Suit details how UM surgeon double-booked surgeries, padded his pay at Texas hospital

Dr. Joseph Lamelas had been a star cardiac surgeon at Mount Sinai Medical Center in Miami Beach when the Baylor College of Medicine lured him to Houston in January 2017 to join an elite team of surgeons who were performing thousands of heart surgeries in dual operating rooms at the same time.

With such extraordinary patient volume and surgical productivity, the move to Baylor would prove to be highly lucrative for Lamelas.

Outside the intensive care unit at Baylor St. Luke’s Medical Center, Lamelas confided in another cardiac surgeon that his compensation package was based on a “pay-per-procedure” system whereby the more he billed, the more he got paid — the standard payment plan for the top heart surgeons at Baylor’s teaching hospital, according to a federal whistle-blower case filed in Texas.

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Based on that incentive, Lamelas and two other cardiac surgeons double-booked their surgical patients for hundreds of simultaneous heart operations at Baylor St. Luke’s Medical Center, according to federal authorities. In doing so, Lamelas and his two colleagues falsely claimed in medical records that they were present during the entirety of each overlapping heart procedure in their bills to Medicare, when in reality “physician trainees” performed the surgeries because the surgeons couldn’t possibly be in two places at once, authorities said.

“I performed this procedure,” Lamelas often attested in the medical record for each surgery, the Justice Department lawsuit said.

The simultaneous double-booking of surgeries paid off handsomely for both the surgeons and the hospital. Between 2013 and 2019, the Baylor-affiliated teaching hospital boosted its revenues by about $150 million from these three surgeons’ cases alone, according to the Justice Department’s suit.

As for the three surgeons? They “enjoyed compensation packages some four-times higher than the average for their specialty in Houston, reaching over $2 million per year,” the suit says.

The other Baylor surgeon in whom Lamelas confided brought this insider information and reams of other evidence to the attention of the federal government in a sealed whistle-blower complaint under the False Claims Act in August 2019. By then, Lamelas’ two-year stint at Baylor had ended with his hiring by the University of Miami’s medical school earlier that year.

$15 million settlement ‘tip of iceberg’

Lamelas and the two other Baylor surgeons are at the center of the government’s false-billing case. Last month, Baylor College of Medicine and St. Luke’s Medical Center agreed to pay $15 million to the Justice Department in a settlement. The settlement stems from the Justice Department suit that accuses the parties of illegally billing Medicare by claiming their cardiac surgeons were performing multiple heart procedures simultaneously in adjacent operating rooms — a practice known as “concurrent” surgeries.

READ MORE: Top UM heart surgeon at center of $15 million settlement between Baylor and feds

“This is just the tip of the iceberg,” Justice Department lawyers claimed in the 2022 lawsuit based on the whistle-blower’s original complaint, which named Lamelas, two other Baylor St. Luke’s Medical Center surgeons, Baylor College of Medicine and the teaching hospital as defendants.

“There are many examples of seasoned heart surgeons at Baylor making false statements about being present for the entirety of multiple simultaneous surgeries over the 10-year period before this case was filed,” the suit says. “Baylor knew about and facilitated the submission of these false statements [to Medicare] by its teaching physicians.”

Lamelas, who was hired in early 2019 by the University of Miami Miller School of Medicine, is still considered a luminary cardiac surgeon, particularly for his pioneering work in the field of minimally invasive heart surgeries. What’s not clear is whether the 63-year-old UM surgeon is still continuing his practice of performing “concurrent” heart surgeries at the University of Miami hospital.

UM, a private institution, has declined to provide that information to the Miami Herald, saying only that it won’t comment on the settlement. Nor did UM make Lamelas available for an interview and he did not respond to a Herald email seeking comment.

When UM medical school heralded the hiring of its new chief of cardiothoracic surgery in early 2019, it noted the vast number of heart surgeries performed by Lamelas — more than 16,000.

Five years later, Lamelas says he has operated on more than 18,000 heart patients throughout his 33-year career, according to a local news report.

