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Speaker 1: This is Bloomberg Law with June Grosso from Bloomberg Radio.

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Speaker 2: Imagine a patient who's anesthetized and intubated, and he goes

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Speaker 2: into the operating room, and he's met with his surgeon,

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Speaker 2: and he has confidence in that surgeon. He believes that

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Speaker 2: he or she is going to be the person who

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Speaker 2: is going to take them through the procedure and be

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Speaker 2: there in the recovery room and give them, hopefully the

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Speaker 2: good news that it went well. Unbeknownst to the patient,

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Speaker 2: that surgeon, as the book A Matthew might say, is

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Speaker 2: serving two masters or maybe three masters, and the surgeon

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Speaker 2: might be involved in multiple surgeries at the same time.

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Speaker 2: And so while that patient is unconscious, intubated, obviously anesthetized,

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Speaker 2: he or she may be operated on by a fellow

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Speaker 2: or a resident in someone substance, not the person entrusted

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Speaker 2: to do the surgery.

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Speaker 1: Doctors ghosting patients during surgeries, scheduling two or even three

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Speaker 1: operations at the same time, and leaving during critical portions.

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Speaker 1: It happens more than you may think, and it's been

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Speaker 1: going on for years. That's because double or even triple

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Speaker 1: billing Medicare can bring in hundreds of millions of dollars

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Speaker 1: to hospitals and cost taxpayers billions. Attorney Reuben Guppen represents

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Speaker 1: two doctors who blew the whistle on their fellow surgeons

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Speaker 1: and were then fired by the Erlinger Health System in Tennessee.

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Speaker 1: He compares the setup to Las Vegas.

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Speaker 2: The reason I have that Las Vegas analogy is you

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Speaker 2: have these hospitals and they make their money on the

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Speaker 2: room and the board and the tests and all the

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Speaker 2: ancillary services that go part and parcel with the surgery,

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Speaker 2: and they want to recruit doctors who can bring in patients,

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Speaker 2: that is into Las Vegas, bringing in patrons to the

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Speaker 2: gambling halls. And so what they do is they give

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Speaker 2: the doctors the round of the mill, allow them to

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Speaker 2: do whatever they want to make as much money as

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Speaker 2: they want, and they reward them by allowing them to

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Speaker 2: build for surgeries for which they were not allowed to

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Speaker 2: bill under the Medicare and Medicaid billing rules. And that's

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Speaker 2: why it's kind of akin to Las Vegas.

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Speaker 1: John Holland, senior investigative reporter for Bloomberg Law, has been

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Speaker 1: investigating these concurrent surgeries and he joins me, now, so, John,

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Speaker 1: you've reviewed more than a dozen federal and state lawsuits

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Speaker 1: over these ghost surgeries. How prevalent are they?

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Speaker 3: It's happening more than we thought. Basically, you go in,

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Speaker 3: you have a surgeon, you've met with him, You've talked

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Speaker 3: to him about what the procedure will be like. What

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Speaker 3: the surgeon isn't telling them, at least in these lawsuits,

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Speaker 3: is that I may not be there during large chunks

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Speaker 3: of the operations, and a lot of patients never know.

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Speaker 3: That's why you don't see too many malpractice claims connected

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Speaker 3: with these, because the patients just don't know that their

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Speaker 3: doctor didn't perform the surgery. Since the story ran, I

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Speaker 3: have gotten fifty or six the emails from doctors, hospital

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Speaker 3: administrator's residents saying that they've seen this problem firsthand, and

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Speaker 3: it's far wider than even these lossuits have talked about.

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Speaker 3: So I was a little surprised just how wide spread

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Speaker 3: it is.

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Speaker 1: Yeah, So just to be clear, are residents allowed to

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Speaker 1: operate when the surgeon is there supervising.

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Speaker 3: Yes, the residents cannot do what it's called critical portions

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Speaker 3: of a procedure. There is as one of the doctors

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Speaker 3: we talked to, there's nuance on that of how you

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Speaker 3: define critical, but in general, the residents should be opening

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Speaker 3: a patient, closing the patient, and doing some minor parts

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Speaker 3: of a procedure only if the surgeon is in the

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Speaker 3: operating room. He can't just walk away and turn over

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Speaker 3: the patient to a resident. And in this case, that

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Speaker 3: is what is happening.

