A Boston anesthesiologist recently argued before a district court judge that her False Claims Act lawsuit has sufficient merit to move forward. The lawsuit accuses Boston’s renowned Massachusetts General Hospital of Medicare and Medicaid fraud.
The plaintiff, Dr. Lisa Wollman, alleges that Mass. General, her former employer, engaged in the practice of double-booking surgeries and having residents and fellows perform the procedures without a supervising doctor. According to the lawsuit, this practice is a material violation of Medicare and Medicaid regulations.
Allegations in the False Claims Act Lawsuit
According to the False Claims Act lawsuit filed by Dr. Wollman, the hospital’s “policy” provided financial incentives for its doctors to perform more surgeries yet never disclosed to patients that their doctor would be going back and forth between operating rooms.
Legal news service Law 360 reported that lawyers representing Mass. General asked a federal judge to dismiss Wollman’s False Claims Act case on the grounds that federal regulations dictating when a surgeon must be present in the operating room are vague.
According to Mass. General’s motion to dismiss, Medicare and Medicaid permit surgeons to “decide what parts of surgeries are critical or key and therefore what they need to be in the room for and what they do not need to be present for.”
Medicare and Medicaid regulations allow fellows and residents to perform some parts of surgery without a supervising doctor in the room, but federal healthcare rules require a licensed surgeon be present for all “key and critical parts,” Law 360 writes.
Mass. General’s motion to dismiss also states, that the False Claims Act lawsuit should be dismissed because Wollman did not name a specific surgery, did not provide proof of improper billing, did not name an instance of overlapping surgeries, and did not detail any particular surgery during which a licensed surgeon was missing during “key or critical” portions.
Wollman counters these claims by arguing that “the fraud occurred in MGH operating rooms sealed off from regular traffic” and not the insurance claims processing department. She also maintains that, as a physician, she does not have access to all patients’ insurance information and claims, but said its “highly implausible” that “none of the thousands of patients involved in these surgeries were covered” by the federal health plan.
Wollman states that while she doesn’t have written documentation, she personally witnessed entire surgeries performed without a licensed surgeon ever present. The False Claims Act lawsuit also alleges that:
- Patients were endangered by at least five surgeons who regularly performed simultaneous surgeries,
- The doctors committed fraud against the government by billing for surgeries for which they were absent during “critical portions” or didn’t attend at all, “leaving the work to unsupervised trainees.”
- Between 2010 and 2015, Mass General orthopedic surgeons repeatedly kept patients anesthetized longer than medically necessary or safe so they could juggle two to three operations at the same time, according to the newspaper.
According to Dr. Wollman, not only were Medicare and Medicaid billed for the additional anesthesia the alleged practice “constitutes unnecessary, excessive and dangerous prescribing.”
The False Claims Act suit states that “this often meant an unwitting patient was left fully anesthetized — unconscious, paralyzed, intubated, dependent on a ventilator to breathe — for longer than medically necessary, often in the care of trainees, without the backup of a properly qualified surgeon, despite legal requirements.’’
The False Claims Act lawsuit referenced above is filed in the US District Court for the District of Massachusetts and is US et al v. Massachusetts General Hospital Inc. et al, case number 1:15-cv-11890.
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