Harvard-affiliated Massachusetts General Hospital settling yet another federal lawsuit alleging fraudulent billing practices makes clear that it’s time to replace the Hippocratic Oath promising to do no harm with this promise upon medical school graduation: “If my healthcare employer’s business practices are endangering patients, I will keep my mouth shut.”

That’s the implied lesson from MassGen’s $14.6 million settlement of a federal lawsuit alleging the hospital fraudulently billed government insurers for surgeries performed by trainees without proper oversight because supervising surgeons were working in another operating room. It’s MassGen’s third settlement to resolve claims of so-called concurrent, or double booking, in which two surgeons juggle two surgeries simultaneously.

MassGen’s previous settlements totaling $18.1 million for double booking obviously weren’t much of a deterrent.

At issue here isn’t just a hospital allegedly ripping off American taxpayers who subsidize MassGen and most other U.S. hospitals by exempting them from paying taxes on their increasingly lucrative and consumer exploitive businesses.  According to a claim brought by former MassGen anesthesiologist Lisa Wollman, at least five orthopedic surgeons regularly kept patients under anesthesia longer than medically necessary – because the doctors were working in two operating rooms.  As reported by the Boston Globe, Wollman said she repeatedly witnessed and complained about the practice from 2010 to 2015, when she left MassGen and filed a whistleblower lawsuit on behalf of the U.S. and Massachusetts governments.

It would be nice to believe that Wollman is heralded at Harvard Medical School for her patient safety advocacy but that doesn’t appear to be the case. According to the Globe, Wollman relinquished her position as assistant professor at Harvard when she left MassGen after working at the hospital for more than two decades. Wollman now works at New England Baptist Hospital.

“I did this for patient safety and transparency,” Wollman told the Globe. “My career trajectory hasn’t recovered. But it was a personal choice.”

MassGen’s business practices are not only what’s alarming here. The hospital, repeatedly ranked among the nation’s best, employs top tier surgeons and anesthesiologists, most of them likely fellowship trained. Yet Wollman apparently was alone willing to protest what she and others no doubt knew was a practice putting surgical patients at risk. According to a 2017 NIH study, “prolonged anesthesia duration is associated with increased odds of complication, venous thromboembolism (blood clots), increased length of stay, and return to the operating room.”

Dr. Jim Rickert/IUH photo

“There’s no world in which you should have a person under anesthesia for an extended period of time waiting for the surgeon when it’s all scheduled, elective surgery,” Dr. Jim Rickert, an Indiana orthopedic surgeon, told the Globe. “Any patient should think twice about going to an institution that sanctions this kind of behavior.”

The public naively believes that most doctors are a fearless lot and would put the safety and care of their patients ahead of their career and financial interests. But the evidence is overwhelming that’s not the case.

I learned this reality writing about Beaumont Health, whose flagship hospital in suburban Detroit was once ranked among the best regional hospitals in the country. John Fox, the former hospital CEO, and John Kerndl, the former hospital CFO, imposed severe cost cutting and other controversial measures that doctors believed were harming patient care.

Yet in 2020 when a doctor began circulating a petition voicing nonconfidence in Fox, Kerndl, and other top executives, most Beaumont doctors refused to sign because they feared repercussions. Only when a survey was conducted assuring the Beaumont doctors anonymity were most willing to admit they had no confidence in Fox and his leadership team.

Beaumont is a cautionary tale about the potential dangers of anesthesiology. In May 2020 the hospital announced plans to outsource anesthesiology to a controversial firm called NorthStar Anesthesia. Although the co-heads of Beaumont’s cardiology department warned the hospital system’s board chair they had “serious concerns” about NorthStar’s capabilities, the warning was ignored. Within three weeks of NorthStar taking over, a patient undergoing a routine colonoscopy died from intubation complications and another landed in the ICU because of a pain medication overdose. Carolyn Wilson, Beaumont’s former COO who awarded NorthStar its contract, later said she was pleased with the transition.

Mark Bohen/MGB headshot

Mark Bohen, chief marketing officer at MassGen’s parent Mass General Brigham, is no stranger to anesthesiology issues. He was Beaumont’s CMO when the NorthStar contract was awarded and legions of surgeons and anesthesiologists resigned. Former Beaumont CFO Kerndl is now CFO of Boston-based Beth Israel Lahey Health. Beaumont was recently taken over by Grand Rapids-based Spectrum Health, potentially netting Fox a golden parachute valued at more than $30 million.

Sadly, conscientious doctors like Wollman are the exception. The majority of doctors today are hired help, working for hospitals or ethically challenged healthcare organizations controlled by insurance companies or private equity firms. Speaking up against these firms is career suicide, and doctors who profit handsomely from filing whistleblower lawsuits deserve every penny they get.

One such doctor was emergency room physician Raymond Brovont, who was awarded $26 million in a wrongful termination lawsuit against private equity owned EmCare. According to media reports, Brovont repeatedly sounded the alarm that EmCare staffed only one physician on the night shift to cover both the regular and pediatric emergency department at a hospital controlled by HCA Healthcare. Brovont, who likely couldn’t get hired at most hospitals and corporate-owned healthcare facilities, now operates Bloom Health & Wellness, which offers pioneering ketamine and IV vitamin treatments for depression.

With no political pressure to reform U.S. healthcare, ranked the most expensive and inefficient in the western world, the likelihood is that alleged corruption and wrongdoing will continue without consequence.

The allegations against hospitals never cease to astound.

Last fall, the Department of Justice joined six lawsuits filed by Kaiser Permanente employees since 2013 alleging the giant health plan systematically defrauded Medicare by overstating the severity of its patients’ medical conditions. Kaiser denies the allegations, and California Gov. Gavin Newsom obviously isn’t worried about them. According to a recent report, Newsom just awarded Kaiser a sweetheart deal jeopardizing Medicaid reforms.

Whomever said crime doesn’t pay didn’t work in U.S. healthcare.  And woe to any doctor that has a problem with it.

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