The U.S. Attorney’s Office, Southern District of Texas announced on June 24, 2024 that Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM), and Surgical Associates of Texas P.A. (SAT) have jointly agreed to pay $15 million to resolve claims they billed for concurrent heart surgeries in violation of Medicare teaching physician and informed consent regulations.
The investigation began on August 7, 2019, upon the filing of a sealed qui tam lawsuit (a whistleblower complaint). The whistleblower alleged Dr. Joseph Coselli, Dr. Joseph Lamelas, and Dr. David Ott – three heart surgeons who performed at St. Luke’s – 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. The heart surgeries at issue are some of the most complicated operations performed at any hospital including coronary artery bypass grafts, valve repairs and aortic repair procedures. These surgeries typically involve opening a patients’ chest and placing the patient on the bypass machine for some portion of time.
Medicare regulations dictate when teaching physicians can leave the operating room for any operation, no matter how complex. The settlement resolves allegations that from June 3, 2013 to December 21, 2020, Ott, Coselli, and Lamelas violated these rules in various respects. Surgeons 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, according to the allegations.
Additionally, surgeons would allegedly enter a second or occasionally a third operation without designating a backup surgeon. At times, the surgeons allegedly hid these activities by falsely attesting on medical records they were physically present for the “entire” operation. In addition, medical staff did not inform patients the surgeon would be leaving the room to perform another operation.
The Special Agent in Charge of the FBI’s Houston field office stated in announcing the settlement, “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. 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.”
The $15 million recovery is the largest settlement to date involving concurrent surgeries.
The False Claims Act entitles the private whistleblower who commences the suit to a portion of the recovery. In this case, the whistleblower will receive $3,075,000.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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