Medicare Compliance & Reimbursement

Yet another case has come to light that highlights the close link between compliance and quality of care. The Department of Justice (DOJ) has alleged in a false claims lawsuit that Satilla Regional Medical Center in Waycross, Ga., and surgeon Najam Azmat, M.D., billed Medicare and Medicaid for services which he was not only not competent enough to perform, but services which were unnecessary. These services, the feds allege, have resulted in one dead and many others injured.

The fight is not over yet though. In a post on www.aishealth.com, Nina Youngstrom, managing editor, www.aispub.com reports that the hospital denies these allegations and has said that it will defend the lawsuit.

The lawsuit, Youngstrom reports, was filed by whistleblower Lana Rogers, a former nurse in Satilla's Heart Center cardiac cath lab, after which DOJ announced it would take over the case April 5. Satilla is accused of allowing Azmat to perform endovascular procedures in the cath lab "even though he lacked experience in performing such procedures and did not have privileges to perform them," DOJ states. Nurses expressed concerns to hospital management that Azmat, who had a high complication rate, was incompetent, DOJ alleges in its press release. But Satilla let the procedures continue, along with the claims submissions, DOJ further alleges.

The lawsuit states that Azmat's record at his previous place of work -- Hardin Memorial Hospital in Kentucky -- did not speak well for him and Satilla was aware of that. In 23 percent of Azmat's cases at Hardin, "an intraoperative complication and/or postoperative complication had occurred," the complaint states. As a result, the medical executive committee at Hardin had requested a second opinion before all of Azmat's elective procedures and required a physician to assist Azmat whenever he performed major surgery.

These restrictions -- which Azmat accepted -- "were reported as an adverse action report to the National Practitioner Data Bank," the lawsuit contends. "Satilla obtained and reviewed" the adverse action report on Azmat but granted him general surgery, thoracic surgery and vascular surgery privileges on Aug. 8, 2005. Satilla also allowed him to perform interventional angiography/arteriography procedures, including invasive peripheral intervention procedures in its Heart Center cath lab, the lawsuit alleges.

The DOJ alleges Azmat performed procedures in Satilla's Heart Center that he wasn't qualified or credentialed to perform, and that Satilla and Azmat submitted claims for the procedures. "As a result, at least one patient died and others were seriously injured," the DOJ press release states.

(Editor's note: Read Nina Youngstrom's post at: www.aishealth.com/Bnow/hbd041610.html. Read the DOJ press release on Satilla at: www.justice.gov/opa/pr/2010/April/10-civ-332.html.)