Doc's Whistleblowing Results in Parkland, UT Southwestern Paying $1.4 Million to Feds

Amidst all the other things going on with Parkland at the moment, there remains one other Very Big Thing you've probably forgotten all about: Dr. Larry Gentilello's allegations that trauma residents at the county hospital were treating patients and performing surgeries without attending physicians looking over their shoulders -- a very clear violation of Medicare and Medicaid statutes. When Gentilello blew that whistle, he was chair of the Division of Burn, Trauma and Critical Care at UT Southwestern. Not afterward. He was demoted. And his bosses at UT Southwestern refused to investigate.

But moments ago, the U.S. Attorney's Office sent word: UT Southwestern and Parkland have agreed to pay $1.4 million to make it all go away. And, of course, they will write that check without acknowledging any wrongdoing. As UT Southwestern says in its statement, "As acknowledged in the agreement, UT Southwestern still vigorously denies any lapse in the supervision of physicians-in-training, inappropriate billing, wrongdoing, or liability." This is from the feds' release:

The U.S. and Texas contend defendants caused "upcoded" claims to be submitted to Medicare and Medicaid for teaching physician-related items and services between 2004 and 2007. Defendants fully cooperated with the investigation, and by settling, did not admit any wrong-doing or liability.

Teaching physicians may submit claims to Medicare and Texas Medicaid for the supervision of residents if they meet certain criteria. Claims generally are reimbursable if the teaching physician is present for the key or critical portion of the service. Supervision of a resident is noted by coding a claim with the modifier GC. Surgeons typically are paid a global fee which represents payment for pre-, intra-, and post-operative management of a patient's care. The United States and Texas contend UTSW submitted improper claims primarily due to its teaching physicians' inadequate supervision of residents during certain key portions of pre-, intra-, and post-operative care of surgeries performed at Parkland Hospital. The United States and Texas allege claims with modifier GC falsely represented to the Medicare and Texas Medicaid programs that UTSW's teaching physicians properly supervised surgical residents at Parkland, even though in some cases, there was no documentation by the physicians that they were present for the critical portion of the resident's pre-, intra-, and post-operative surgical care.

Says Mike Shields, Special Agent in Charge of the Dallas office of the Office of the Inspector General, in a prepared statement: "Medicare should get what it pays for. If you submit a claim for supervising a resident you should actually be present supervising that resident, particularly when that resident is performing surgery." And, of course, under the the False Claims Act and Texas Medicaid Fraud Prevention Act, Gentilello could get up to 25 percent of the settlement.

This is what UT Southwestern offers:

UT Southwestern Medical Center President Daniel K. Podolsky, M.D., today issued the following statement regarding settlement of pending litigation:

"UT Southwestern has reached a settlement agreement with the U.S. Attorney and the State of Texas related to claims made in two lawsuits filed under seal four years ago regarding Medicaid and Medicare billing practices and the supervision of resident physicians between 2004 and 2007.

"As acknowledged in the agreement, UT Southwestern still vigorously denies any lapse in the supervision of physicians-in-training, inappropriate billing, wrongdoing, or liability. Moreover, both state and federal parties to this settlement have provided us a full release from any such claims, as is expressly stated in the settlement agreement.

"In fact, the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services reviewed our current billing compliance practices and found them to be robust and consistent with state and federal billing requirements. As a result, unlike many such settlement agreements, the OIG will not require any ongoing oversight or supervision through either a 'Corporate Integrity Agreement' or a 'Corporate Compliance Agreement.'

"To avoid ongoing litigation expenses and prevent further distraction from our mission, UT Southwestern has agreed to pay to the government $1.4 million to settle this matter in its entirety with all involved. This amount represents a small fraction of the projected legal expense and consumption of internal time and resources if we continued to argue this matter. While we deeply regret that any of the institution's resources - in this instance funds from clinical earnings - will be diverted from our core missions of patient care, education, and research, we believe it is clearly in the best interest of the University to put this matter behind us.

"While not trivial, the payment amount nevertheless represents less than one-half of one percent of our Medicaid and Medicare collections during the period questioned - and is far from the 'hundreds of millions' in payments that certain of our detractors claimed would result from this lawsuit.

"UT Southwestern takes enormous pride in the service we provide to our patients, to the Dallas community, Texas, and the nation. We remain committed to the very highest standards of care for our patients and to the rigorous supervision of the resident-physicians who will be the next generation of caregivers."

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