Teaching Hospital Settles False Claims Case

DALLAS (CN) - The University of Texas Southwestern Medical Center at Dallas will pay the federal and state governments $1.4 million to settle allegations that it and Parkland Health & Hospital System violated the False Claims Act and Texas Medicaid Fraud Prevention Act.

"Medicare should get what it pays for. If you submit a claim for supervising a resident you should actually be present supervising that resident, particularly when that resident is performing surgery," said Mike Fields, special agent in charge of the Dallas office of the U.S. Department of Health and Human Services Office of Inspector General.

Prosecutors say the hospitals fraudulently "upcoded" Medicare and Medicaid claims for teaching-physician-related items and services between 2004 and 2007; that several claims falsely represented that UTSW's teaching physicians properly supervised surgical residents at Parkland, though in some cases, there was no documentation that physicians were present for the critical portion of the resident's surgical care.

The medical center's president said in a statement: "To avoid ongoing litigation expenses and prevent further distraction from our mission, UT Southwestern has agreed to pay to the government $1.4 million to settle this matter in its entirety with all involved. This amount represents a small fraction of the projected legal expense and consumption of internal time and resources if we continued to argue this matter," according to Dr. Daniel Podolsky, UT Southwestern Medical Center president.

State and federal authorities began investigating in response to a June 2007 whistleblower suit brought by Dr. Larry M. Gentilello, former chairman of the Burns, Trauma, and Critical Care Division at UTSW Medical Center at Dallas.

Gentilello may receive up to 25 percent of the recovery under the settlement.

Prosecutors say the defendants cooperated with the investigation, and did not admit any wrongdoing or liability.

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