On June 24, the U.S. Attorney for the Southern District of Texas announced that three medical center institutions jointly agreed to pay $15 million to resolve allegations that they violated the False Claims Act (FCA) by billing Medicare for concurrent heart surgeries.
The three institutions are set to pay $15 million, the largest penalty ever for concurrent surgery charges, as part of the settlement, which is the result of a qui tam whistleblower lawsuit.
Under the FCA’s qui tam provisions, individuals may file whistleblower suits alleging fraud against the U.S. government. In this case, the whistleblower is set to receive $3 million as their share of the recovery.
The whistleblower alleged that three heart surgeons who performed at a teaching hospital formerly known as St. Luke’s Episcopal Hospital “engaged in a regular practice of running two operating rooms at once and delegating key aspects of extremely complicated and risky heart surgeries to unqualified medical residents.”
According to the government, these surgeons violated Medicare regulations dictating when teaching physicians can leave the operating room. These surgeons allegedly “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.”
“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).
On July 25, a bipartisan group of senators introduced the False Claims Amendments Act of 2023, which address a few technical loopholes undermining the success of the FCA. The bill is widely supported by whistleblower advocates.
National Whistleblower Center (NWC) has issued an Action Alert calling on Congress to pass the bill.
Join NWC in Taking Action:
Demand that Congress strengthen the False Claims Act
Further Reading:
Bipartisan Legislation Unveiled to Strengthen False Claims Act