Vasc. Surgeon filed Federal lawsuit for fraudulent billing due to computer/phone use in OR

[kidthor]

what does antitrust have to do with this?

You cited “restraint of trade” which is an antitrust claim in this context.

And sure they can sue for for something or other but I don’t see any viable claim against an anesthesiologist or group who won’t work with a dangerous, difficult, or litigious surgeon.

You can’t be forced to do anything, ever.

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[caligas]

You cited “restraint of trade” which is an antitrust claim.

And sure they can sue for for something or other but I don’t see any viable claim against an anesthesiologist or group who won’t work with a dangerous, difficult, or litigious surgeon.

You can’t be forced to do anything, ever.

Fair enough. Obviously, I’m not an attorney I just know restraint of trade was what the surgeons attorney quoted when threatening our group who was refusing to work with a dangerous surgeon. Fortunately, that situation worked itself out at the medical staff level.

I don’t think we are really disagreeing. I just know from experience that it’s often not that difficult to find an attorney to make the anesthesia groups life miserable.

 

[Dr. Rude]

You cited “restraint of trade” which is an antitrust claim in this context.

And sure they can sue for for something or other but I don’t see any viable claim against an anesthesiologist or group who won’t work with a dangerous, difficult, or litigious surgeon.

You can’t be forced to do anything, ever.

You could be in breech of your agreement with the hospital and be risking termination for cause of the group contract.

 

[nimbus]

Hypothetically if I were a baker, would I need to bake a wedding cake for this clown? I don’t agree with his values.

 

[Maz777]

Agree!!

But you CAN be sued by a surgeon if your entire group boycotts him especially if he has a clean clinical record.

The dude has already done a dang good job of documenting his perioperative complications for the whole world to see. I imagine it would get very tricky with non-elective cases though.

 

[kidthor]

You could be in breech of your agreement with the hospital and be risking termination for cause of the group contract.

Also you can adequately defend yourself via various legal and medical staff means for exposing you and the public to a negligent unsafe surgeon.

Again, no one can force you to do anything.

 

[Dr. Rude]

Also you can adequately defend yourself via various legal and medical staff means for exposing you and the public to a negligent unsafe surgeon.

Again, no one can force you to do anything.

You can’t be forced to do anything, but there may very well be consequences for declining to meet your obligations.

 

[kidthor]

You can’t be forced to do anything, but there may very well be consequences for declining to meet your obligations.

Certainly. But you aren’t obligated to put up with toxicity or do things that are unsafe either.

I think a great part of this on-fire employment market is that physicians realize they can just walk away from a toxic situation and get a decent job tomorrow. Plus hospitals know this too.

 

[coffeebythelake]

what does antitrust have to do with this?

Restraint of trade is very much in that realm.

 

[Beeftenderloin]

You could be in breech of your agreement with the hospital and be risking termination for cause of the group contract.

If a strong, united anesthesia group says across the board they won’t work with a particular surgeon, that surgeon will get canned (politely told by admin that their contract won’t be renewed). It only gets messy if the anesthesia group is weak, disjointed, and not well respected.

 

[GassYous]

Fair enough. Obviously, I’m not an attorney I just know restraint of trade was what the surgeons attorney quoted when threatening our group who was refusing to work with a dangerous surgeon. Fortunately, that situation worked itself out at the medical staff level.

I don’t think we are really disagreeing. I just know from experience that it’s often not that difficult to find an attorney to make the anesthesia groups life miserable.

Plenty of groups drop coverage for surgeons and centers all the time

 

[caligas]

Hypothetically if I were a baker, would I need to bake a wedding cake for this clown? I don’t agree with his values.

Actually this is a good point, could recent SCOTUS decision give us more freedom to refuse to work with certain people?

 

[rowsdower88]

Hypothetically if I were a baker, would I need to bake a wedding cake for this clown? I don’t agree with his values.

Depends... does anyone know what Neil Gorsuch would think the Framers would have thought about the etiquette of a profession that hadn't been invented yet?

 

[coffeebythelake]

Hypothetically if I were a baker, would I need to bake a wedding cake for this clown? I don’t agree with his values.

