Laurence M. Deutsch and Steven E. North
In September we blogged about allegations against one of Lennox Hill Hospital’s prominent urologists, Dr. David Samadi – chairman of the department – who allegedly double-booked surgeries, that is, booked more than one operation at the same time, even though he had told his patients that he would be their surgeon.
It is now reported that Dr. Samadi is under formal investigation by the U.S. Attorney’s Office in Manhattan for allegedly overbilling patients.
In scheduling surgeries, there is some acceptable overlap between procedures. For example, a surgeon may have a resident close an incision after the main procedure is done, or hold an instrument during surgery. However, Medicare regulations and standards of safe medical practice require that a sufficiently experienced surgeon perform the critical portions of any procedure.
Dr. Samadi has been regarded as a rising star in the field of urology, particularly in robotic surgeries of the prostate. Nonetheless, his apparent desire to create a lucrative and high-profile practice may have outpaced acceptable norms in both scheduling and fee structure.
Previous reports have estimated that Dr. Samadi overlapped operations in about 70% of 2,200 surgeries performed between 2013 and 2016. He is, of course, entitled to the presumption of innocence until proven guilty.
Nonetheless, the sheer number of his surgeries has raised the appearance of improper double booking in the eyes not only of the press but also by fellow physicians who reportedly felt uncomfortable performing procedures that Dr. Samadi requested, e.g., doing critical and complex portions of procedures beyond their expertise.
It is unusual for surgeons to publicly criticize fellow surgeons in this manner. Coupled with investigations by the U.S. Attorneys’ office, it appears that Dr. Samadi may have pushed the envelope to increase his billings..
These practices raise additional and troubling questions for medical institutions themselves.
It is hard to believe that Lenox Hill Hospital was unaware of Dr. Samadi’s unusually high revenues and practice volume. In fact, it may have taken notice and ignored, or even encouraged the double booking because of the revenue Dr. Samadi was bringing to the hospital.
The legal theories of medical malpractice are normally tailored to an individual doctor’s actions in individual cases. This may be an area in which novel legal theories are required to hold hospitals accountable for either ignoring or actively countenancing excessive double booking of surgeries and unsafe practices if they are done by the hospital just to increase its bottom line.
There is an old expression to "follow the money" when confronted with questions of wrongdoing. This seems another example in which an apparently unsafe practice was sparked by simple greed on the part of a physician and, perhaps, an institution trying to increase its revenue at the expense of safe patient practices.
Source: “One of the city’s highest-paid surgeons allegedly overcharges patients,” New York Post, 10/14/17
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