If you divide 18,000 surgeries by 33 years, the math shows that Lamelas would have performed 545 surgeries in a given year, “an extremely high number,” said Dr. Alexander Marmureanu, a Los Angeles cardiac surgeon.

A 2018 study published in the Journal of Thoracic and Cardiovascular Surgery noted in 2010, the number of cases performed per cardiothoracic surgeon in the United States averaged 135 per year. The study’s caseloads were based on heart surgery, as well as lung and esophageal surgery.

And the type of surgery Lamelas specializes in — mitral valve repairs — can take, on average, four hours, Marmureanu said.

Lamelas, in a UM video, says he does three to five surgeries a day. In 2022, UM paid him more than $3 million, according to tax forms filed on Guidestar, which tracks financial information about nonprofits, including their highest-paid people.

REALITY CHECK: UM surgeon at center of settlement says he does 3 to 5 surgeries a day. Is that possible?

‘Churned through’ cardiac surgeries, feds say

The Justice Department’s whistle-blower case accused Baylor College of Medicine, St. Luke’s Medical Center, Lamelas and the two other cardiac surgeons — Dr. Joseph Coselli, 71, and Dr. David Ott, 77 — of benefiting financially from double-booking their heart surgeries while not being entirely present throughout their operations.

According to the federal lawsuit, the three surgeons performed more than 7,000 cardiovascular surgeries at Baylor St. Luke’s between June 2013 and December 2020, equating to more than 300 cases on average per doctor per year. The yearly average was much higher for Ott and Coselli given that Lamelas was only at Baylor for two years. Federal authorities estimated that Ott performed about 550 cases per year, Coselli about 450 and Lamelas over 350.

“This cardiac surgical volume is more than two to four times the average number of procedures performed by cardiac surgeons in America and cannot be done without concerted overlapping simultaneous surgical procedures,” the government’s suit says, adding that 80 percent of the three Baylor surgeons’ operations were overlapping with others scheduled simultaneously with the same three teaching physicians.

“In short, the teaching physicians churned through as many cardiac surgeries as possible to generate revenue for Baylor, [Medicare] regulations be damned, and were rewarded with lavish compensation,” the suit says, noting the “scheme could not have been carried out for so long without the concerted conspiracy of all defendants to defraud the government.”

In one case noted in the suit, Coselli, now executive vice chair in the surgery department at Baylor’s medical school, was “scheduled to perform more than 32 hours of surgery over a 16-hour period. On that day, every single hour between 7:50 a.m. and 2:00 a.m. the next morning was booked with two to four concurrent surgeries.”

Medicare rules require that surgeons be present for at least the critical parts of operations, though some overlapping of surgeries is allowed.

A spokesperson for the Centers for Medicare & Medicaid Services said in an email to the Herald that the federal agency “takes Medicare and Medicaid fraud and abuse very seriously, and we are committed to taking swift and aggressive action to identify and investigate fraud.” It would not comment about this case.

Justice Department lawyers pointed out in the suit that concurrent surgeries are allowed to facilitate the use of highly skilled surgeons more efficiently. But they also said those rules for teaching physicians at Baylor St. Luke’s Medical Center and other similar teaching hospitals nationwide must be strictly followed to ensure patient care, student training and honest billing to the taxpayer-funded Medicare program.

Justice Department lawyers said in the suit that the three surgeons and their institutions engaged in “hundreds of incidents of brazen lies and misleading, incomplete deceptive statements to falsify medical records for overlapping cases to hide [their Medicare billing violations] from the government.”

By failing to be present throughout the overlapping heart surgeries as they went from one operating room to the other, the surgeons generated more hospital revenue from Medicare reimbursements “to justify disproportionate salaries.”

As a result, Justice Department lawyers said, Baylor St. Luke’s surgeons created an “illicit financial relationship for the purpose of increasing Medicare reimbursements,” calling it a “textbook Stark Law violation.”

Under that law, which prohibits physicians from referring patients to entities with which they have a financial interest, at least two of the surgeons — Coselli and Lamelas — had an inherent conflict of interest because they were employed by Baylor College of Medicine. The medical school has an ownership interest in the teaching hospital, St. Luke’s Medical Center.