Most places allow you to refuse service to anyone. Before SCOTUS it wasn't allowed for certain protected reasons. Now... seems like anything is ok

 

[Lecithin5]

I should report all the surgeons who regularly use their phones during davinci operations…

 

[Dr. Rude]

I should report all the surgeons who regularly use their phones during davinci operations…

They don’t bill time units.

 

[nimbus]

They don’t bill time units.

Time units is based on
our physical presence for the duration of surgery. I don’t know that there is a rule that specifies a minimum proportion of attention.

 

[repititionition]

They don’t bill time units.

Is the implication that use of PEDs somehow prolongs the surgical/anesthesia time?

 

[Dr. Rude]

Is the implication that use of PEDs somehow prolongs the surgical/anesthesia time?

No, the plaintiff’s accusation is that time that they were billing for anesthesia care they were devoting attention to other matters and thus “defrauding” the government.

Extending your logic, If the anesthesiologist fell asleep for part of the procedure but they were still physically present and should therefore be reimbursed fully. Same if If they were impaired.

Might technically meet the requirements for billing. Does breaching the standard of care in this way constitute billing fraud? That is the whole point of this suit. Somebody is spending some dough and risking their career on this bet.

 

[coffeebythelake]

Time units is based on
our physical presence for the duration of surgery. I don’t know that there is a rule that specifies a minimum proportion of attention.

Medicare doesn't specify a time. neither does ASA. the ASA standards describe frequent and continual monitoring of patient, which is up for interpretation exactly what that means. the blood pressure cuff for instance is typically set to between 2.5-5 minutes.

 

[Beeftenderloin]

No, the plaintiff’s accusation is that time that they were billing for anesthesia care they were devoting attention to other matters and thus “defrauding” the government.

Extending your logic, If the anesthesiologist fell asleep for part of the procedure but they were still physically present and should therefore be reimbursed fully. Same if If they were impaired.

Might technically meet the requirements for billing. Does breaching the standard of care in this way constitute billing fraud? That is the whole point of this suit. Somebody is spending some dough and risking their career on this bet.

With variable pitch pulse ox, whether I’m reading, doing MOCA questions, or just doom scrolling on Reddit, I’m still monitoring the patient. Quick scan of everything else every so often along with appropriately programmed alarms and you are unequivocally meeting all the ASA requirements for monitoring, regardless of what your eyes are doing the rest of the time.

Sleeping is tougher to defend because you can’t hear alarms or pulse ox. Practicing while impaired is something we’ve all agreed as a physician community that we are okay with since 80+ hour work weeks and 24+ hour calls exist.

 

[Dr. Rude]

With variable pitch pulse ox, whether I’m reading, doing MOCA questions, or just doom scrolling on Reddit, I’m still monitoring the patient. Quick scan of everything else every so often along with appropriately programmed alarms and you are unequivocally meeting all the ASA requirements for monitoring, regardless of what your eyes are doing the rest of the time.

And a judge has decided that this is a question of fact for a jury.

Like I said earlier, this is the same system that freed O.J. And sent over 100 innocent people to death row.

Do you feel lucky?

 

[rowsdower88]

variable pitch pulse ox

The suit alleges one of the docs had headphones on while watching football. Might be getting close to impaired with that unless he was able to jerryrig some picture-in-picture for pt vitals, which would be a pretty slick innovation.

 

[Beeftenderloin]

The suit alleges one of the docs had headphones on while watching football. Might be getting close to impaired with that unless he was able to jerryrig some picture-in-picture for pt vitals, which would be a pretty slick innovation.

Anything that prevents you from being able to hear the pulse ox is pretty tough to defend. It’s gotta be clearly audible. Headphones are at the very least a bad look, if not unsafe, IMO.

 

[Maz777]

Anything that prevents you from being able to hear the pulse ox is pretty tough to defend. It’s gotta be clearly audible. Headphones are at the very least a bad look, if not unsafe, IMO.

Watching live TV or sports is not a good look. You are just asking for someone to write you up.

You'd also be nuts not to routinely use VPN if you are using the hospital wi-fi.

