Houston-based Baylor St. Luke's Medical Center, Baylor College of Medicine and Surgical Associates of Texas have jointly agreed to pay $15 million to resolve claims they billed for concurrent heart surgeries that violated CMS teaching physician and informed consent regulations.
Eight things to know:
1. Baylor St. Luke's is a joint venture between Chicago-based CommonSpirit and Baylor College of Medicine. Baylor St. Luke's operates a teaching hospital, formerly known as St. Luke's Episcopal Hospital, in its medical center and the medical school employs teaching physicians and residents who perform services at the facility.
2. CMS launched an investigation in August 2019 after a whistleblower complaint alleged Joseph Coselli, MD, Joseph Lamelas, MD, and David Ott, MD — three heart surgeons operating at Baylor St. Luke's — regularly ran two operating rooms simultaneously and delegated key aspects of complex procedures to unqualified medical residents.
3. The surgeries at issue are some of the most complicated operations performed by any hospital, including coronary artery bypass grafts, valve repairs and aortic repair procedures, according to the Justice Department. These surgeries generally involve opening a patients' chest and placing the patient on the bypass machine for a period of time.
4. CMS regulations dictate 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 Dec. 21, 2020, Drs. Coselli, Lamelas and Ott violated these rules in various ways.
5. Prosecutors alleged that Drs. Coselli, Lamelas and Ott often ran two operating rooms at once and failed to attend the surgical "timeout" — a critical moment where the entire team would pause and identify key risks to prevent surgical errors.
6. The three teaching surgeons would allegedly enter a second or occasionally a third operation without designating a backup surgeon. Prosecutors also allege the surgeons hid these activities by falsely attesting on medical records they were physically present for the "entire" operation. In addition, medical staff did not inform patients the surgeon would be leaving the room to perform another operation, according to investigators.
7. A spokesperson for Baylor St. Luke's told Becker's that the settlement, which is not an admission of liability, resolves allegations made by the Justice Department. Baylor College of Medicine told Becker's it did not engage in conduct that violates any applicable federal law or regulation and that no patients were harmed. The college being a party to the agreement is also not an admission of liability.
"The college decided to amicably resolve the dispute prior to a trial on the merits after considering the cost and expense incurred by Baylor to date, and anticipated future costs and expenses, including attorneys' fees," Robert Corrigan Jr, general counsel for Baylor College of Medicine, said in a statement to Becker's.
8. The $15 million recovery is the largest settlement to date involving concurrent surgeries, according to the Justice Department. The private whistleblower who filed the complaint will receive more than $3 million of the settlement.