Two Chattanooga, Tennessee-based orthopedic surgeons and a former chief information officer have filed a whistleblower lawsuit against Erlanger Health System and other defendants alleging violations of federal laws.
The lawsuit lists the following as defendants: Chattanooga-Hamilton County Hospital Authority (doing business as Erlanger Medical Center and Erlanger Health System); UT-Erlanger Medical Group, Inc.; The Plastic Surgery Group; University Surgical Associates, P.C.; and Anesthesiology Consultants Exchange, P.C.
The relators (the plaintiffs) brought the lawsuit under the federal False Claims Act and the Tennessee Medicaid False Claims Act. In the complaint, the relators assert that the Centers for Medicare & Medicaid Services (CMS) provides that “a teaching physician must be present for the critical or key elements of each surgery.” Additionally, the relators claim that CMS will only pay for surgeries involving residents if “a teaching physician is present during the key portion of [the] service or procedure.”
In the complaint, the relators allege that the defendants have “allowed surgeons to operate on as many as three patients at the very same time, leaving residents and interns alone with anesthetized patients without appropriate medical back-up or supervision.” The relators claim that “surgeries were often scheduled to start within fifteen to thirty minutes of one another and, in the case of three overlapping bookings, two or more surgeries frequently occurred entirely within the duration of a third.”
Additionally, the relators also assert that the defendants “violated the False Claims Act by allowing unqualified and unsupervised staff members to impersonate physicians and then perform tasks like generating and signing prescriptions, including for controlled substances, and signing orders for imaging studies and surgeries—all of which must be performed by a physician under Medicare and Medicaid rules.”
The relators claim they were “punished” for bringing their complaints about the alleged violations. They assert that they ultimately lost their jobs and academic positions for bringing their concerns about “patient safety and compliance.”
The whistleblower provisions of the False Claims Act allow private individuals to file a lawsuit on behalf of the government for false claims. If the government intervenes in the lawsuit and the lawsuit is successfully settled or the government prevails at trial, the whistleblower is entitled to a share of the recovery. If the government declines to intervene, the relators (whistleblowers) can proceed on their own.
The United States of America and the State of Tennessee have requested extensions of time to notify the court of whether or not they will elect to intervene. According to court documents, the United States of America and the State of Tennessee had until April 10, 2023, to decide whether to intervene in the action.