 

[PpfSuxTube]

Anything that prevents you from being able to hear the pulse ox is pretty tough to defend. It’s gotta be clearly audible. Headphones are at the very least a bad look, if not unsafe, IMO.

Agreed, you carry on like this you deserve to get ****ed

 

[PikminOC]

I’m all for using personal devices in the OR when things are stable and cruising.

But I’ve covered a few CRNAs that openly browse the web , shop, book flights etc on the large vent / machine 24” monitor, in full view of everyone. That’s what makes us look bad.

Reprimand them, but you’re being the dick of course , as “I’ve always done this , it’s fine “…

Just like with my front desk staff..smh

 

[C-Hawk]

Citizens For Responsible Care and Research
CIRCARE Citizens For Responsible Care and Research Home Page › kho...PDF
FDA Warning Letter to Michael Khoury, M.D. 2005-06-23

 

[Anesthesia_Guy]

View attachment 374141

https://health.usnews.com/doctors/michael-khoury-188183

Good luck doing your vascular cases on awake patients from now on.. douche!

Looks like an absolute tool.

 

[Dr. Rude]

Case won't die.

U.S. ex rel. Khoury v. Mountain W. Anesthesia, L.L.C. 2024 WL 1197712 (D. Utah 2024)

UNITED STATES of America and State of Nevada EX REL. Michael D. KHOURY, M.D., Plaintiffs, v. MOUNTAIN WEST ANESTHESIA, L.L.C.; David A. Debenham, M.D.; Eric A. Evans, M.D.; Joshua J. Larson, M.D.; ...

app.ediscoveryassistant.com

Summary
The court ordered the defendants to produce ESI related to surgeries in which they performed general anesthesia services, including a sampling of the content of communications on their personal electronic devices (PEDs). The defendants objected, citing confidentiality concerns, but the court found that the relevance of the content outweighed the privacy interests and ordered its production. The court also granted the relator's motion for leave to file an amended complaint, alleging that the defendants not only used PEDs during surgeries, but also left the operating room.

 

[makemoney2024]

You forget that our legal system freed OJ and has sent over 100 innocent people to death row.

Also

Settlement in Minnesota

THere will be no press conference scheduled (due to court order) BUT those who have been around awhile will know what I am talking about!!!! There has been a se...

allnurses.com

Michigan Doctors Must Pay Out in Anesthesiology Whistleblower Case

Two CRNAs will split a $120,000 reward after filing an anesthesiology whistleblower claim alleging that a Michigan anesthesiology group violated TEFRA and c

www.mahanyertl.com

Double-booked surgeries lead to $14.6 million settlement

BOSTON (AP) — Massachusetts General Hospital will pay $14.6 million to settle a lawsuit that alleged overbilling for double-booked surgeries that were simultaneously overseen by the same surgeon.

www.salemnews.com

Hospital, top surgeon to pay $8.5 mln in whistleblower suit over simultaneous surgeries

The University of Pittsburgh Medical Center and the head of its cardiothoracic surgery department have agreed to pay $8.5 million to settle claims that they fraudulently billed Medicare and Medicaid for complex surgeries.

www.reuters.com

Yes they are all different. But there is considerable risk in a trial.

All these to me seem legitimate. Unlike the one in the OP. There are a bunch of lazy anesthesiologists that give us a bad name.

 

[makemoney2024]

Case won't die.

U.S. ex rel. Khoury v. Mountain W. Anesthesia, L.L.C. 2024 WL 1197712 (D. Utah 2024)

UNITED STATES of America and State of Nevada EX REL. Michael D. KHOURY, M.D., Plaintiffs, v. MOUNTAIN WEST ANESTHESIA, L.L.C.; David A. Debenham, M.D.; Eric A. Evans, M.D.; Joshua J. Larson, M.D.; ...

app.ediscoveryassistant.com

Summary
The court ordered the defendants to produce ESI related to surgeries in which they performed general anesthesia services, including a sampling of the content of communications on their personal electronic devices (PEDs). The defendants objected, citing confidentiality concerns, but the court found that the relevance of the content outweighed the privacy interests and ordered its production. The court also granted the relator's motion for leave to file an amended complaint, alleging that the defendants not only used PEDs during surgeries, but also left the operating room.

