaware their doctor was leaving for another operating room. This settlement reaffirms the importance of Medicare requirements governing surgeon presence and ensuring that no physician - no matter how prominent or successful - can skirt around the rules."
"The complete disregard for patient safety exhibited by these three doctors put patients at risk and violated Medicare regulations for their own convenience and greed," said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG). "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 health care programs."
"Any time any one of us goes under the knife as a vulnerable patient, we implicitly trust that the surgeons and medical professionals have our best interest at heart, especially here in Houston’s world-renowned hospitals," said Special Agent in Charge Douglas Williams of the FBI - Houston field office. "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. We hope today’s civil settlement announcement represents accountability for doctors and hospitals everywhere."
The $15 million recovery is the largest settlement to date involving concurrent surgeries.
The False Claims Act entitles the private whistleblower who commences the suit to a portion of the recovery. In this case, the whistleblower will receive $3,075,000.
In a statement to FOX 26 on Monday night, Baylor St. Luke's Medical Center (part of CommonSpirit Health), released a statement saying, "Baylor St. Luke’s Medical Center has reached an agreement with the Department of Justice (DOJ) to resolve a documentation and billing matter involving compliance and billing requirements set forth by the Centers for Medicare and Medicaid Services (CMS). The DOJ claims are strictly allegations and the settlement by Baylor St. Luke’s is not an admission of liability. Baylor St. Luke’s remains committed to complying with all CMS regulations.Baylor St. Luke’s is a world-renowned academic medical center that cares for patients from throughout the world with the most complex conditions. The hospital provides its patients with safe, high-quality care and remains committed to compliance with all applicable regulations."
Robert Corrigan, Jr., General Counsel for Baylor College of Medicine, also released a statement Monday night, saying, "Baylor College of Medicine did not engage in conduct that violates any applicable federal law or regulation. It is also important to note that no patients were harmed. The settlement agreement acknowledged that BCM disputed that any violations of federal law occurred and that the College being a party to the agreement is not an admission of liability by Baylor. The College decided to amicably resolve the dispute prior to a trial on the merits after considering the cost and expense incurred by Baylor to date, and anticipated future costs and expenses, including attorneys’ fees."