Three doctors are suing Vanderbilt University Medical Center for Medicare fraud. They submitted their whistleblower lawsuit under the False Claims Act’s qui tam provision.
The plaintiffs, all ex-VUMC anesthesiologists, are accusing the medical center of taking part in a scam involving the use of its medical practices to maximize income through the submission of false claims to state and federal health insurance programs, even though it knew that the doctor services they were billing for did not satisfy Medicare’s terms for these services. The Mediare fraud lawsuit contends that these false billing practices went on for over 10 years.
Federal law only lets hospitals bill Medicare and state insurance programs for “teaching physician services” if the teaching doctor was there during key portions of the procedure. During surgeries, the teaching physicians has to be there for the “critical” moments, as well as easily and immediately available in the event that his/her services are required at any other time during the procedures.
The ex-VUMC doctors contend that Vanderbilt’s policies regarding staffing and schedule forced surgeons to overbook regularly, which means that residents were depended upon to conduct these “critical” parts of the surgery. They said that frequently, surgeons were scheduled for multiple procedures that were happening at the same time and in areas of the hospital that were “geographically disparate” from one another. Still, they claim, Vanderbilt billed these procedures as if they had met Medicare’s criteria, even coming up with a proprietary electronic system to generate documents that backed up these alleged false billing claims.
The former employees are also accusing the medical center of turning in false claims for “medically directed” anesthesia even when strict criteria mandated by the federal government, were not met. The plaintiffs say that doctors who questioned the practices were let go or removed and that this is what happened to them.
Meantime, Vanderbilt is denying the Medicare fraud allegations.
Types of Medicare billing fraud:
• Medical equipment fraud • Up-coding • Billing for medical services that weren’t provided • Double-billing • Unbundling
Massachusetts Medicare Fraud
Please contact our Massachusetts Medicare billing attorneys to explore your legal options. Our Boston Whistleblowers know what steps to take to pursue a qui-tam lawsuit on behalf of the government. Your free case assessment with Altman & Altman, LLP is free.
Whistleblower suit accuses Vanderbilt of Medicare fraud, Nashville Business Journal, September 12, 2013
The False Claims Act, Justice.gov
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