A federal judge in the Southern District of Texas has dismissed a summary judgment alleging millions of dollars of fraud from Cornerstone Regional Hospital in Edinburg, Texas, and orthopedic surgeon in residence Raul Marquez, MD, according to a Dec. 11 report from Law.com.
The practice and Dr. Marquez were sued by a medical devices salesman who alleged Dr. Marquez arranged for unlicensed physicians from Mexico to practice in the U.S. and perform surgical and other procedures on patients.
Dr. Marquez was accused of submitting hundreds of false certifications and claims to federal and state agencies, as well as payment requests to Medicare, Medicaid and TriCare for these services.
Dr. Marquez denied all allegations that he violated the Federal False Claims Act and the Texas Medicaid Fraud Prevention Act.
Cornerstone also denied any and all wrongdoing.
Relator Mark Masso alleged that unlicensed practitioners were performing operations in Cornerstone operating rooms. The claims came from actions he witnessed as a sales representative for Smith+Nephew.
Mr. Masso claimed would join Dr. Marquez in the operating room to open medical-device packaging and answer questions about their use.
Mr. Masso alleged that, starting in 2016, Dr. Marquez allowed foreign physicians to perform orthopedic procedures.
Dr. Marquez claims, as is supported by hospital records, that he was inviting Mexican medical professionals into the room to observe and question his surgical procedures within the context of an educational fellowship program.
The judge in Texas found Mr. Masso's lawsuit insufficient. For his case, he presented operating room logs for 14 surgeries showing unlicensed individuals in the OR, featuring photos taken by Mr. Masso showing those individuals holding surgical devices over patients.
He also submitted bills to the government listing only Dr. Marquez as the operating surgeon.
The judge determined that the evidence failed to prove fraud, noting that in each operation Dr. Marquez was in the room "before or at the 'cut time,' which is when the surgical procedure actually begins," according to court documents.
Dr. Marquez testified that while he allowed unlicensed individuals to touch bone to get the fine points of how to do the surgery, they were not actually doing surgery.
"Marquez testified that he would allow the unlicensed individuals to conduct the 'mapping' of the patient pre-surgery but would then 'erase' those marks and 'do it himself,'" the judge's order noted.
Mr. Masso was asked to name an instance, procedure of date where he witnessed an unlicensed physician placing an implant.
"I can't recall a specific day" because "it just happened all the time," Mr. Masso alleged.