So how do practices where doctors are doing their own cases and no extra staff available for breaks get to use the bathroom? For example in an 8 hour spine case? Or a long Vascular case?

 

[abolt18]

So how do practices where doctors are doing their own cases and no extra staff available for breaks get to use the bathroom? For example in an 8 hour spine case? Or a long Vascular case?

Recently discussed in another thread, but if stable, you ask the nurse to watch while you run out for a second (out and back before the blood pressure cuff cycles again), or you ask a colleague to come cover for you for a moment.

 

[nimbus]

So how do practices where doctors are doing their own cases and no extra staff available for breaks get to use the bathroom? For example in an 8 hour spine case? Or a long Vascular case?

During the day, someone is usually between cases and available to give a pee break. After hours and some weekends, don’t drink too much and pee before you start. We have many days where we inhale lounge snacks for lunch.

 

[DazedWanderer]

Recently discussed in another thread, but if stable, you ask the nurse to watch while you run out for a second (out and back before the blood pressure cuff cycles again), or you ask a colleague to come cover for you for a moment.

Leaving the room even for a moment while a patient is under anesthesia to use the bathroom is technically not allowed, though it's inhumane and unrealistic to expect a solo practitioner to not be able to legally use a bathroom for 8 hours straight, that doesn't seem to be taken into consideration at all. In any other job field an employer barring their employs from using the bathroom for a full 8 hour shift would be a human rights violation yet when they do it to an anesthesiologist it's called an average Tuesday. Hence why in the real world many groups where everyone is doing solo cases play fast and loose with the rules, because it's impossible to actually strictly abide by them depending on the nature of the cases in your room.

 

[makemoney2024]

During the day, someone is usually between cases and available to give a pee break. After hours and some weekends, don’t drink too much and pee before you start. We have many days where we inhale lounge snacks for lunch.

I can’t go 8 hours without having to urinate.

 

[nimbus]

I can’t go 8 hours without having to urinate.

Do I know you?

 

[Drwine]

You mean the airline pilot can eat food or have personal conversations with his co-pilot while simultaneously flying a jumbo jet? That is outrageous! He shouldn't be doing anything but staring at the instrument clusters for 7 hours straight and if he blinks there needs to be an incident report!

The Airbus pilot manual clearly spells out sterile cockpit rules and times when pilots can monitor at a lesser level. They are all business from pushback until they are in restricted vertical separation airspace with the autopilot engaged. Then the rules are relaxed until approach at the destination airport when they are again fully engaged. The litmus test in the OR is what a pilot and crew would be doing at any point in the flight.

Surgery and anesthesia are more like flying a plane as opposed to driving a car.

 

[narcotics999]

Leaving the room even for a moment while a patient is under anesthesia to use the bathroom is technically not allowed, though it's inhumane and unrealistic to expect a solo practitioner to not be able to legally use a bathroom for 8 hours straight, that doesn't seem to be taken into consideration at all. In any other job field an employer barring their employs from using the bathroom for a full 8 hour shift would be a human rights violation yet when they do it to an anesthesiologist it's called an average Tuesday. Hence why in the real world many groups where everyone is doing solo cases play fast and loose with the rules, because it's impossible to actually strictly abide by them depending on the nature of the cases in your room.

Interventional radiology, anesthesiologists leave the room all the time (Ct scans). This is the case for a major academic center.

Hiw about mri? You are pretty much outside, with a monitor that stops cycling bp frequently.

 

[Ashers]

The Airbus pilot manual clearly spells out sterile cockpit rules and times when pilots can monitor at a lesser level. They are all business from pushback until they are in restricted vertical separation airspace with the autopilot engaged. Then the rules are relaxed until approach at the destination airport when they are again fully engaged. The litmus test in the OR is what a pilot and crew would be doing at any point in the flight.

Surgery and anesthesia are more like flying a plane as opposed to driving a car.

I just sat next to a pilot deadheading who was deadheading back to his home airport. He was interesting to talk to. I learned a lot, and what he told me didn't surprise me. Like usually 1 person will sleep at a time on the overnight flights even though they aren't supposed to. Both aren't supposed to sleep at a time (like the recent flight that got caught sleeping). He also said he was overpaid because it was the easiest job he's ever had. He uses his skills 0.5% of the time in the plane. This was all after there was a call for a doctor for an emergency just as we pushed back from the gate, so we had an hour delay before getting to actually leave again.

