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Surgeons’ double duty leads to legal fallout and a $15 million settlement

Three prominent Texas heart surgeons recently settled a $15 million claim related to concurrent billing practices during critical surgeries. The case highlights the importance of adhering to Medicare regulations and the potential consequences for physicians who fail to do so.

What happened in this case?

The allegations are tied to a medical center and college of medicine as well as a private practice. The government claims the three facilities worked in collaboration to bill for multiple concurrent procedures — often when a physician was not even in the operating room. More specifically, a whistleblower complaint alleged that these surgeons:

  • Regularly ran two operating rooms simultaneously.
  • Delegated critical aspects of complex heart surgeries to unqualified medical residents.
  • Failed to attend the surgical “timeout,” a crucial moment for risk identification.
  • Occasionally entered a third operation without designating a backup surgeon.
  • Falsely attested on medical records that they were present for the entire surgery.

Medicare regulations guide when teaching physicians must remain present during operations. The prosecution argued the situation described above was a violation of these regulations. Upon review of the evidence, those involved agreed to move forward with the $15 million settlement — of which the whistleblower will get a $3 million cut.

What can other physicians and medical practitioners learn from this case?

This case serves as a stark reminder that no physician can bypass Medicare regulations. Physicians in similar situations can mitigate the risk of allegations of wrongdoing by making sure they maintain detailed records of their presence during surgeries while ensuring they supervise residents appropriately. It is also wise to regularly review Medicare guidelines and stay informed about any changes.

Attorney John Rivas is responsible for this communication.