Whistleblower Doctors Shed Light on Patient Safety and Medicare Fraud with Concurrent Surgeries and Double-Billing
Posted in Accident & Injury, Consumer Protection, Drug & Medical Devices, Health & Wellness, Medical Malpractice on September 21, 2023
Doctors at some large teaching hospitals in the United States are speaking out against a concerning practice that jeopardizes patient safety and potentially defrauds Medicare. Surgeons, they claim, are scheduling multiple operations simultaneously, leaving critical portions unattended, and then billing for services they still need to provide fully. In this blog post, we will delve into the details of this issue, revealing a complex web of allegations, ethical concerns, and staggering profits within the healthcare system. We can address how patients can best protect themselves and family members as well.
The Prevalence of Concurrent Surgeries and Lack of Supervision
Concurrent surgery practices, where one surgeon juggles multiple surgeries utilizing residents/ fellows simultaneously, have been ongoing for years. However, recent lawsuits and investigations have brought this issue to the forefront. Massachusetts General Hospital’s involvement in such practices triggered a congressional investigation in 2016, shedding light on the broader problem. Today, whistleblower lawsuits across the country expose even more extensive fraud and greater patient risks.
These lawsuits allege hospitals devised schemes to boost income while concealing the true nature of surgeries from patients. Dr. Stephen Adams, one of the plaintiffs in a False Claims Act lawsuit in Tennessee, described it as a “careful calculus” where hospitals aimed to maintain their income using concurrent surgeries and fraudulent billing which were deemed acceptable risks.
While delegation of tasks in surgery is common, Medicare rules mandate the lead surgeon’s presence during critical parts of an operation. Allegations suggest surgeons often leave the operating room to perform other surgeries, leaving residents or trainees to take over, sometimes unsupervised. This violates patient safety standards and Medicare regulations.
Examples of Hospital Allegations
The University of Southern California’s hospital system is accused of billing thousands of cases where the teaching physician left residents unattended during spine and brain surgeries.
In Tennessee, Erlanger Health System faces a False Claims Act lawsuit alleging endangerment of patients and systematic Medicare fraud.
Medicare billing relies on a complex system of codes, with hospitals submitting bills for procedures. Hospitals then pay doctors for their services. Some hospitals, like the University of Pittsburgh Medical Center, allowed surgeons to double-book surgeries, potentially endangering patients for profit.
The Consequences
These practices have dire consequences for patient safety, potentially leading to complications and unnecessary risks. Patients know their surgeries may involve multiple surgeons including sometimes trainees. The patients are unaware often these trainees are unsupervised and “the surgeon” may be operating on one or more other patients simultaneously. This lack of transparency can put patients’ well-being at risk.
Concurrent surgeries and double-billing practices in healthcare are a significant concern, not only for patient safety but also for potential Medicare fraud. Whistleblower doctors are crucial in shedding light on these issues and holding hospitals accountable for their actions. The goal is to ensure patient care remains the top priority within the healthcare system and that the trust between patients and healthcare providers is upheld.
Takeaway
Patients and families must advocate for themselves. We recommend a direct conversation with your surgical team to ask critical questions. Who is going to be in the operative field? Will my surgeon be present for the entire procedure? Are there portions of my surgery that a trainee will participate in? Training is necessary in medicine, but transparency with patients is necessary. Engage in a discussion and be honest with your team about your requests.