Vanderbilt Medical Center Accused of Massive Medicare Fraud

  1. The plot thickens. Perhaps the layoffs and decision to make nurses do more housekeeping were a distraction from bigger issues, like a Medicare fraud charge.
    A lawsuit unsealed this week in federal court alleges that Vanderbilt University Medical Center has engaged in widespread Medicare fraud for more than a decade.

    Amid the allegations, the lawsuit identifies Dr. Jeffrey Balser, the current head of VUMC, as one of the chief proponents behind a medical record system that was used to carry out a portion of the alleged fraud. . . .

    As a teaching hospital, Vanderbilt is eligible for Medicare payments for certain services. But Vanderbilt is eligible only for those payments if those procedures happen according to Medicare guidelines.

    One such stipulation is that an "attending physician" must attend surgeries, or at least key parts of them. According to the lawsuit, Vanderbilt double-booked attending physicians, making it impossible to meet Medicare billing standards, but VUMC billed state and federal insurers as if it had complied with regulations.

    "As Vanderbilt is aware, many surgeons' routine practice is to simultaneously schedule multiple surgeries in multiple locations throughout the day," the lawsuit says. It continues to say that in the case of anesthesia services, for instance, Vanderbilt practically never complied with the steps to adequately classify its services as "medically directed," yet reported them as such.
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    About Not_A_Hat_Person, RN

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  3. by   xoemmylouox
    My My.. I wonder what else will come out. Sounds like they were greedy for some time now.
  4. by   HouTx
    Hmm - just read the article. It looks like a Qui Tam (whistleblower) claim that was made in 2011 & has been 'under investigation' since that time. According to the information in that article, appears that there was a complex, multi-year effort to falsify anesthesia records in order to maximize revenues. If this is so, I wonder why the individuals have not yet been indicted?

    At any rate, this is another 'ding' on electronic records that permit remote access so it looks as though the clinician is "in the room" when s/he is not. That's a defect that needs to be fixed for EHR systems used for interventional procedures.