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Speaker 1: And you found cases where doctors build for simultaneous surgeries

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Speaker 1: but at two different hospitals that were a.

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Speaker 3: Mile apart, and that's exactly what's happening. We saw in

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Speaker 3: the University of Southern California case where one of the

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Speaker 3: chief star surgeons booked five surgeries for the same morning

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Speaker 3: from eight am until two and wrote basically when he

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Speaker 3: submitted the bill that he was there for the entire

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Speaker 3: time of all five surgeries, even though they were in

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Speaker 3: different operating rooms and one was conducted at a hospital

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Speaker 3: more than a mile away. So obviously it was fraudulent.

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Speaker 3: There was not a lot of mystery from what we understand.

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Speaker 3: All sides are deep in settlement talks and the case

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Speaker 3: could be wrapped up later this month. I don't believe

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Speaker 3: USC will contest some of these cases. That remains to

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Speaker 3: be seen, but it looks like they're trying to settle.

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Speaker 1: Is this about violating Medicare rules or violating patients rights

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Speaker 1: or harming patients.

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Speaker 3: All of the above. In the beginning, I didn't expect

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Speaker 3: to see the harm. I thought this was going to

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Speaker 3: be more of a billing of fraud issue. But as

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Speaker 3: we started looking through these lawsuits and many others and

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Speaker 3: started talking to a lot different doctors, this is a

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Speaker 3: real issue, particularly since you're putting someone under anesthesia for

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Speaker 3: hours longer than they should be because you're bouncing from

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Speaker 3: operating room to operating rooms. In some cases, the residents

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Speaker 3: are finishing. In other cases, the residents are acting almost

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Speaker 3: as babysitters, waiting for the lead surgeon to come back,

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Speaker 3: and that could be many hours, and that puts patients

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Speaker 3: in nager. One of the studies that we cited looked

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Speaker 3: at hip surgeries a year out and they found it

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Speaker 3: without any question, the adverse outcomes went up exponentially the

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Speaker 3: longer someone was under anesthesia, and that was directly tied

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Speaker 3: to doctors not performing one surgery and then moving on.

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Speaker 3: So it's a little both.

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Speaker 1: If these claims are being filed, five claims wants different hospitals,

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Speaker 1: why isn't Medicare catching that.

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Speaker 3: That is the biggest question I have and that we

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Speaker 3: are following up very hard on that now to see

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Speaker 3: why does it take doctors coming forward to essentially expose

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Speaker 3: their own institutions. Why is medicare not catching these very

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Speaker 3: blatant billion practices. We didn't get into the subtle ones

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Speaker 3: the story. I took the ones that, after spending months

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Speaker 3: on this, were as open and shut as we could

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Speaker 3: possibly find. It's hard to believe that Medicare would be

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Speaker 3: showing out hundreds of millions of dollars without somebody saying, hey,

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Speaker 3: there's a problem here. And so that is the thing

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Speaker 3: I'm working on right now to see if we can

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Speaker 3: nail down what is going on and why did nobody

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Speaker 3: catch this?

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Speaker 1: Are we talking hundreds of millions of dollars? Billions when

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Speaker 1: you consider all.

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Speaker 3: These When you look at this, it's in the billions.

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Speaker 3: The government alleged in the Pittsburgh case that it was

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Speaker 3: thousands of surgeries done by particular doctor, doctor Luke Dich.

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Speaker 3: Southern California attorneys are claiming that this is several hundred

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Speaker 3: million at that one institution alone, and Ellinger Hospitally in

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Speaker 3: Chattanooga Tennessee. They are alleging minimum of eighty five one

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Speaker 3: hundred incarnoral overlapping surgeries. So again, that would get into

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Speaker 3: the tens of millions of dollars worth of billings. It

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Speaker 3: is staggering the amount of money that we're talking and

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Speaker 3: it's equally staggering that nobody caught it. And so that's

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Speaker 3: what we're trying to figure out. The next step is

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Speaker 3: what is going on here in terms of the payment.

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Speaker 3: The first focused on the patients and the practices and

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Speaker 3: the deception, but the bigger question for the next round

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Speaker 3: is why did nobody catch this?

