Forged physician signatures, padded anesthesia times and angry outbursts from clinicians toward billing staff – these are just a few of the incidents alleged in a whistleblower complaint recently settled by a group of Georgia physician practices and the federal government.
In that case, Atlanta-based Georgia Bone & Joint (GBJ), its ambulatory surgery center (ASC), its anesthesia provider, Sentry Anesthesia Management and another anesthesia practice, Southern Crescent Anesthesiology PC agreed to pay the government $3.2 million to settle charges of providing and receiving kickbacks and unlawfully billing for imported drugs that did not have FDA approval.
However, the government opted not to pursue charges against the practices for other alleged infractions detailed in the original qui tam (whistleblower) complaint.
Nevertheless, from a compliance and a practice management standpoint, some of the lesser allegations in the original complaint, filed in April 2013 by fired GBJ practice administrator Sharon Kopko and obtained from court records by Part B News, make for useful object lessons. For example:
David LaGuardia, a certified registered nurse anesthetist named as a defendant in the complaint for allegedly paying kickbacks to surgeons, also had a problem completing the anesthesia record, Kopko alleges.
“As a matter of routine, LaGuardia does not complete patient charts until after the procedure has been completed, frequently at the end of the day,” the complaint alleges. “When he does complete the patient charts, he routinely fabricates anesthesia start and stop times based on the times the patient arrived at and departed the facility, rather than the times the anesthesia services began and ended, in order to increase the number of anesthesia units that may be billed. In addition, he will frequently falsify the identity of the anesthetist providing the services, and will invent other important entries for patients’ vital signs, such as blood pressure readings, which are not generally monitored during the performance of the procedure.”
In one alleged incident: “a member of the billing department asked [Kopko] to have an anesthesia record corrected because it identified as the anesthesia provider a CRNA who had been on vacation at the time, and because it appeared that the anesthesia times had been altered. When Relator [Kopko] took the record to LaGuardia, he became very angry and wrote a message on the record stating never to ask him such questions again,” according to the original complaint.
“When Relator returned the record to [Sentry billing manager Renee] Morris, Morris told her that she was keeping the record, and that if they ever treated her badly again she would report them to the OIG and become a millionaire.”
Ultimately, it is Kopko who will receive an unspecified share of the settlement, the Department of Justice confirms.
Also, “when [Kopko] began working at the Surgery Center in October 2008 as a PRN nurse, she noticed that the nurse manager was having full-time nurses perform chart audits and flag places in the medical records that were incomplete or were missing a physician’s signature. The nurses would routinely sign the physicians’ names, including on prescriptions, and would practice how to make the physicians’ signatures,” according to the complaint.
“When [Kopko] became a full-time nurse in early 2009, she told [the nurse manager] that she would not forge physicians signatures.” She was told, “that was fine, and that she should just bring the documents to [one of the other nurses] to sign.”