Massachusetts General Hospital has agreed to a $14.6 million settlement following a whistleblower lawsuit. The settlement will put an end to allegations of overbilling government insurers due to overlapping surgery.
This settlement follows two other similar settlements that were brought against the Harvard-affiliated teaching hospital. All three settlements all related to a controversial hospital practice known as concurrent surgery. This type of practice allows doctors to double-book surgeries so that they are attending to two operations at the same time. This latest settlement brings the sum of out-of-court settlements related to double-booking to a total of $32.7 million.
The latest settlement is the result of a federal whistleblower lawsuit that was brought forward by a former anesthesiologist at Massachusetts General Hospital, Dr. Lisa Wollman. Dr. Wollmnan filed the whistleblower lawsuit under the False Claims Act. The act, which was passed during the American Civil War, allows private citizens to sue on behalf of the government when fraudulent practices take place. As part of the suit, Dr. Wollman will receive between 20 - 30% of the settlement funds.
Dr. Wollman detailed claims that the hospital violated Medicare and Medicaid rules which required surgeons to be present during the critical parts of an operation. Instead, Dr. Wollman detailed that patients were kept under anesthesia longer than necessary because the supervising surgeons were busy attending to another operation booked at the same time.
By keeping patients under anesthesia longer than needed, the hospital overbilled government insurers for anesthesiology services. Dr. Wollman alleged that at least five orthopedic surgeons regularly participated in this practice of concurrent surgery between 2010 and 2015. Despite voicing her concerts, the practice continued. Dr. Wollman, who now works at New England Baptist Hospital shared, “I did this entirely for patient safety and transparency.” She also shared that because she voiced her concerns, she faced blowback that impacted her career.
With this latest case, the settlement funds will be shared among the Massachusetts health insurers, according to Attorney General Maura Healey. “Patients should be fully informed about the details of any medical procedure, especially when it comes to simultaneous surgeries,” Healey shared in a statement. “This resolution returns nearly $2 million to MassHealth and the Group Insurance Commission, and requires updated consent forms at Mass General Brigham to improve transparency.”
Massachusetts General Hospital has denied the allegations made against them in this latest suit. The hospital maintains that they performed the concurrent surgeries in accordance with the law. They also maintain that the practice of concurrent surgeries is an effective way to schedule operations and that it allows trainees the opportunity to practice routine skills such as closing up wounds.
The hospital’s president, Dr. David F.M. Brown, and the hospital physician organization president, Dr. Marcela del Carmen, shared in a statement, “While the MGH continues to believe it always has complied with legal requirements regarding overlapping surgery, we determined that it would be most prudent to resolve the matter fully by settlement at this time.”
In addition to the funds, the settlement will also require all surgeons in hospitals that are part of the Mass General Brigham Network to disclose to patients whether or not their operation will be concurrent with another.
