Concurrent Surgeries, Again

The Justice Department is going after the University of Pittsburgh Medical Center (UPMC) over the issue of concurrent surgeries.

The facts of the case is that a senior surgeon leading a team more junior physicians conducted three surgeries in three different operating rooms at the same time. The UPMC apparently isn’t disputing this.

The Federal Government alleges that the UPMC overbilled the government for the surgeries, by billing the senior doctor’s time as if he were present for the entire duration of each of the surgeries. The government further alleges that the multiple simultaneous surgeries placed patients at risk by having them under anesthesia for longer than necessary, and resulted in complications requiring additional procedures, including two amputations.

The UPMC’s defense is that what they did was not in violation of any government regulations and that the government’s case is based on a misinterpretation of regulations published by the Centers for Medicare and Medicaid Services (CMS), a Federal agency.

To me, the defense is absurd. The simple solution would be for CMS to sanction UPMC, preventing the release of any Medicare or Medicaid funds to the hospital. That would lead to the hospital’s bankruptcy within months, long before anything could be settled in court. That threat alone should cause UPMC to cave. This is not a fight they can win, even with a better defense than what they have.

I don’t know what you think about this, but I don’t want a doctor splitting time between different patients when he’s doing surgery on me. Period. If a doctor is going to do that, patients need to be told in advance, to allow them time to find another surgeon. Unless you find a doc who can literally walk on water, there is no doc good enough for this nonsense.

Source: https://www.benefitspro.com/2021/09/09/feds-sue-upmc-department-head-for-allegedly-filing-false-claims-412-120910/?kw=Feds%20sue%20UPMC%2C%20department%20head%20for%20allegedly%20filing%20false%20claims&utm_source=email&utm_medium=enl&utm_campaign=bprodaily&utm_content=20210910&utm_term=bpro&slreturn=20210812173710

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