The FBI is accusing a Chicago hospital of taking Medicare fraud and Medicaid
fraud to an appalling level. According to
FBI allegations about the Medicare and Medicaid fraud, secret tape recordings prove that doctors at Sacred Heart Hospital in
Chicago intentionally sedated patients so much during surgery that the
patients could not breathe on their own. The doctors then used the fact
that the patients were not breathing on their own to justify performing
lucrative tracheotomies on the patients. A doctor does a tracheotomy –
that is to say, cuts a hole into the patient’s throat, directly
into the windpipe – to open up a direct breathing passage for a
patient who otherwise cannot breathe on his or her own.
The Government made its allegations in a criminal complaint. To date no
False Claims Act case has been unsealed, so we do not know whether a whistleblower
filed a lawsuit and alerted the Government to what the doctors were doing.
If a whistleblower is the one who uncorked the bottle on this frightening
behavior, then a tip of the hat to him or her.
According to the astonishing allegations, Sacred Heart surgeons were not
performing tracheotomies to save lives; instead, they were using powerful
anesthesia drugs to keep patients from breathing on their own so that
the surgeons would have an excuse to perform tracheotomies. According
to the FBI affidavit, “the nurse manager stated that one of the
ICU nurses had advised her that Physician D had previously directed the
nurse to “snow the patient,” meaning that Individual A should
be heavily sedated to the point where the nurse could only see the whites
of Individual A’s eyes, thereby precluding the patient from being
weaned from the ventilator.”
But why? Why on earth would these doctors want to cut these patients’
throats when they had no medical reason to do so? According to the FBI,
the hospital and its doctors wanted to pull in lucrative payments of up
to $160,000 per patient. Medicare and Medicaid were charged for these
tracheotomies, regardless of whether the patients really needed them.
Wow. Cutting throats for money? The FBI says it has secret tape recordings
that prove physicians operating at Sacred Heart were intentionally performing
tracheotomies that patients did not need. They quote the hospital’s
owner, Edward Novak, as saying that tracheotomies are the hospital’s
“biggest money maker.”
The tracheotomies left scars on the patients, of course, but sometimes
the effects were far more serious. According to the FBI affidavit in the
criminal case, the patients of one of the surgeons had a death rate three
times the normal rate among Illinois surgeons performing similar procedures.
Of 28 Medicare patients on which the surgeon performed tracheotomies,
five of the patients died within 2 weeks of the surgery.
While we do not know whether a False Claims Act case has been filed, it
is possible that an FCA case was filed and is being kept under seal while
the FBI pursues the criminal charges. The FBI does say that a physician
and two administrators from Sacred Heart worked with the FBI as it pursued
its investigation. Apparently these three obtained the tape recordings
that the FBI mentions in the criminal complaint. If these people have
filed whistleblower lawsuits, they are entitled to between 15% and 25%
of what the Government recovers if the Government intervenes in the case
(more if the Government does not). In all my years of representing whistleblowers
(also known as relators), I am not sure I have ever heard of a more serious
case of fraud. In my view, any relator helped the Government stop fraud
as serious as this sounds would be entitled to the absolute maximum percentage
of the Government’s recovery.