This is Bloomberg Law with June Grosso from Bloomberg Radio.
Imagine a patient who's anesthetized and intubated, and he goes into the operating room, and he's met with his surgeon, and he has confidence in that surgeon. He believes that he or she is going to be the person who is going to take them through the procedure and be there in the recovery room and give them, hopefully the
good news that it went well. Unbeknownst to the patient, that surgeon, as the book A Matthew might say, is serving two masters or maybe three masters, and the surgeon might be involved in multiple surgeries at the same time. And so while that patient is unconscious, intubated, obviously anesthetized, he or she may be operated on by a fellow or a resident in someone substance, not the person entrusted to do the surgery.
Doctors ghosting patients during surgeries, scheduling two or even three operations at the same time, and leaving during critical portions. It happens more than you may think, and it's been going on for years. That's because double or even triple billing Medicare can bring in hundreds of millions of dollars
to hospitals and cost taxpayers billions. Attorney Reuben Guppen represents two doctors who blew the whistle on their fellow surgeons and were then fired by the Erlinger Health System in Tennessee. He compares the setup to Las Vegas.
The reason I have that Las Vegas analogy is you have these hospitals and they make their money on the room and the board and the tests and all the ancillary services that go part and parcel with the surgery, and they want to recruit doctors who can bring in patients, that is into Las Vegas, bringing in patrons to the
gambling halls. And so what they do is they give the doctors the round of the mill, allow them to do whatever they want to make as much money as they want, and they reward them by allowing them to build for surgeries for which they were not allowed to bill under the Medicare and Medicaid billing rules. And that's why it's kind of akin to Las Vegas.
John Holland, senior investigative reporter for Bloomberg Law, has been investigating these concurrent surgeries and he joins me, now, so, John, you've reviewed more than a dozen federal and state lawsuits over these ghost surgeries. How prevalent are they?
It's happening more than we thought. Basically, you go in, you have a surgeon, you've met with him, You've talked to him about what the procedure will be like. What the surgeon isn't telling them, at least in these lawsuits, is that I may not be there during large chunks of the operations, and a lot of patients never know. That's why you don't see too many malpractice claims connected with these, because the patients just don't know that their
doctor didn't perform the surgery. Since the story ran, I have gotten fifty or six the emails from doctors, hospital administrator's residents saying that they've seen this problem firsthand, and it's far wider than even these lossuits have talked about. So I was a little surprised just how wide spread it is.
Yeah, So just to be clear, are residents allowed to operate when the surgeon is there supervising.
Yes, the residents cannot do what it's called critical portions of a procedure. There is as one of the doctors we talked to, there's nuance on that of how you define critical, but in general, the residents should be opening a patient, closing the patient, and doing some minor parts of a procedure only if the surgeon is in the operating room. He can't just walk away and turn over the patient to a resident. And in this case, that is what is happening.
And you found cases where doctors build for simultaneous surgeries but at two different hospitals that were a.
Mile apart, and that's exactly what's happening. We saw in the University of Southern California case where one of the chief star surgeons booked five surgeries for the same morning from eight am until two and wrote basically when he submitted the bill that he was there for the entire time of all five surgeries, even though they were in different operating rooms and one was conducted at a hospital more than a mile away. So obviously it was fraudulent.
There was not a lot of mystery from what we understand. All sides are deep in settlement talks and the case could be wrapped up later this month. I don't believe USC will contest some of these cases. That remains to be seen, but it looks like they're trying to settle.
Is this about violating Medicare rules or violating patients rights or harming patients.
All of the above. In the beginning, I didn't expect to see the harm. I thought this was going to be more of a billing of fraud issue. But as we started looking through these lawsuits and many others and started talking to a lot different doctors, this is a real issue, particularly since you're putting someone under anesthesia for hours longer than they should be because you're bouncing from operating room to operating rooms. In some cases, the residents
are finishing. In other cases, the residents are acting almost as babysitters, waiting for the lead surgeon to come back, and that could be many hours, and that puts patients in nager. One of the studies that we cited looked at hip surgeries a year out and they found it without any question, the adverse outcomes went up exponentially the longer someone was under anesthesia, and that was directly tied to doctors not performing one surgery and then moving on. So it's a little both.
If these claims are being filed, five claims wants different hospitals, why isn't Medicare catching that.
That is the biggest question I have and that we are following up very hard on that now to see why does it take doctors coming forward to essentially expose their own institutions. Why is medicare not catching these very blatant billion practices. We didn't get into the subtle ones the story. I took the ones that, after spending months on this, were as open and shut as we could
possibly find. It's hard to believe that Medicare would be showing out hundreds of millions of dollars without somebody saying, hey, there's a problem here. And so that is the thing I'm working on right now to see if we can nail down what is going on and why did nobody catch this?