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Speaker 1: So there are a lot of people in an operating room,

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Speaker 1: I'm shocked that a lot of those people haven't talked

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Speaker 1: about this, complained about this, reported this.

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Speaker 3: Apparently they have. There've been a lot of internal complaints

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Speaker 3: at Hospital twenty fifteen in the Boston Globe did a

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Speaker 3: great theories on this. This spotlight team looking at just

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Speaker 3: one hospital, Mass General, and they talked to a star

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Speaker 3: surgeon named Dennis Burke, and they talked to their top anesthesiologist,

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Speaker 3: Lisa Bahman, who went on the record of the problems

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Speaker 3: they were seeing. But it wasn't enough to get the

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Speaker 3: hospital to stop what it was doing. It was only

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Speaker 3: after lawsuits came that the hospital changed its ways a bit,

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Speaker 3: but that was rare and the hospital. The medical profession

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Speaker 3: is very tight lipped and they do not speak up

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Speaker 3: against each other. Is very tough to even get a

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Speaker 3: doctor to testify a trial against another doctor in malpractice cases.

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Speaker 3: So it doesn't surprise me just because of the nature

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Speaker 3: of the profession. You risk losing your career. So it's

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Speaker 3: sometimes you may be outrage, you may complain internally, but

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Speaker 3: then you throw your hands in the air and say,

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Speaker 3: what can I do about this? And that is based

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Speaker 3: on all of the doctors I talked to and all

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Speaker 3: the attorneys. That is the biggest problem. People are afraid

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Speaker 3: to come forward because the hospital can crush them.

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Speaker 1: And Reuben Gutman told me that two clients who were

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Speaker 1: nationally recognized orthopedic surgeons were crushed after they reported concurrent

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Speaker 1: surgeries on the hospital's internal system.

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Speaker 2: So our clients made a report to the hospital, the

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Speaker 2: document their concerns, which they had been articulating for a

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Speaker 2: period of time, and then within forty eight hours is

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Speaker 2: our complaint alleges their services at the hospital will terminate.

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Speaker 2: It's been almost impossible for them to get a position

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Speaker 2: in the United States, and two of them are now

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Speaker 2: in Scotland. These are folks of national reputation. They are

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Speaker 2: probably some of the leading surgeons in the country and

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Speaker 2: what Erlanger has done to them made it impossible for

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Speaker 2: them to get jobs and es centrally tried to destroy

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Speaker 2: their careers. But you know, as a lawyer, believes that

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Speaker 2: at the end of the day, when the full story

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Speaker 2: comes out as it has been, these folks are our

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Speaker 2: national heroes.

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Speaker 1: And in that case, the doctors say they filed the

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Speaker 1: report because hospital administrators suggested they do so, and then

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Speaker 1: they got fired two days.

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Speaker 3: Later after being told by the administrators, we're going to

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Speaker 3: address this. Put it in writing so that we can

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Speaker 3: do something about it, and according to lawsuit, they did

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Speaker 3: do that. They were very respected surgeons. Both had taught

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Speaker 3: at the Mayo Clinic in Minnesota. One of them had

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Speaker 3: been born in Aerlanga and she wanted to go back

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Speaker 3: and be close to her family. Her husband was the

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Speaker 3: head of orthopedics. He was one of the best orthopedic

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Speaker 3: surgeons in the country, and within two years they were gone.

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Speaker 3: Talking to them, they said the practices were so much

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Speaker 3: worse than they had ever seen. They felt like they

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Speaker 3: didn't have a choice. They had to speak up. They

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Speaker 3: kept assuming that the hospital would fix it. They didn't

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Speaker 3: realize they were losing their jobs until it was too late.

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Speaker 3: They kept thinking, well, expose it, will write the ship

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Speaker 3: and we'll come up with new policies, and instead they

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Speaker 3: kept the policy and fired the surgeon.

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Speaker 1: Explain why these respected doctors are now practicing in Scotland

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Speaker 1: because they couldn't get a job in the US after reporting.

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Speaker 3: This, because in the beginning they couldn't explain these sealed lawsuits,

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Speaker 3: so they couldn't even say why they left the hospital

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Speaker 3: or that they had these going. They suddenly were no

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Speaker 3: longer at the hospital. They were fired and they couldn't

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Speaker 3: get a good reference. But every about their case was sealed.

