Over the weekend, I read a press release about an otolaryngologist who’s facing federal indictments for allegedly fraudulently billing Medicare for millions of dollars for services rendered over a five-year period. The charges revolve around the practice of in-office dilation procedures, in which it’s alleged that the surgeon re-used an FDA-approved single-use device on multiple patients. Additionally, there are allegations of falsifying medical records and paying illegal remunerations.
And, as bad as this sounds, it’s certainly not the first time one of our colleagues has been accused of fraudulent billing and improper surgical indication practices. Most of us practicing in the late 2000s can recall the story of an otolaryngologist in southern Indiana who faced multiple malpractice suits alleging unnecessary sinus surgery procedures and fraudulent billing practices. While on a trip to Greece, the surgeon went on the run, leaving behind a partner in serious debt and patients harmed over missed cancer diagnoses and complications from unnecessary sinus procedures. The surgeon was eventually caught living in a tent in the European Alps, extradited to the United States, and later pleaded guilty to 22 counts of healthcare fraud.
Billing practices for sinus surgery have a long history of alleged abuse. Lawsuits have been brought against surgeons billing for frontal sinus surgery in pediatric patients too young to have developed frontal sinuses. Billing for postoperative debridements has been a consistent source of alleged abuse. One physician settled with the federal government after a patient filed a whistleblower complaint alleging that postoperative debridement codes were falsely billed. The complaint went on to detail a year of Medicare bills in which the accused otolaryngologist used the postoperative debridement code at a rate 12 times higher than it’s used by the median national otolaryngologist.
And although it seems like sinus surgery is the likeliest area for a lapse in conduct, there are many other examples within otolaryngology that fall into the grey zone of ethical behavior. Many cities are aware of the physician who’s notorious for never seeing their postop tonsillectomy bleeds, relying on the rest of the community to manage these patients when they present to the emergency department at night; or the cancer patient who has been grossly mismanaged, undergone a subtotal surgery that left positive margins, and suffered complications from said surgery, leading to further delays in care; or the ear surgeon who’s aggressive with their indications for acoustic neuroma surgery, never giving the patient the option of nonoperative therapy and leaving the patient with postoperative functional deficits and significant residual tumor.
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Thankfully, a very small minority of our community runs afoul of the billing laws, but it does bring up an interesting question: What responsibility do we have in the otolaryngology community to police ourselves? In employed hospital groups and academic departments, monthly morbidity and mortality meetings and quality assurance conferences are good deterrents to improper surgical indications. Centralized compliance departments also guard against fraudulent billing practices.
But what safeguards are there for practices without that infrastructure? Is it enough to rely on whistleblowers? Or should there be a more centralized, national data-driven method to make sure a few bad apples don’t spoil it for the rest of the community? And are there examples from other specialties within medicine that we can draw upon?
I don’t have the answers, but it is food for thought. I remain convinced that none of us started our career with the intention of ever hurting a patient. And as we all struggle with fatigue, burnout, and the financial pressures caused by an ongoing pandemic, let’s please remember to listen to the better angels on our shoulders. Please take care of yourselves and stay safe.
—Alex