Chattanooga, Tenn.-based Erlanger Health System is pushing back against False Claims Act allegations, arguing that alleged overlapping surgeries are allowed in some circumstances under Medicare.
Two former orthopedic surgeons with Erlanger, Julie Adams, MD, and Scott Steinmann, MD, filed a lawsuit against the health system in April 2021 in the U.S. District Court for the Eastern District of Tennessee. They, along with former CIO Stephen Adams, MD, alleged that hospital leaders knew overlapping surgeries were happening and allowed trainees to operate on patients without physician supervision. Erlanger then billed for two or three surgeries taking place in the same time frame.
Medicare and Tennessee's Medicaid program, TennCare, require a supervising physician to be present for each surgery to receive federal payment.
However, in a memorandum filed June 8, Erlanger argued that Medicare rules do allow overlapping surgeries and only prohibit cases when the "key and critical" portions cross over. The memorandum said the whistleblower suit didn't provide any necessary details that could "support a viable FCA claim."
Erlanger also pushed back at allegations that it retaliated against the suing physicians for expressing concerns because the complaints were related to patient safety, not protecting against fraud.