A record settlement has been reached on allegations that Houston surgeons violated regulations during heart surgery

HOUSTON – Three Texas Medical Center institutions have agreed to pay $15 million to resolve claims they were billed for concurrent heart surgeries in violation of Medicare’s attending physician and informed consent regulations, the U.S. attorney’s office announced.

Baylor St. Luke’s Medical Center (BSLMC), Baylor College of Medicine (BCM) and Surgical Associates of Texas PA (SAT) are the three institutions that have agreed to the settlement.

“BSLMC is a joint venture of CommonSpirit Health, a national hospital network, and BCM, a medical school in Houston. BSLMC operates a teaching hospital at its Medical Center, formerly known as St. Stephen’s Episcopal Hospital. Luke. BCM employs physician educators and residents who provide services at BSLMC, including Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. “SAT is a group of medical practitioners affiliated with various cardiac surgeons, including Dr. David Ott, 77, Houston,” the U.S. Attorney’s Office said.

The investigation began on August 7, 2019, following the filing of a sealed qui tam lawsuit, known as a whistleblower complaint. The whistleblower alleged that Coselli, Lamelas and Ott – three cardiac surgeons who worked at St. Luke – regularly ran two operating rooms simultaneously and outsourced key aspects of extremely complex and risky heart surgeries to unskilled medical residents.

“The heart surgeries in question are some of the most complex surgeries performed in any hospital, including coronary artery bypass grafts, valve repairs and aortic repair procedures. These surgeries typically involve opening the patient’s chest and placing the patient on a bypass device for a period of time,” the U.S. Attorney’s Office said.

Medicare regulations determine when attending physicians may leave the operating room to perform any surgery, regardless of its complexity.

“The settlement resolves allegations that, between June 3, 2013 and December 21, 2020, Ott, Coselli and Lamelas violated these rules in various respects. Surgeons often ran two operating rooms at once and failed to report for a “break” in surgery – the allegations allege a critical moment when the entire team stopped and identified key risks to prevent surgical errors, according to the U.S. attorney’s office. “In addition, surgeons allegedly performed second and sometimes third surgeries without appointing a backup surgeon. At times, surgeons allegedly concealed these activities by falsely certifying in medical records that they were physically present during the “entire” operation. In addition, medical staff did not inform patients that the surgeon would leave the room to perform another operation.”

“Patients were trusting these surgeons with their lives – undergoing surgeries where one missed incision meant the difference between life and death,” said U.S. Attorney Alamdar S. Hamdani. “Supposedly, patients were unaware that their doctor was going to a different operating room. This settlement confirms the importance of Medicare requirements regulating the presence of surgeons and ensuring that no physician – no matter how prominent or successful – can circumvent these rules.

“These three physicians’ total disregard for patient safety put patients at risk and violated Medicare regulations for their own convenience and greed,” said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “This record-setting settlement demonstrates our steadfast commitment to protecting Medicare beneficiaries and working with our law enforcement partners to use every tool in our arsenal to hold accountable those who steal from Medicare and other federal health care programs.”

“Whenever any of us go under the knife as a defenseless patient, we trust implicitly that surgeons and healthcare workers have our best interests at heart, especially here at Houston’s world-renowned hospitals,” said Special Agent in Charge Douglas Williams of the field office FBI-Houston. “In this case, physicians risked the care of their patients, no less during complex open-heart surgery, by prioritizing quality of care over quantity, and then falsely billed Medicare for reimbursement for services they improperly delegated. We hope that today’s announcement of the civil settlement reflects the responsibility of physicians and hospitals around the world.”

The $15 million recovery is the largest settlement ever involving simultaneous operations, according to the U.S. Attorney’s Office.

The False Claims Act entitles a private whistleblower who brings a lawsuit to a portion of any recovery. In this case, the whistleblower will receive $3,075,000.

The investigation was conducted by the U.S. Attorney’s Office, DHHS-OIG, and the FBI. The case is being prosecuted by Assistant U.S. Attorneys Brad Gray and Andrew Bobb.

Baylor College of Medicine General Counsel Robert Corrigan issued the following statement:

“Baylor College of Medicine has not engaged in conduct that violates any applicable federal law or regulation. It is also worth noting that no patient was injured. The settlement acknowledges that BCM disputes the existence of any violations of federal law and that the College’s being a party to the settlement does not constitute an admission of liability by Baylor. The College resolved to amicably resolve the dispute before a hearing on the merits after considering Baylor’s costs and expenses to date and anticipated future costs and expenses, including attorneys’ fees.