It has been a while since we posted on this blog. But an important False Claims Act case was settled this week. This is a case that health care providers should be aware of, especially any provider that could be accused of over-scheduling procedures.
The case was filed by a whistleblower against the University of Pittsburgh Medical Center, one of its physician groups and the head of its Department of Cardiothoracic Surgery. The original complaint was filed by a former colleague of the surgeon named in the complaint. However, after the whistleblower complaint was filed, the government partially intervened in the case. The government alleged that the defendants “regularly sacrificed patient health in order to increase surgical volume” and to “maximize profit.”
The facts alleged in the complaint were that a cardiothoracic surgeon regularly performed as many as three complex surgical procedures at the same time, failed to participate in all of the “key and critical” portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time as he moved between operating rooms and attended to other patients or matters.
According to the government, those practices amounted to violations of the statutes and regulations which prohibit “teaching physicians” from billing government programs for “concurrent surgeries”. For that reason, the case was filed under the False Claims Act. The lawsuit contended that the surgeon falsely billed Medicare, Medicaid and other government programs for those procedures.
After a failed attempt to have the Court dismiss the lawsuit on legal grounds, the defendants elected to settle the case.
The key elements of the settlement included payment of $8.5 million to the government to resolve the claims against them. The Defendants also agreed to create and effectuate a Corrective Action Plan for the surgeon, and to submit to a year-long, third-party audit of the surgeon’s physician fee services billings to Medicare.