Two former orthopedic surgeons with Erlanger, Julie Adams, MD, and Scott Steinmann, MD, filed a lawsuit against the health system in April 2021 in the U.S. District Court for the Eastern District of Tennessee. They, along with former CIO Stephen Adams, MD, alleged that hospital leaders knew overlapping surgeries were happening and allowed trainees to operate on patients without physician supervision. Erlanger then billed for two or three surgeries taking place in the same time frame.
Medicare and Tennessee’s Medicaid program, TennCare, require a supervising physician to be present for each surgery to receive federal payment.
However, in a memorandum filed June 8, Erlanger argued that Medicare rules do allow overlapping surgeries and only prohibit cases when the “key and critical” portions cross over. The memorandum said the whistleblower suit didn’t provide any necessary details that could “support a viable FCA claim.”
Erlanger also pushed back at allegations that it retaliated against the suing physicians for expressing concerns because the complaints were related to patient safety, not protecting against fraud.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
