Extreme Medicare Fraud: Astonishing Claims that Doctors Cut Patients' Throats for Money

 The FBI is accusing a Chicago hospital of taking Medicare fraud and Medicaid fraud to an appalling level. According to FBI allegations about the Medicare and Medicaid fraud, secret tape recordings prove that doctors at Sacred Heart Hospital in Chicago intentionally sedated patients so much during surgery that the patients could not breathe on their own. The doctors then used the fact that the patients were not breathing on their own to justify performing lucrative tracheotomies on the patients. A doctor does a tracheotomy - that is to say, cuts a hole into the patient's throat, directly into the windpipe - to open up a direct breathing passage for a patient who otherwise cannot breathe on his or her own.

The Government made its allegations in a criminal complaint. To date no False Claims Act case has been unsealed, so we do not know whether a whistleblower filed a lawsuit and alerted the Government to what the doctors were doing. If a whistleblower is the one who uncorked the bottle on this frightening behavior, then a tip of the hat to him or her.

According to the astonishing allegations, Sacred Heart surgeons were not performing tracheotomies to save lives; instead, they were using powerful anesthesia drugs to keep patients from breathing on their own so that the surgeons would have an excuse to perform tracheotomies. Lawyer firm in Michigan. According to the FBI affidavit, "the nurse manager stated that one of the ICU nurses had advised her that Physician D had previously directed the nurse to "snow the patient," meaning that Individual A should be heavily sedated to the point where the nurse could only see the whites of Individual A's eyes, thereby precluding the patient from being weaned from the ventilator."

But why? Why on earth would these doctors want to cut these patients' throats when they had no medical reason to do so? According to the FBI, the hospital and its doctors wanted to pull in lucrative payments of up to $160,000 per patient. Medicare and Medicaid were charged for these tracheotomies, regardless of whether the patients really needed them.

Wow. Cutting throats for money? The FBI says it has secret tape recordings that prove physicians operating at Sacred Heart were intentionally performing tracheotomies that patients did not need. They quote the hospital's owner, Edward Novak, as saying that tracheotomies are the hospital's "biggest money maker."

The tracheotomies left scars on the patients, of course, but sometimes the effects were far more serious. According to the FBI affidavit in the criminal case, the patients of one of the surgeons had a death rate three times the normal rate among Illinois surgeons performing similar procedures. Of 28 Medicare patients on which the surgeon performed tracheotomies, five of the patients died within 2 weeks of the surgery.

While we do not know whether a False Claims Act case has been filed, it is possible that an FCA case was filed and is being kept under seal while the FBI pursues the criminal charges. The FBI does say that a physician and two administrators from Sacred Heart worked with the FBI as it pursued its investigation. Apparently these three obtained the tape recordings that the FBI mentions in the criminal complaint. If these people have filed whistleblower lawsuits, they are entitled to between 15% and 25% of what the Government recovers if the Government intervenes in the case (more if the Government does not). In all my years of representing whistleblowers (also known as relators), I am not sure I have ever heard of a more serious case of fraud. In my view, any relator helped the Government stop fraud as serious as this sounds would be entitled to the absolute maximum percentage of the Government's recovery.