Poor physician credentialing leads to hospital False Claims billing charges

Failure to enforce a robust physician credentialing program could have significant financial consequences for one Georgia hospital. The federal government has joined a False Claims Act lawsuit alleging that Satilla Health Services Inc. in Waycross, doing business as Satilla Regional Medical Center, and Dr. Najam Azmat submitted Medicare and Medicaid claims for medically substandard and unnecessary services, according to the U.S. Department of Justice (DOJ). The complaint charges that the hospital submitted claims for medical procedures that Azmat wasn't qualified or properly credentialed to perform, resulting in serious injuries and at least one patient death.

The hospital allegedly placed the physician on staff "even after learning that the hospital where he previously worked had restricted his privileges as a result of a high complication rate on his surgical procedures," says the DOJ. The complaint also states that hospital management allowed Azmat to perform endovascular procedures in the hospital's Heart Center "even though he lacked experience in performing such procedures and did not have privileges to perform them." Hospital managers are charged with ignoring both the physician's high complication rates and repeated warnings from nursing staff, allowing him to continue to perform these procedures and to bill federal healthcare programs.

"In this case, the defendants allegedly not only provided substandard and unnecessary medical services --they caused harm to patients," says Tony West, assistant attorney general for the Civil Division of the DOJ. "We are committed to bringing to justice those who put profits ahead of patient health and safety."

To learn more:
- read the DOJ press release
- check out this Florida Times-Union article