Specifically, the lawsuit alleged MCW submitted false claims to the Medicare and TRICARE programs for neurosurgeries from April 2006 through March 2013.
When a resident assists in performing a surgery, “Medicare will pay for a teaching physician’s services only if he was present for the surgery’s key parts and either remained immediately available throughout the surgery or else arranged for a back-up surgeon to be available,” according to the DOJ. The lawsuit alleged MCW did not satisfy the supervision requirements and “billed for teaching physicians’ services even though they were responsible for multiple overlapping surgeries,” according to the DOJ.
The lawsuit was originally filed under the qui tam, or whistle-blower, provisions of the False Claims Act.
Although MCW has agreed to this settlement, there has been no admission of wrong doing in this case.
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