Federal authorities accused the surgeons of violating the Stark Law by referring their patients to St. Luke’s for their own financial benefit without giving them an option to undergo cardiac surgery at another hospital.

Ott, the former chief of cardiovascular service at St. Luke’s Medical Center, was affiliated with the medical practice group, Surgical Associates of Texas.

Under the terms of the $15 million settlement agreement, just over $3 million will be paid to the Justice Department’s whistle-blower, Dr. Jeffrey Morgan, a former cardiac surgeon at Baylor College of Medicine.

When the Justice Department announced the settlement in June, Baylor College of Medicine, which is not affiliated with Baylor University, issued a statement denying any wrongdoing.

“Baylor College of Medicine did not engage in conduct that violates any applicable federal law or regulation. It is also important to note that no patients were harmed,” Robert Corrigan Jr., general counsel for Baylor College of Medicine, said in the statement.

“The settlement agreement acknowledged that BCM disputed that any violations of federal law occurred and that the College being a party to the agreement is not an admission of liability by Baylor,” the statement said. “The College decided to amicably resolve the dispute prior to a trial on the merits after considering the cost and expense incurred by Baylor to date, and anticipated future costs and expenses, including attorneys’ fees.”

Similar whistle-blower settlements

The Justice Department’s settlement with Baylor’s medical school and its teaching hospital is the latest in a series of government crackdowns on illegal Medicare billing generated by prominent surgeons who perform “concurrent” surgeries.

Major federal enforcement followed a Boston Globe Spotlight Team series in 2015 that revealed for the first time the controversy of double-booking patients for surgery at Massachusetts General Hospital, which is affiliated with Harvard Medical School.

The series detailed how Mass. General gave orthopedic surgeons financial incentives to perform more procedures, and a handful of doctors regularly took advantage of the policy by scheduling concurrent surgeries in two operating rooms.

Like the case at Baylor, Mass. General billed Medicare and other government insurers for surgeries performed by Harvard medical trainees without proper oversight because supervising surgeons were working in another operating room.

Mass. General leaders forcefully defended concurrent surgery, according to the Globe. They said the practice of overlapping operations was an efficient way to deploy the most talented physicians, allowing surgical trainees to perform routine tasks such as closing surgical wounds while attending surgeons move on to other cases. Nonetheless, the reports provoked a national debate in the medical community, a congressional inquiry and regulatory changes in Massachusetts.

The Globe reports also led to a series of Mass. General settlements with the Justice Department that were prompted by whistle-blower surgeons at the renowned Harvard-teaching hospital. Between 2019 and 2022, Mass. General agreed to pay $32.7 million to resolve three claims stemming from concurrent surgeries.

In similar lawsuits, the Justice Department also reached settlements over concurrent surgeries and unlawful Medicare billing with the University of Pittsburgh Medical Center. The teaching hospital agreed to pay $2.5 million in 2016. Then, last year, it agreed to pay a bigger settlement — $8.5 million — to resolve the Medicare violations.

In the latter case, the settlement was reached with James L. Luketich, M.D., the longtime chair of the University of Pittsburgh Medical Center’s Department of Cardiothoracic Surgery, the medical center itself and University of Pittsburgh Physicians.

The whistle-blower case brought by the Justice Department alleged that Dr. Luketich regularly performed as many as three complex surgical procedures at the same time, failed to participate in all of the “key and critical” portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time — allegations similar to those made at Mass. General in Boston.

Meanwhile, Luketich moved between operating rooms and attended to other patients or matters while medical residents assisted him, Justice Department lawyers said.

After the settlement, a senior official with Health and Human Services-Office of Inspector General said the surgeon’s misconduct was driven by greed, calling it a betrayal of his patients, the healthcare system and the Medicare program.

“When physicians and other healthcare providers put financial gain above patient well-being and honest billing of government healthcare programs, they violate the basic trust the public extends to medical professionals,” Special Agent in Charge Maureen Dixon said.

Miami Herald investigative team reporter Ana Claudia Chacin and Miami Herald writer Milena Malaver contributed to this report.