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Speaker 3: They couldn't even say I followed the lawsuits or describe

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Speaker 3: any of the reasons for them leaving. So suddenly you're

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Speaker 3: unemployed and you can't explain why, and the hospital's refusing

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Speaker 3: to give you a recommendation. It stay on the seal

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Speaker 3: for years. That was just unsealed in March. That's why

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Speaker 3: I found it. And the other one was unsealed about

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Speaker 3: a year ago the USC case, so it takes a

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Speaker 3: lot to come forward, least so woman quit before she

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Speaker 3: was fired, which made her life a little easier, but

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Speaker 3: trying to explain why I walked out of Mass General

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Speaker 3: without being able to provide the details, she sort of

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Speaker 3: ruined her career for about a year.

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Speaker 1: I think the scariest part of your article is this.

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Speaker 1: Some of Erlanger's residents were so unskilled that the hospital's

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Speaker 1: own doctors said in secretly recorded conversations they were concerned

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Speaker 1: about leaving them alone in operating rooms. And according to

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Speaker 1: the lawsuit, an orthopede is told a colleague Resident III

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Speaker 1: is scarier. He's got this spasmodic index finger. You know,

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Speaker 1: he makes an incision and it's just, oh my god, stop.

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Speaker 1: I mean, that's just astonishing.

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Speaker 3: It was stunning to me. And this is the type

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Speaker 3: of thing. Is a report you wouldn't include in a

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Speaker 3: story very od because I don't trust it. In this case,

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Speaker 3: they were fully recorded. These conversations were recorded that were

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Speaker 3: transcripts filed with the court. This happened so during my

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Speaker 3: fact check and once I started talking to the attorneys,

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Speaker 3: I realized these were serious attorneys that are not going

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Speaker 3: to put that in a filing, and then they had

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Speaker 3: transcripts and tapes, So this is a whole different level

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Speaker 3: than I have ever come across. Clearly, they are problems

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Speaker 3: with those residents that they're turning patients.

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Speaker 1: Over to Erlanger told you in a statement that it

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Speaker 1: strongly denies the claims and looks forward to the truth

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Speaker 1: coming out during the court proceedings. I'm wondering if the

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Speaker 1: truth about residents performing surgeries ever comes out in personal

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Speaker 1: injury lawsuits, or whether it's too hard to find out

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Speaker 1: if a resident did perform the surgery.

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Speaker 3: It's very difficult to tell, especially since when you are harmed,

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Speaker 3: you may never know that there was a resident doing

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Speaker 3: any portion of your surgery. That is not something that

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Speaker 3: comes out, and most attorneys, you know so little about

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Speaker 3: this practice that they never even wind up looking for

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Speaker 3: in discovery. It's basically been a well held secret by

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Speaker 3: the medical profession, and well it comes out once in

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Speaker 3: a while, like the Boston Globe series a decade ago.

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Speaker 3: For the most part, hospitals do a good job of

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Speaker 3: keeping this down and keeping this quiet, and I think,

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Speaker 3: judging by the response I'm getting that's going to change.

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Speaker 3: I don't think there's much doubt. Doctors and surgeons around

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Speaker 3: the country, and professors at medical schools all been reaching

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Speaker 3: out to me.

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Speaker 1: Do we assume that the administrators of these hospitals know

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Speaker 1: what's going on because they're handling the billings, Yes.

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Speaker 3: They would have doing. They're also strong federal law on

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Speaker 3: paying kickbacks to doctors to pay them for referrals because

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Speaker 3: they can be conflict of interest where they would basically

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Speaker 3: prescribing a surgeries. In this case, the administrators were paying

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Speaker 3: these huge sums to doctors. Who was a doctor Somadi

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Speaker 3: out of Lenox Hill Hospital in New York. He made

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Speaker 3: five million dollars in one year according to federal prosecutors,

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Speaker 3: and that was in large part because of been proper kickbacks.

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Speaker 3: Doctor Luketicch made millions of dollars according to federal prosecutors.

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Speaker 3: That was again improper payments that were in violation of

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Speaker 3: federal anti kickback statutes. So it can't happen if the

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Speaker 3: administrators don't know about it. They just wouldn't because nobody

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Speaker 3: could pay them.

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Speaker 1: Are the lawsuits we're talking about all false claim lawsuits.

