Two former Chattanooga, Tenn.-based Erlanger Health System orthopedic surgeons — Julie Adams, MD, and Scott Steinmann, MD — and former CIO Stephen Adams, MD, have filed a whistleblower lawsuit against the system alleging Medicaid fraud, according to a March 27 report from the Chattanooga Times Free Press.
The lawsuit accuses hospital leaders of knowingly overlapping surgeries and allowing trainees to operate on patients without physician supervision. Erlanger would then bill for two or three surgeries taking place in the same time frame.
Medicare and Tennessee's Medicare program, TennCare, require a supervising physician to be present for each surgery to receive federal payment.
"The surgeries were often scheduled to start within 15 to 30 minutes of one another and, in the case of three overlapping bookings, two or more surgeries frequently occurred entirely within the duration of a third," the lawsuit reads. "This routine practice meant unwitting patients were subjected to longer-than-necessary operating-room times and charges, often under anesthesia, often in the care of trainees, and nearly always without the backup of a properly qualified surgeon, despite legal requirements."
Dr. Julie Adams, Dr. Steinmann and Dr. Stephen Adams allege that when they raised concerns about safety and compliance with the health system, they were terminated. The three physicians are seeking damages for a "malicious and unlawful campaign of retaliation," according to court documents.
"Erlanger has worked with and otherwise fully cooperated with the government's review of the claims as they relate to Erlanger over the past 18 months. Erlanger disputes the merit of the allegations," Erlanger spokesperson Blaine Kelley told the Times Free Press. "No instances of patient harm relating to these allegations have been identified."