Houston facility to pay $21M in alleged Medicare scheme in which unlicensed doctors performed surgeries

Houston facility to pay M in alleged Medicare scheme in which unlicensed doctors performed surgeries

A medical center in Houston agreed Wednesday to pay over $21 million to the federal government to settle alleged false Medicare claims submitted after orthopedic procedures that weren’t covered or performed so inadequately that the procedures were deemed “worthless.”

Cornerstone Healthcare Group Holding Inc. billed alleged claims to Medicare for services —  including total knee and hip replacements —  performed by unqualified and unlicensed surgeons and doctors, the U.S. Attorney’s Office for the Southern District of Texas said in a news release.

Cornerstone Hospital Medical Center, a former long-term acute care facility that operated as a long-term care hospital until 2020, violated state and federal law by submitting the claims while knowing unlicensed and unauthorized students of Drs. Jorge Guerrero, Joel Joselevitz and Joseph Varon illegally rendered these medical procedures, the release said.

FBI Houston and other federal agencies began investigating Cornerstone in 2018 when a whistleblower lawsuit was filed under seal in September 2018. The person who filed the lawsuit worked as a medical sales representative who sold surgical implants and trauma-room devices to hospitals and doctors in the area, including Dr. Raul A. Marquez in 2016, court records show. Marquez, an orthopedic surgeon at Cornerstone Orthopedic Institute, is also listed as a defendant in the complaint.

The Chronicle attempted to contact Cornerstone’s and Marquez’s lawyers Thursday and Friday for comment on the settlement but did not receive a response.

Doctors without credentials

During the whistleblower’s employment in at least early 2016, he witnessed unlicensed physicians perform orthopedic surgery and other orthopedic procedures, according to court documents.

At Marquez’s request, the whistleblower joined him and other physicians in the operating room during surgeries to assist in opening medical device packaging, answering questions about the devices and ensuring all needed devices were available to complete the scheduled surgery.

When first observing surgeries at Cornerstone, the whistleblower noticed none of the physicians had the badges the medical center requires all its other doctors to have while in the operating room. The badges signify that the individual operating had completed Cornerstone’s processes for credentials and privileges, according to court documents.

No Cornerstone employee ever asked the physicians to show their badges or any proof that they could perform surgery on a patient, court documents show.

‘Taking advantage of the elderly’

In addition, Cornerstone submitted claims for payment for procedures that certain doctors allegedly completed. However, federal investigators found that those physicians were actually out of the country at the time and couldn’t possibly have performed the services, the U.S. Attorney’s Office said.

The investigation concluded that from Jan. 1, 2012, through Dec. 31, 2018, Cornerstone committed fraudulent claims and rendered the either worthless or unauthorized procedures. The medical center will pay $21,637,512 in the settlement.

“Taking advantage of the elderly and infirm is disgraceful,” U.S. Attorney for the SDTX Alamdar S. Hamdani said in the news release. “When providers accept federal funds for reimbursement, they have a duty and responsibility to provide the necessary and best care possible to the patient. As one of the largest of its kind in our district, this settlement shows our commitment to protecting our most vulnerable citizens and the integrity of the Medicare system.”

The whistleblower will receive $4,327,502 due to the Under the False Claims Act, which allows a private party to file an action on behalf of the U.S. and receive a portion of the recovery.


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