Six orthopedic surgeons at Rush University Medical Center's orthopedic department violated federal Medicare billing rules, according to a newly unsealed whistleblower lawsuit filed in U.S. District Court in Chicago, the Chicago Tribune reports.
In one case, a surgeon never entered the operating room to supervise a procedure, the suit alleges. In others, a surgeon monitored residents performing operations via video feed while simultaneously doing his own operations in a different room.
The lawsuit, filed by Rush University Medical Center orthopedic surgeon Robert S. Goldberg and June Beecham, a former administrator at the center, describes physicians filing Medicare claims for surgeries performed by residents. Under Medicare reimbursement rules for surgical procedures, the teaching physician must be present during all critical portions of the procedure and immediately available to furnish services during the entire service, according to rules cited in the suit.
The six surgeons named as defendants are: Richard Berger, Brian Cole, Mitchell Sheinkop, Aaron Rosenberg, Craig Della Valle, and Wayne Paprosky. Rush SurgiCenter, an outpatient surgery center, and Midwest Orthopaedics, a practice with many professional athletes among its clients, also were named. The lawsuit focuses on procedures performed in 2004 and 2005.
Rush released a statement that said "Rush believes that the lawsuit has no merit and intends to vigorously defend the case."
One of the residents who performed a knee replacement on a 67-year-old patient said that Sheinkop, who was the supervising physician, never entered his OR. He performed another procedure in a different OR. The resident stated that Sheinkop had told him to falsify the medical record, the complaint alleges.
When Cole had surgeries scheduled for the same time, he would "remain physically present in one OR, while 'monitoring' a second OR through an electronic video link that projected images through the fiber optic arthroscopy camera onto a large monitor, according to the complaint.
A year after Goldberg filed his lawsuit, Berger left Medicare. He told Orthopedics Today that while performing more than 750 joint replacements a year, he was drowning in paperwork and worried about making an honest mistake and being penalized.
To learn more:
- read the Chicago Tribune account
- read the article in Outpatient Surgery