Erlanger Health System and one of its service providers, University Surgical Associates, have asked a federal judge to rule in their favor in a whistleblower lawsuit that alleges illegal billing practices for overlapping surgeries.
The hospital’s former chief information officer, Stephen Adams, and orthopedic surgeons Julie Adams and Scott Steinmann brought the complaint against Erlanger in April 2021 under the False Claims Act and Tennessee Medicaid False Claims Act.
Even if a resident performs an entire surgery, government insurance will still foot the bill as long as a teaching physician was present during all of the critical portions of the procedure.
But physicians have been accused of billing insurance providers such as Medicare and Medicaid for operations in which interns and residents complete surgeries without that oversight or patient consent, according to the complaint.
In separate Jan. 13 motions for summary judgment, University Surgical Associates and Erlanger argued there is no evidence that proves Erlanger’s teaching physicians were not present during critical portions of surgeries as required.