Highlight on Wisconsin: Medical College of Wisconsin Opens Checkbook to Resolve FCA Claims

The Medical College of Wisconsin, Inc. (MCW) paid the federal government $840,000 to settle allegations that the college violated the federal False Claims Act (FCA) (31 U.S. C. § 3729), according to an FBI press release.   The college was alleged to have unlawfully billed federal healthcare programs for the supervision time of neurosurgery residents’ teaching physicians who were, in fact, not present at the time of surgery.

Reimbursement

According to the FBI, Medicare will reimburse teaching hospitals for the time that teaching physicians spend in surgery with neurosurgery residents when the teaching physician is present for the key components of the surgery. Additionally, in order to receive reimbursement for their supervision, teaching physicians must either remain immediately available during the surgery or arrange for a backup teaching physician to be available in his or her absence.

Settlement

The nearly $1 million settlement arose out of allegations that MCW billed the Medicare and TRICARE programs for the time of supervising teaching physicians who were  supervising overlapping surgeries at the same time. In other words, the allegations claimed that the college billed in a manner that suggested its teaching physicians were in two places at once.  The settled claims were submitted between April 16, 2006, and March 31, 2013.According to a story in the Milwaukee Wisconsin Journal Sentinel, the lawsuit was brought by a surgeon in residency at MCW under the qui tam provision of the FCA and the settlement will entitle the resident to a portion of the recovery. According to a release from PRWeb, the United States Attorney’s Office for the Eastern District of Wisconsin intervened in the lawsuit.

Response

According to a report from the Milwaukee Business Journal, a spokeswoman for MCW, Maureen Mack, indicated that patient safety was not a concern in the allegations and MCW cooperated with the authorities throughout the investigation. Specifically, Mack said “the federal government’s focus on this matter was on compliance with Medicare regulations regarding requirements for surgical schedules and billing.” MCW denied the allegations. Mack also indicated that MCW took steps to ensure that the college remains compliant with federal health care program billing requirements in the future.