Physician blows whistle on Dignity Health hospital system and neurosurgical group in surgeries by inexperienced medical students

An anesthesiologist and member of the medical staff at Dignity Health, d/b/a St. Joseph’s Hospital, brought a False Claims Act qui tam lawsuit against the hospital and Neurosurgical Associates, LTD, in which he alleged a bait-and-switch scheme whereby patients thought they were undergoing invasive and high-risk surgeries performed by highly regarded and experienced neurosurgeons. However, he alleged the surgeries were performed by inexperienced medical students with no oversight from their teachers.  The alleged scheme allowed the experienced surgeons to bill Medicare for multiple surgeries performed by others at the same time, at the higher rate that Medicare reimburses for the highly skilled surgeons.The settlement resolves a lawsuit filed in June 2018 by Dr. Bruce P. Kingsley under the qui tam, or whistleblower provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and
share in any recovery obtained.

The hospital and neurosurgical group paid $10 Million to the government for the alleged Medicare fraud described by the United States as billing Medicare “for certain doubly and triply concurrent and overlapping surgeries.”  For bringing the allegations to the attention of the government, the anesthesiologist was paid a whistleblower reward, although the Justice Department did not include the amount of the reward in its press release.  Typically, that reward would be between 15% to 25% of the $10 Million.