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Transcript for audio podcast: Anesthesia Service Payments

From the Office of Inspector General of Department of Health and Human Services

http://oig.hhs.gov

[Lori Ahlstrand] This is Lori Ahlstrand, Regional Inspector General for Audit Services in San Francisco, speaking with Kristin Scully, an auditor from the San Diego field office. Let's talk about your involvement with the anesthesia services investigation, which led to a $1.2 million dollar settlement. Can you tell us more about your role in this investigation?

[Kristin Scully] Thanks, Lori. Well, we assisted OIG's Office of Investigations and Office of Counsel to the Inspector General, the Department of Justice, and the FBI with a case involving whistleblower allegations at the University of California, Irvine, Medical Center. Anesthesiologists at the hospital allegedly falsified claims by signing anesthesia records before procedures were performed. In some cases, anesthesiologists were not physically present or immediately available to supervise resident physicians who were performing procedures. DOJ asked us to help them by reviewing Medicare and Medicaid claims along with the anesthesia records.

[Lori Ahlstrand] Can you describe some of the things you did to assist?

[Kristin Scully] Yes, they wanted us to determine whether anesthesiologists were physically present or immediately available while supervising resident physicians. We reviewed the operating room logs and other anesthesia records and determined the percentage of anesthesia procedures improperly billed to Medicare and Medicaid. We reviewed the start and stop times of the operations and the locations of the operating rooms. Because there was no explicit definition in Federal law or regulations of what is considered "immediately available," we decided the best way to determine this would be to take a tour of the hospital's operating room floor to better understand the distances between operating rooms.

[Lori Ahlstrand] Now tell us more about your visit to the hospital.

[Kristin Scully] Well, when we arrived at the hospital, they asked us to put on full-body scrubs since the operating room was a sterile area, and there was a chance of unscheduled emergency surgeries at any time. The hospital staff then guided us through the floor and showed us each operating room, and we took careful notes. This is not something that auditors normally do. But since the audit required us to determine whether the anesthesiologist was "immediately available," the tour helped us visualize the distance that an anesthesiologist would have to travel from room to room or building to building and the time that it would take.

[Lori Ahlstrand] What kind of errors did you find?

[Kristen Scully] After reviewing selected numbers of Medicare and Medicaid claims, we found that anesthesiologists oversaw multiple procedures, in different buildings or on different floors, where they were not immediately available. Anesthesiologists also incorrectly billed Medicare and Medicaid, indicating that they had personally performed the services instead of supervising, or medically directing, the services. And finally, there was insufficient documentation to support the services. For example, we found cases where there were missing physician initials on the anesthesia records, or no post-operation records at all.

[Lori Ahlstrand] How were you involved in the settlement negotiations between the Department of Justice (DOJ), OIG's Office of Counsel to the Inspector General (OCIG), and the hospital?

[Kristin Scully] We reviewed the operating room logs and anesthesia records for all procedures performed on the selected dates. Then we provided our calculation of the Medicare and Medicaid error rates to DOJ. DOJ then used these rates to reach a settlement with the hospital. The audit team participated in the meetings with the hospital and assisted DOJ throughout the settlement process. After months of back-and-forth negotiations, they reached a final settlement of $1.2 million dollars.

[Lori Ahlstrand] Wow, $1.2 million dollars. From this collaboration with OI, OCIG, and DOJ, you came up with an audit idea for the 2013 Office of Inspector General work plan, correct?

[Kristin Scully] Yes, we came up with an audit idea to review anesthesia services, paid by Medicare that may have been incorrectly claimed as personally performed. Our initial plan is to review a few other hospitals. This audit idea is now in the 2013 work plan, and we just started analyzing the Medicare data, so I am interested to see what we find!

[Lori Ahlstrand] Thank you, Kristin, for sharing your experience in collaborating with OI, OCIG, and DOJ.

[Kristin Scully] Thank you Lori.

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