Are we talking hundreds of millions of dollars? Billions when you consider all.
These When you look at this, it's in the billions. The government alleged in the Pittsburgh case that it was thousands of surgeries done by particular doctor, doctor Luke Dich. Southern California attorneys are claiming that this is several hundred million at that one institution alone, and Ellinger Hospitally in Chattanooga Tennessee. They are alleging minimum of eighty five one hundred incarnoral overlapping surgeries. So again, that would get into
the tens of millions of dollars worth of billings. It is staggering the amount of money that we're talking and it's equally staggering that nobody caught it. And so that's what we're trying to figure out. The next step is what is going on here in terms of the payment. The first focused on the patients and the practices and the deception, but the bigger question for the next round is why did nobody catch this?
So there are a lot of people in an operating room, I'm shocked that a lot of those people haven't talked about this, complained about this, reported this.
Apparently they have. There've been a lot of internal complaints at Hospital twenty fifteen in the Boston Globe did a great theories on this. This spotlight team looking at just one hospital, Mass General, and they talked to a star surgeon named Dennis Burke, and they talked to their top anesthesiologist, Lisa Bahman, who went on the record of the problems they were seeing. But it wasn't enough to get the
hospital to stop what it was doing. It was only after lawsuits came that the hospital changed its ways a bit, but that was rare and the hospital. The medical profession is very tight lipped and they do not speak up against each other. Is very tough to even get a doctor to testify a trial against another doctor in malpractice cases. So it doesn't surprise me just because of the nature
of the profession. You risk losing your career. So it's sometimes you may be outrage, you may complain internally, but then you throw your hands in the air and say, what can I do about this? And that is based on all of the doctors I talked to and all the attorneys. That is the biggest problem. People are afraid to come forward because the hospital can crush them.
And Reuben Gutman told me that two clients who were nationally recognized orthopedic surgeons were crushed after they reported concurrent surgeries on the hospital's internal system.
So our clients made a report to the hospital, the document their concerns, which they had been articulating for a period of time, and then within forty eight hours is our complaint alleges their services at the hospital will terminate. It's been almost impossible for them to get a position in the United States, and two of them are now
in Scotland. These are folks of national reputation. They are probably some of the leading surgeons in the country and what Erlanger has done to them made it impossible for them to get jobs and es centrally tried to destroy their careers. But you know, as a lawyer, believes that at the end of the day, when the full story comes out as it has been, these folks are our national heroes.
And in that case, the doctors say they filed the report because hospital administrators suggested they do so, and then they got fired two days.
Later after being told by the administrators, we're going to address this. Put it in writing so that we can do something about it, and according to lawsuit, they did do that. They were very respected surgeons. Both had taught at the Mayo Clinic in Minnesota. One of them had been born in Aerlanga and she wanted to go back and be close to her family. Her husband was the head of orthopedics. He was one of the best orthopedic surgeons in the country, and within two years they were gone.
Talking to them, they said the practices were so much worse than they had ever seen. They felt like they didn't have a choice. They had to speak up. They kept assuming that the hospital would fix it. They didn't realize they were losing their jobs until it was too late. They kept thinking, well, expose it, will write the ship and we'll come up with new policies, and instead they kept the policy and fired the surgeon.
Explain why these respected doctors are now practicing in Scotland because they couldn't get a job in the US after reporting.
This, because in the beginning they couldn't explain these sealed lawsuits, so they couldn't even say why they left the hospital or that they had these going. They suddenly were no longer at the hospital. They were fired and they couldn't get a good reference. But every about their case was sealed. They couldn't even say I followed the lawsuits or describe any of the reasons for them leaving. So suddenly you're unemployed and you can't explain why, and the hospital's refusing
to give you a recommendation. It stay on the seal for years. That was just unsealed in March. That's why I found it. And the other one was unsealed about a year ago the USC case, so it takes a lot to come forward, least so woman quit before she was fired, which made her life a little easier, but trying to explain why I walked out of Mass General without being able to provide the details, she sort of ruined her career for about a year.
I think the scariest part of your article is this. Some of Erlanger's residents were so unskilled that the hospital's own doctors said in secretly recorded conversations they were concerned about leaving them alone in operating rooms. And according to the lawsuit, an orthopede is told a colleague Resident III is scarier. He's got this spasmodic index finger. You know, he makes an incision and it's just, oh my god, stop. I mean, that's just astonishing.
It was stunning to me. And this is the type of thing. Is a report you wouldn't include in a story very od because I don't trust it. In this case, they were fully recorded. These conversations were recorded that were transcripts filed with the court. This happened so during my fact check and once I started talking to the attorneys, I realized these were serious attorneys that are not going to put that in a filing, and then they had transcripts and tapes, So this is a whole different level
than I have ever come across. Clearly, they are problems with those residents that they're turning patients.
