Ex-employees accuse hospital of decade-long Medicare fraud scheme

Three former anesthesiologists at Vanderbilt University Medical Center have filed a lawsuit alleging the Nashville, Tenn., hospital fraudulently billed Medicare for more than 10 years, The Tennessean reported.

Federal investigators have examined Vanderbilt's billing practices for the past two years and asked a judge for additional time to investigate. When the judge denied that request, the suit, originally filed in 2011, was unsealed this week in federal court, the article noted.

In the suit, the former employees claim Vanderbilt double-booked attending physicians, which made it impossible to meet Medicare billing standards that an attending physician must be present at surgeries or during key parts of them. However, Vanderbilt still billed state and federal insurers as if it had met Medicare's conditions for payment.

Vanderbilt also designed a medical record system that was used to carry out a portion of the alleged fraud, the lawsuit claims.

"In reality, Vanderbilt has used the [Vanderbilt Perioperative Information Management System] to maximize its false billing practices by taking advantage of its remote access features to schedule attending physicians to be in multiple places at once, while continuing to bill their services as if they were actually present and personally performing the services at each place," the lawsuit states.

The hospital refutes claims that the software is a billing tool and maintains the system enhances medical documentation and provides detailed patient tracking, according to the Tennessean.

Adding to Vanderbilt's legal troubles, last month a former nurse accused the 626-bed hospital of violating the Family and Medical Leave Act after cutting 300 employees in a plan to axe as many as 1,000.

For more:
- read the Tennessean article

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