Assembly lines have their place in commerce. But healthcare? Federal prosecutors fined Lenox Hill Hospital in New York for submitting Medicare claims for procedures only partially performed or supervised by the attending surgeons. At least one urologist was frequently absent from the operating room while surgeries were being performed. In the words of Manhattan’s U.S. Attorney, “Hospitals cannot pay surgeons for their referrals, and they cannot run their operating rooms like assembly lines. Defendants prioritized maximizing their own revenues over regulatory compliance. This office will not tolerate such behavior."
Assembly Line Healthcare
Patients need personalized attention. While we understand the need for hospitals to pay their bills, mistakes happen when we push doctors to do too much – or when the doctors elect to put profits before patients.
Many hospitals are run as for-profit businesses. That’s okay as long as the focus remains on patient care. Hospitals aren’t factories, however. The focus should never be how many patients can simultaneously goes through surgery with just one attending physician on duty. Unfortunately, that appears to be what happened at Lenox Hill Hospital.
We don’t like assembly line healthcare for several reasons:
- Rushing healthcare leads to mistakes.
- Patients don’t have time to tell their story. Very few patients know what is wrong, they know their symptoms but not what disease or condition is causing those symptoms. It takes time to properly listen to a patient. Something that doesn’t happen when doctors are rushed.
- Doctors can’t properly supervise residents and other healthcare professionals. We see this often at teaching hospitals. While learning their craft, medical residents and interns are required to be supervised. This is what was happening at Lenox Hill Hospital in New York. The hospital scheduled the chair of the urology department to perform two separate surgeries at the same time. How is that possible? It’s not unless you allow an unsupervised resident perform one of the surgeries.
- Residents and interns don’t learn. You can’t learn if the doctor that is supposedly supervising and training isn’t even in the room.
Assembly Line Healthcare Wasn’t the Only Problem at Lennox Hill
We almost always find that a hospital or practitioner engaged in Medicare fraud usually violates more than one regulation or rule. That was certainly the case at Lenox Hill Hospital. The doctor at the heart of the assembly line healthcare allegations, Dr. David Samadi, was also part of an illegal kickback scheme.
Prosecutors say the hospital violated the federal Stark Law. This law prohibits a hospital from receiving Medicare reimbursement for services referred by a physician with whom the hospital has a prohibited financial relationship. The law is intended to prevent conflicts of interest in physician referrals. Patients care should be based on the patient’s needs, not on kickbacks and illegal financial schemes.
The hospital paid Dr. Samadi a guaranteed salary of over two million dollars each year plus an additional an incentive bonus of an additional two to five million dollars each year! This compensation grossly exceeded fair market value. It is also illegal because it was based on the value of doctor’s referrals to Lenox Hill.
Finally, prosecutors say that Dr. Samadi and Lenox Hill were scheduling minor procedures for the hospital’s operating room. Procedures that could better be handled on an outpatient basis. That means more stress for the patient and much larger bills to Medicare.
Not only is unnecessary inpatient surgery stressful, the risks are also greater. In patient surgeries carry increased infection risks and anesthesia reaction risks.
A spokesperson from the U.S. Department of Health and Human Services said “Lenox Hill Hospital elected to increase their profits by paying handsomely for referrals without any regard to patient care – ultimately violating Medicare rules and regulations. “
Patients Claim They Were Harmed by Improperly Supervised Surgeries
Many medical journals have already reported on the government’s Medicare fraud charges against Lenox Hill. We have the rest of the story.
There is often a human side to Medicare fraud cases. It’s not always just about the losses suffered by taxpayers. (Medicare is funded with tax dollars.)
Three patients filed medical malpractice claims in New York state court against Dr. Samadi. Patients Peter Nadler, Robert Ross, and Kenneth Pabon, each received treatment for urinary tract/prostate issues from Dr. Samadi at Lenox Hill.
The three patients claim their surgeries were not performed by Dr. Samadi but instead by unsupervised residents, and that during these surgeries, Dr. Samadi was simultaneously performing surgeries in a different operating room. They also say they were never informed that Dr. Samadi was not performing their surgeries.
Rewards for Medicare Fraud
Most Medicare fraud cases start with a tip from patients and healthcare workers. Regulators can’t be everywhere at once. An there are only enough auditors to audit a fraction of one percent of healthcare providers each year. Even then, chances remain good that fraud won’t be detected without someone inside help.
Under the federal False Claims Act, insiders with “original source” information about fraudulent billing schemes or medically unnecessary treatment can receive a cash reward for their information. Rewards typically range between 15% and 30% of whatever the government recovers from the wrongdoers. In the case of Lenox Hill, that means a reward of between $1.8 million and $3.7 million! Not a bad payday for doing the right thing.
Worried about retaliation? It’s illegal but happens. Fortunately, the law allows healthcare workers to receive double damages (typically lost wages) and attorney’s fees.
Over half the states have similar cash rewards for information about state funded Medicaid fraud claims.
Do You Have Inside Information about Medicare or Medicaid Fraud?
Let’s not wait for patients to suffer harm or taxpayers to needlessly fund a wrongdoer’s greed. If you have inside information about Medicare fraud you may qualify for a reward. If you simply want to remain anonymous and aren’t interested in a reward, feel free to call 1-800-MEDICARE. If the case only involves Medicaid, you can also contact your state Medicaid Fraud Control Unit as well.
If you are interested in collecting a cash reward and protecting yourself from illegal retaliation, contact our hotline number. All inquiries are kept confidential. We do not charge for our services.
For more information, contact one of our operators toll-free at 888.742.7248. You can also contact us online.