An former MGH anesthesiologist has filed a false claims act suit in relations to concurrent surgery at Massachusetts General Hospital. The practice, described as dangerous in a long Boston Globe series, has been defended by MGH as “an important method of managing busy operating rooms” that is widely used.
According to the Globe, the anesthesiologist’s suit was unsealed after the state a
ttorney general declined to joint as a plaintiff. Note that in another lawsuit decided in January, a jury found that double-booked surgery was not the cause of the plaintiff’s quadriplegia.
Link here to a Health Leaders interview with Globe Spotlight team editor Scott Allen.
Dr. Lisa Wollman, a former anesthesiologist at Mass. General, alleges in the lawsuit that at least five surgeons endangered patients by regularly performing simultaneous surgeries. Wollman charges that the doctors also defrauded the government by submitting bills for surgeries in which they were not in the operating room for critical portions of procedures, leaving the work to unsupervised trainees.
The surgeries “do not conform in material respects to Medicare and Medicaid rules designed…to protect patient safety.
These violations caused improper billing of Medicaid and Medicare for concurrent surgeries in which:
- the patient’ surgeon the teaching physician is not present during the majority of the
surgery, including the “key and critical” portions;
- the patient is left alone with a resident or fellow during surgery at times when his/her surgeon is involved in another surgery and no other qualified teaching physician is made immediately available to assist, if needed or in time of emergency;
- the patient is administered anesthesia, which is not medically reasonable or necessary, while waiting sometimes for an hour or more for his/her surgeon (the teaching physician) to conclude work in another surgery and scrub in;
- the patient has not given valid consent to the concurrent surgery because written
informed consent documents fail to mention that the surgeon will be involved in another surgery at the same time;
- the surgeon has failed to appropriately document concurrent surgeries; and
- Defendants knew (and still know) that they have been overpaid by Medicare and Medicaid in connection with the unlawful requests for payment, but have not taken appropriate steps to satisfy obligations owed to government payers.
- Virtually every concurrent surgery MGH billed to Medicare and Medicaid is
marked (and compromised) by at least one or more of the violations detailed above because policies and practices driven by the desire to increase pro?ts ensure that such
derelictions occur including, but not limited to:
- encouraging and/or failing to discipline teaching or attending physicians who bill
- government payers when they are not present during the majority of the surgery nor readily available when residents or fellows are performing the surgery;