Over to Erlanger told you in a statement that it strongly denies the claims and looks forward to the truth coming out during the court proceedings. I'm wondering if the truth about residents performing surgeries ever comes out in personal injury lawsuits, or whether it's too hard to find out if a resident did perform the surgery.
It's very difficult to tell, especially since when you are harmed, you may never know that there was a resident doing any portion of your surgery. That is not something that comes out, and most attorneys, you know so little about this practice that they never even wind up looking for in discovery. It's basically been a well held secret by the medical profession, and well it comes out once in a while, like the Boston Globe series a decade ago.
For the most part, hospitals do a good job of keeping this down and keeping this quiet, and I think, judging by the response I'm getting that's going to change. I don't think there's much doubt. Doctors and surgeons around the country, and professors at medical schools all been reaching out to me.
Do we assume that the administrators of these hospitals know what's going on because they're handling the billings, Yes.
They would have doing. They're also strong federal law on paying kickbacks to doctors to pay them for referrals because they can be conflict of interest where they would basically prescribing a surgeries. In this case, the administrators were paying these huge sums to doctors. Who was a doctor Somadi out of Lenox Hill Hospital in New York. He made five million dollars in one year according to federal prosecutors, and that was in large part because of been proper kickbacks.
Doctor Luketicch made millions of dollars according to federal prosecutors. That was again improper payments that were in violation of federal anti kickback statutes. So it can't happen if the administrators don't know about it. They just wouldn't because nobody could pay them.
Are the lawsuits we're talking about all false claim lawsuits.
For the most part, Doctor Burke was a wrongful termination. He was the mass general doctor. But all of the others that I mentioned in the story were false claims cases. I looked at maybe a dozen others that were a combination of false claims and employment law. But for the most part, these are doctors coming forward and finally on behalf of the government.
Explain a little more for those who don't know the mysterious world of fault claimed lawsuits.
I am learning on the fly, But essentially in this you see it with defense contracting quite a bit. If someone is being paid by the federal government and they commit fraud on the federal government, anyone who learns about it and can expose that fraud is entitled to file a lawsuit as long as they can prove the allegation
on behalf of the Justice Department. It remains under seal, often for many years while the Justice Department investigates, and then the Justice Department has a choice of joining the lawsuit, or often if they see it's going well, they just step out of the way and they let the attorneys in the plaintiff continue their lawsuit, and then when there's a settlement, the Justice Department steps in and signs off
on that settlement and gets all of the money. So if there's a settlement for one hundred million, it goes to the government to taxpayers, and then the whistleblower will get thirty percent of whatever the settlement is, but all of the money is filed in good to the US government and the whistleblower gets paid on the back end.
If it's a false claims, are there any provisions then for things to be corrected at the hospital so it doesn't happen again.
That is usually as part of the settlement, and we saw this in Pittsburgh. The government said that it was going to be auditing some of the surgeons practices. They were going to be monitoring them for three years. That's a little unusual just because that was one that the Justice Department took over from the initial attorneys. For the most part, if there's just the settlement, there aren't a lot of restrictions placed on the hospital. Lisa Wollman, the
anesthesiologist of Mass General. As part of her settlement, she insisted that the hospital change its consent form so the patients would know one hundred percent who was going to be doing their surgery. So that was just her tenacity winning out on that issue, but for the most part, unless the government handles it directly, they weren't a lot of sanctions put in at the end.
You also reported about the University of Southern California's hospital system being accused of billing for thousands of cases where the teaching physician left residents unattended to perform even spine and brain.
Surgeries, and this kind of goes to the heart the allegations at the usse that they were different outcomes at their different hospitals, where in one of the hospitals in the system, patients were more than twice as likely to be injured or harmed during surgery according to the laws, and it's mentioned several times in the lawsuits. The attorney and the surgeon who brought the lawsuit alleged that one of the administrators said, that's where we send residents to
practice on poor folks. So, if the lawsuit is correct, and it seems to be in the final stage of the settlement, the hospital knew that it was putting patients in one of their institutions in harm, but they were doing it so that they could have residents practicing their work. That was pretty stunning.
I found so much in your story, stunning, John, and I hope you'll come back with the next part of your investigation. Thanks so much. That's John Holland, senior investigative reporter for Bloomberg Law. And that's it for this edition of The Bloomberg Law Show. Remember you can always get
the latest legal news on our Bloomberg Law podcasts. You can find them on Apple Podcasts, Spotify, and at www dot Bloomberg dot com slash podcast Slash Law, and remember to tune into The Bloomberg Law Show every weeknight at ten pm Wall Street Time. I'm June Grosso and you're listening to Bloomberg