Health System on the Hook for $22M Over Unnecessary Spine Surgeries

Providence Health and Services agreed to pay $22.7 million to settle allegations that two of its neurosurgeons oversaw federal health programs for medically unnecessary spine surgery in the largest health care fraud settlement in the Eastern District of Washington. Billed incorrectly. Department of Justice (DOJ),

health system, US federal government and Washington state jointly arrived Settlement Mary’s Medical Center in Walla Walla provided poor care and committed billing fraud from 2013 to 2018.

Providence, a large health system that has 51 hospitals in seven states, paid neurosurgeons based on productivity metrics, giving them a financial incentive to perform more surgeries of greater complexity, the DOJ alleged. According to the settlement agreement, from 2014 to 2017, one of the surgeons in question earned between $2.5 and $2.9 million per year based on this metric.

The health system acknowledged that during the time periods when spine surgeons were employed, other medical staff expressed concerns that they put patients at risk, performed surgery that resulted in complications, performed surgery on patients when they were not appropriate, and did not adequately document their procedures. ,

Providence also acknowledged that despite eventually placing both of these surgeons on administrative leave, it allowed both doctors to resign on leave, and required them to report any action to the National Physician Data Bank or the Washington State Department of Health. Didn’t.

“Ensuring that surgical procedures are medically appropriate and properly executed is critical to building safe and strong communities here in the Eastern District of Washington,” U.S. Attorney Vanessa Waldref said in a press release.

Waldref said, “Patients with back pain and spinal cord injury require top-notch care from a provider who puts the patient first and is not unreasonably influenced by how much he or she can bill for the procedure.” ” He said that despite repeated warnings, Providence’s failure to ensure that its physicians are performing safe and necessary procedures “puts patients’ lives and safety at grave risk.”

in a statement to medpages todayA spokesperson for Providence said the incidents in question have prompted an internal investigation into policies, practices and procedures to ensure the delivery of high-quality care.

“We are committed to taking specific, concrete action to ensure that this isolated incident does not recur in Vala Vala,” the spokesperson said. “Providence has robust existing protocols and safeguards in place to ensure that we provide quality care and makes continuous improvements that further enhance those protocols and safeguards.”

In January 2020, a whistleblower had filed Complaint Pointing out that two spine surgeons at Providence St. Mary’s Medical Center — Dan Elskens, MD, and Jason Dreyer, DO — provided substandard care from 2013 to 2018. Elskens and Dreyer were not named in the settlement agreement.

The whistleblower, also a neurosurgeon, had found that Elskens had made several surgical errors upon internal review, the complaint said, including conducting an incorrect spinal section requiring emergency curative surgery.

The whistleblower reportedly reported these concerns to Providence’s chief medical officer, recommending that Elskens be terminated. However, Providence rejected that initial recommendation. The whistleblower then found that the Elskens allegedly performed an additional surgery—nearly paralyzing the patient—before Providence placed the Elskens on suspension.

During this time, whistleblowers also began to review the work of Dreyer, who studied under the Elskens. His review found that Providence billed the federal government for procedures that Dreyer never did. In addition, he complained that Dreyer was “building up patient diagnosis and treatment to justify a complicated operation and increase reimbursement for both himself and Providence.”

The complaint states that some incidents caused the federal government to pay more than $150,000 for unnecessary and under-performing procedures. He alleged that the whistleblower reported these concerns before Providence suspended Dreyer in November 2017 and again in May 2018.

According to the complaint, both Elskens and Dreyer resigned during their suspensions. elscans’ medical license Banned in Washington and Michigan, but active in Indiana and Ohio. Dreyers medical license remains active in Washington and Michigan, and no action has been taken by state medical boards.

The whistleblower will receive approximately $4 million as a result of the agreement.

  • Amanda D’Ambrosio is a reporter on MedPage Today’s Enterprise and Investigation Team. She covers obstetrics-gynecology and other clinical news, and writes about the American healthcare system. Pursuance

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