Houston, Texas – June 24, 2024 – Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM), and Surgical Associates of Texas P.A. (SAT) have agreed to a record $15 million settlement over allegations of improper billing for heart surgeries. This is the largest settlement of its kind to date.
BSLMC, a collaboration between CommonSpirit Health and BCM, along with SAT, faced claims that they billed Medicare for overlapping heart surgeries. The accusations, brought forward by a whistleblower in August 2019, centered on prominent heart surgeons Dr. Joseph Coselli, Dr. Joseph Lamelas, and Dr. David Ott.
The whistleblower’s complaint alleged that these surgeons often ran two operating rooms at once, delegating critical parts of complex heart surgeries to less experienced medical residents. These surgeries, including coronary artery bypasses and valve repairs, are extremely risky and typically involve opening the chest and using a bypass machine.
From June 2013 to December 2020, the surgeons were accused of:
- Managing multiple operating rooms simultaneously without attending essential safety pauses known as surgical “timeouts.”
- Starting new surgeries without assigning a backup surgeon.
- Falsifying medical records to claim they were present for the entire surgery.
- Failing to inform patients that the primary surgeon might leave the room to perform another operation.
U.S. Attorney Alamdar S. Hamdani stressed the severity of the situation, saying, “Patients trusted these surgeons with their lives during operations where a single mistake could be fatal. The patients were allegedly unaware their doctor was leaving to work on another surgery. This settlement reinforces the importance of Medicare rules that ensure a surgeon’s presence during operations.”
Jason E. Meadows, Special Agent in Charge at the Department of Health and Human Services Office of Inspector General (HHS-OIG), remarked, “These doctors showed a blatant disregard for patient safety, putting their own convenience and greed first. This settlement demonstrates our commitment to protecting Medicare beneficiaries.”
Douglas Williams, Special Agent in Charge of the FBI’s Houston field office, added, “These doctors compromised patient care during complex open-heart surgeries, prioritizing quantity over quality. They then falsely billed Medicare for these services. This settlement is a step toward accountability for doctors and hospitals everywhere.”
As part of the settlement, the whistleblower will receive over $3 million. The investigation was led by the U.S. Attorney’s Office, HHS-OIG, and the FBI, with Assistant U.S. Attorneys Brad Gray and Andrew Bobb managing the case. It’s important to note that the settlement resolves the allegations without determining liability.
This landmark settlement highlights the need for transparency and strict adherence to medical regulations, especially during high-risk surgeries. It serves as a powerful reminder to medical professionals of their duty to prioritize patient safety and integrity in medical billing.
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