 

[anbuitachi]

Leaving the room even for a moment while a patient is under anesthesia to use the bathroom is technically not allowed, though it's inhumane and unrealistic to expect a solo practitioner to not be able to legally use a bathroom for 8 hours straight, that doesn't seem to be taken into consideration at all. In any other job field an employer barring their employs from using the bathroom for a full 8 hour shift would be a human rights violation yet when they do it to an anesthesiologist it's called an average Tuesday. Hence why in the real world many groups where everyone is doing solo cases play fast and loose with the rules, because it's impossible to actually strictly abide by them depending on the nature of the cases in your room.

yea thats why people just pee into the trash can in the OR

 

[gunnershow]

None of you have to leave the room because of poor anesthesia tech support over the weekend? Our trauma room is 5ft from the anesthesia supply room, so I step out for 20 seconds to grab what I need (eg, fentanyl, micropuncture, etc).

Sure, I could ask the circulator, but they're usually a traveler who barely knows the surgical equipment, much less the anesthesia supplies.

 

[IIMC]

I just sat next to a pilot deadheading who was deadheading back to his home airport. He was interesting to talk to. I learned a lot, and what he told me didn't surprise me. Like usually 1 person will sleep at a time on the overnight flights even though they aren't supposed to. Both aren't supposed to sleep at a time (like the recent flight that got caught sleeping). He also said he was overpaid because it was the easiest job he's ever had. He uses his skills 0.5% of the time in the plane. This was all after there was a call for a doctor for an emergency just as we pushed back from the gate, so we had an hour delay before getting to actually leave again.

“Controlled rest” is when one pilot of a 2 pilot crew is permitted to take a short nap whilst at the controls. It is permitted in certain air spaces. I believe it is allowed in Europe. The FAA forbids it. The deadheading pilot who admitted to a stranger/passenger that he breaks FAA rules is a total douche.

 

[makemoney2024]

Recently discussed in another thread, but if stable, you ask the nurse to watch while you run out for a second (out and back before the blood pressure cuff cycles again), or you ask a colleague to come cover for you for a moment.

Do I know you?

I don’t know. Do you?

 

[caligas]

Case won't die.

U.S. ex rel. Khoury v. Mountain W. Anesthesia, L.L.C. 2024 WL 1197712 (D. Utah 2024)

UNITED STATES of America and State of Nevada EX REL. Michael D. KHOURY, M.D., Plaintiffs, v. MOUNTAIN WEST ANESTHESIA, L.L.C.; David A. Debenham, M.D.; Eric A. Evans, M.D.; Joshua J. Larson, M.D.; ...

app.ediscoveryassistant.com

Summary
The court ordered the defendants to produce ESI related to surgeries in which they performed general anesthesia services, including a sampling of the content of communications on their personal electronic devices (PEDs). The defendants objected, citing confidentiality concerns, but the court found that the relevance of the content outweighed the privacy interests and ordered its production. The court also granted the relator's motion for leave to file an amended complaint, alleging that the defendants not only used PEDs during surgeries, but also left the operating room.

Makes me wonder: where would this data come from? Would physicians have to turn in their phones? How might private browsing or VPN use effect this data?

 

[repititionition]

Makes me wonder: where would this data come from? Would physicians have to turn in their phones? How might private browsing or VPN use affect this data?

1) Phone or computer itself is meaningless unless you’re truly slow and don’t lose it in a fishing accident.

2) A VPN just hides your activity from your ISP, which, if connected to hospital Wi-Fi, is the hospital. A VPN obscures this as a source of evidence.

3) If you have cloud sync/icloud across devices, are logged in to a browser eg chrome, etc., your web activity is going to be essentially permanent via browser history if they can compel you to produce it.

A VPN is a reasonable thing to do, but you’re gonna get pinned for data use with or without it unless you’re meticulous with your use (VPN, only use private browsing, etc) and you have a prosecutor that’s not tech savvy.