Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM), and Surgical Associates of Texas, P.A. (SAT), have agreed to pay $15 million to resolve claims that they billed for concurrent heart surgeries, in violation of Medicare teaching physician and informed consent regulations. BSLMC is a joint venture between CommonSpirit Health and BCM, a medical school in Houston, Texas. BSLMC operates a teaching hospital in its medical center and employs teaching physicians and residents who perform services at the facility, including Dr. Joseph Coselli and Dr. Joseph Lamelas. SAT is a medical practice group affiliated with cardiothoracic surgeons, including Dr. David Ott.
The government’s investigation began in 2019 after a whistleblower filed a sealed qui tam lawsuit alleging that Coselli, Lamelas, and Ott engaged in a regular practice of running two operating rooms at once, delegating key aspects of complicated and risky heart surgeries to less qualified medical residents. According to the government, the heart surgeries at issue in this case are “some of the most complicated operations performed at any hospital” and often involve opening a patient’s chest and placing the patient on a bypass machine for a period of time, including coronary artery bypass grafts, valve repairs, and aortic repair procedures.
Not only is the action of a surgeon leaving an operating room in the middle of critical surgery in the hands of an unqualified medical resident concerning, Medicare regulations also state when teaching physicians can leave the operating room for any operation.
The government alleged that from June 2013 to December 21, 2020, the three doctors mentioned above violated Medicare regulations. In addition to running two operating rooms at once, the doctors allegedly would not attend the surgical “timeout,” an important moment when the entire surgical team pauses to identify key risks to prevent surgical errors.
Further, when running multiple operating rooms, the surgeons would allegedly enter a second (and occasionally third) operation without designating a backup surgeon. In some instances, the physicians falsified the records saying that they were present for the “entire” operation. On top of allegedly leaving the room in the middle of these critical surgeries, medical staff did not inform the patients that the surgeon would be leaving the room to perform another operation.
The $15 million settlement amount is the largest settlement involving concurrent surgeries. Of the settlement amount, the whistleblower will receive $3,075,000. As we often see, the claims resolved by the settlement are only allegations and there has been no determination of liability.
Responses
“Patients entrusted these surgeons with their lives – submitting to operations where one missed cut is the difference between life and death,” said United States 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.”
“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.”
“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,” Robert Corrigan Jr, general counsel for Baylor College of Medicine, said in a statement emailed to USA Today. “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.”