Record Settlement Reached Following Allegations That Houston Surgeons Violated Regulations During Heart Operations

HOUSTON – Three Texas Medical Center facilities have agreed to pay $15 million to resolve claims they billed for concurrent heart surgeries in violation of Medicare rules on teaching physician and informed consent, the Office of the Commissioner announced. US Attorney.

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

“BSLMC is a joint venture between CommonSpirit Health, a national hospital chain, and BCM, a medical school in Houston. BSLMC operates a teaching hospital, formerly known as St. Luke’s Episcopal Hospital, within its medical center. BCM employs teaching physicians and residents who provide services at BSLMC, including Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. SAT is a medical practice group affiliated with various cardiothoracic surgeons, including Dr. David Ott, 77, Houston,” the U.S. Attorney’s Office said.

The investigation began on August 7, 2019, after the filing of a sealed qui tam complaint, otherwise known as a whistleblower complaint. The whistleblower alleged that Coselli, Lamelas and Ott – three cardiac surgeons who had practiced at St. Luke’s – routinely engaged in running two operating rooms at once and delegated key aspects of extremely complicated heart surgeries and risks to unqualified resident doctors.

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

Medicare regulations determine when teaching physicians can leave the operating room for any operation, no matter how complex.

“The settlement resolves allegations that, from June 3, 2013 to December 21, 2020, Ott, Coselli and Lamelas violated these rules in various respects. Surgeons were often running two operating rooms at once and failed to attend surgical “time-out” – a critical time when the entire team takes a break and identifies key risks to avoid surgical errors, according to the allegations,” the U.S. Attorney’s Office said. “In addition, surgeons allegedly carry out a second or sometimes a third operation without appointing a replacement surgeon. At times, surgeons allegedly concealed these activities by falsely attesting in medical records that they were physically present during the “entire” operation. Additionally, medical staff did not inform patients that the surgeon would be leaving the room to perform another operation.

“Patients have entrusted their lives to these surgeons – submitting to operations where a missed cut means the difference between life and death,” said United States Attorney Alamdar S. Hamdani. “Apparently, the patients did not know that their doctor was leaving for another operating room. This agreement reaffirms the importance of Medicare’s requirements governing the presence of surgeons and ensuring that no physician – no matter how large or successful – can circumvent the rules.

“These three doctors’ complete 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 Bureau of the Inspector General of the Department of Health and Human Services (HHS-OIG). “This record settlement demonstrates our unwavering 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 programs health care.

“Every time one of us goes under the knife as a vulnerable patient, we implicitly trust that surgeons and medical professionals have our best interests at heart, especially here at world-renowned hospitals of Houston,” said Special Agent in Charge Douglas Williams of the FBI’s Houston Field Office. “In this case, the doctors gamed their patients’ care, including complicated open-heart surgeries, compromising quality of care over quantity, and then falsely billed Medicare for reimbursement for the services they had delegated inappropriately. We hope that today’s civil settlement announcement represents accountability for doctors and hospitals around the world.

The $15 million recovery is the largest settlement involving concurrent surgeries to date, according to the U.S. Attorney’s Office.

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

The U.S. Attorney’s Office, DHHS-OIG, and the FBI conducted the investigation. Assistant United States Attorneys Brad Gray and Andrew Bobb are handling the case.

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

“Baylor College of Medicine has not engaged in conduct that violates any applicable federal law or regulation. It is also important to note that no patients were injured. The settlement agreement acknowledged that BCM disputed any violation of federal law and that the fact that the College was a party to the agreement did not constitute an admission of liability on the part of Baylor. The College has decided to resolve the dispute amicably prior to a trial on the merits, after considering the costs and expenses incurred by Baylor to date, as well as anticipated future costs and expenses, including attorneys’ fees.