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January 27, 2015 Healthcare Fraud

The Medical College of Wisconsin Settles False Claims Act Allegations Over Neurosurgeries

In a somewhat harrowing set of facts, the Medical College of Wisconsin – located in Milwaukee – is alleged to have allowed medical residents the opportunity to perform neurosurgery on patients without proper supervision from teaching physicians. The case, which recently settled for $840,000, came about following the filing of a whistleblower complaint by Dr. Ganesh Elangovan, a physician with ties to the medical school. As a result of his willingness to come forward, Mr. Elangovan will receive an undisclosed portion of the final settlement, which can amount to up to 30 percent in some cases.

Details of United States of America, ex rel. Ganesh Elangovan, M.D., v. Medical College of Wisconsin

Filed nearly four years ago, the case against the Medical College of Wisconsin involves unlawful billing procedures occurring with regard to the supervision and presence of teaching physicians during neurosurgery performed by residents. Under Medicare and TRICARE billing guidelines, teaching physicians are eligible to receive reimbursement for their time spent monitoring and supervising residents during surgery, provided certain criteria are met.

First and foremost, teaching physicians must be readily available to residents to offer guidance and support during the critical points of the surgical procedure. While a teaching physician need not stand next to a resident for the duration of the operation, federal guidelines mandate the physician be present during the “critical” points in the process.

Moreover, in addition to being in the surgical room during the critical milestones of the surgery, Medicare and TRICARE will only reimburse a physician for his time if he or she was also immediately available for the entire duration of the surgery. If the physician could not be immediately available during the surgery, he or she must have arranged for a stand-in physician to cover the operation.

According to allegations, the Medical College of Wisconsin engaged in the consistent and routine practice of scheduling overlapping neurosurgeries and allowing teaching physicians to bill for their time attending to multiple procedures at one time. This practice is alleged to have occurred for a period spanning from 2006 through 2013 and is believed to have involved just a small number of neurosurgeons and residents.

Government’s Response

As we have explained in the past, reporting false claims and unlawful billing procedures can actually help increase patient safety and eliminate dangerous practices that could quickly lead to an oversight. Today’s case is certainly no exception and the federal government made the following remarks about the settlement.

According to the U.S. Attorney’s Office:

“The settlement we are announcing today reflects the focused, sustained, and purposeful efforts of the Justice Department, together with our partnered federal agencies, to investigate and redress fraud in our healthcare system….Under the authority of the False Claims Act, we are aggressive yet even-handed in pursuing health care fraud to ensure that taxpayer dollars are spent lawfully and that federal monies that should not have been paid are returned with an appropriate penalty.”

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