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Speaker 3: For the most part, Doctor Burke was a wrongful termination.

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Speaker 3: He was the mass general doctor. But all of the

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Speaker 3: others that I mentioned in the story were false claims cases.

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Speaker 3: I looked at maybe a dozen others that were a

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Speaker 3: combination of false claims and employment law. But for the

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Speaker 3: most part, these are doctors coming forward and finally on

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Speaker 3: behalf of the government.

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Speaker 1: Explain a little more for those who don't know the

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Speaker 1: mysterious world of fault claimed lawsuits.

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Speaker 3: I am learning on the fly, But essentially in this

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Speaker 3: you see it with defense contracting quite a bit. If

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Speaker 3: someone is being paid by the federal government and they

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Speaker 3: commit fraud on the federal government, anyone who learns about

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Speaker 3: it and can expose that fraud is entitled to file

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Speaker 3: a lawsuit as long as they can prove the allegation

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Speaker 3: on behalf of the Justice Department. It remains under seal,

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Speaker 3: often for many years while the Justice Department investigates, and

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Speaker 3: then the Justice Department has a choice of joining the lawsuit,

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Speaker 3: or often if they see it's going well, they just

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Speaker 3: step out of the way and they let the attorneys

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Speaker 3: in the plaintiff continue their lawsuit, and then when there's

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Speaker 3: a settlement, the Justice Department steps in and signs off

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Speaker 3: on that settlement and gets all of the money. So

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Speaker 3: if there's a settlement for one hundred million, it goes

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Speaker 3: to the government to taxpayers, and then the whistleblower will

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Speaker 3: get thirty percent of whatever the settlement is, but all

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Speaker 3: of the money is filed in good to the US

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Speaker 3: government and the whistleblower gets paid on the back end.

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Speaker 1: If it's a false claims, are there any provisions then

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Speaker 1: for things to be corrected at the hospital so it

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Speaker 1: doesn't happen again.

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Speaker 3: That is usually as part of the settlement, and we

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Speaker 3: saw this in Pittsburgh. The government said that it was

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Speaker 3: going to be auditing some of the surgeons practices. They

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Speaker 3: were going to be monitoring them for three years. That's

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Speaker 3: a little unusual just because that was one that the

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Speaker 3: Justice Department took over from the initial attorneys. For the

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Speaker 3: most part, if there's just the settlement, there aren't a

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Speaker 3: lot of restrictions placed on the hospital. Lisa Wollman, the

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Speaker 3: anesthesiologist of Mass General. As part of her settlement, she

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Speaker 3: insisted that the hospital change its consent form so the

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Speaker 3: patients would know one hundred percent who was going to

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Speaker 3: be doing their surgery. So that was just her tenacity

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Speaker 3: winning out on that issue, but for the most part,

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Speaker 3: unless the government handles it directly, they weren't a lot

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Speaker 3: of sanctions put in at the end.

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Speaker 1: You also reported about the University of Southern California's hospital

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Speaker 1: system being accused of billing for thousands of cases where

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Speaker 1: the teaching physician left residents unattended to perform even spine

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Speaker 1: and brain.

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Speaker 3: Surgeries, and this kind of goes to the heart the

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Speaker 3: allegations at the usse that they were different outcomes at

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Speaker 3: their different hospitals, where in one of the hospitals in

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Speaker 3: the system, patients were more than twice as likely to

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Speaker 3: be injured or harmed during surgery according to the laws,

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Speaker 3: and it's mentioned several times in the lawsuits. The attorney

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Speaker 3: and the surgeon who brought the lawsuit alleged that one

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Speaker 3: of the administrators said, that's where we send residents to

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Speaker 3: practice on poor folks. So, if the lawsuit is correct,

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Speaker 3: and it seems to be in the final stage of the settlement,

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Speaker 3: the hospital knew that it was putting patients in one

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Speaker 3: of their institutions in harm, but they were doing it

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Speaker 3: so that they could have residents practicing their work. That

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Speaker 3: was pretty stunning.

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Speaker 1: I found so much in your story, stunning, John, and

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Speaker 1: I hope you'll come back with the next part of

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Speaker 1: your investigation. Thanks so much. That's John Holland, senior investigative

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Speaker 1: reporter for Bloomberg Law. And that's it for this edition

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