Vanderbilt Medical Center Accused of Massive Fraud
Feds say internal software helped it fleece Medicare.
Published: September 13, 2013
Vanderbilt University Medical Center has been systematically defrauding the federal government for at least a decade, aided in large part by the development of its award-winning information-management software, which let it schedule attending physicians to be in multiple places at once, according to a lawsuit unsealed this week in federal court.
Vanderbilt is accused of encouraging physicians to routinely schedule simultaneous multiple surgeries in various locations and of billing Medicare for those procedures, in defiance of a Medicare requirement that attending physicians at teaching hospitals be present at surgeries, or at least key parts of those surgeries.
According to the suit, the software let the hospital "maximize its false billing practices by taking advantage of its remote access features to schedule attending physicians to be in multiple places at once, while continuing to bill their services as if they were actually present and personally performing the services at each place." The software known as the Vanderbilt Perioperative Information Management System includes a default function that requires physicians to document that they meet Medicare's conditions for payment, the suit alleges.
To document anesthesia services, according to the suit, the software provides only one choice for describing the level of treatment: "medically directed." As such, physicians can't choose lower-reimbursement alternatives like "medical supervision," though, the suit continues, the latter would be more accurate in almost all of Vanderbilt's cases.
The software won a 2008 Microsoft Healthcare Innovation Award, according to Vanderbilt, and has been licensed to several other hospitals.
The suit names Jeffrey Balser, MD, PhD, and current dean of the school of medicine, as a key proponent of the software. Three former employees John D'Alessio, MD, Alexander Fisher, MD and Heather Hagerman, MD, all anesthesiologists are listed as plaintiffs.
Vanderbilt spokesman John Hoswer calls the accusations regarding the software "patently false," according to the Tennessean, adding that Vanderbilt has been cooperating with the government during the investigation and plans to "defend itself vigorously."
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