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Texas medical center institutions agree to pay $15M record settlement involving concurrent billing claims for critical surgeries

Monday, June 24, 2024

HOUSTON – 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, announced U.S. Attorney Alamdar S. Hamdani.     

BSLMC is a joint venture between CommonSpirit Health, a national hospital chain, and BCM, a medical school in Houston. BSLMC operates a teaching hospital, formerly known as St. Luke’s Episcopal Hospital, in its Medical Center. BCM employs teaching physicians and residents who perform services at BSLMC, including Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. SAT is a medical practice group affiliated with various cardiothoracic surgeons, including Dr. David Ott, 77, Houston. 

The investigation began Aug. 7, 2019, upon the filing of a sealed qui tam lawsuit aka whistleblower complaint. The whistleblower alleged Coselli, Lamelas and 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 Dec. 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. 

“Patients entrusted these surgeons with their lives - submitting to operations where one missed cut is the difference between life and death,” said 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.”

“The complete disregard for patient safety exhibited by these three doctors put patients at risk and violated Medicare regulations for their own convenience and greed,” said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “This record settlement demonstrates our steadfast commitment to protecting Medicare beneficiaries and working with our law enforcement partners to utilize all the tools in our arsenal to hold accountable those who steal from Medicare and other federal health care programs.”

“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.”

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.

The U.S. Attorney’s Office, DHHS-OIG and FBI conducted the investigation. Assistant U.S. Attorneys Brad Gray and Andrew Bobb are handling the case.

The claims resolved by the settlement are allegations only and there has been no determination of liability.