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United States Attorney James T. Jacks

Northern District of Texas

FOR IMMEDIATE RELEASE MEDIA INQUIRIES: KATHY COLVINTHURSDAY, SEPTEMBER 1, 2011 (214) 659-8600

www.usdoj.gov/usao/txnUTSW AND PARKLAND RESOLVE ALLEGATIONS OF IMPROPER

PHYSICIAN SUPERVISION OF SURGICAL RESIDENTSDALLAS The University of Texas Southwestern Medical Center at Dallas; the

University of Texas Southwestern Medical Center at Dallas Medical Service, Research, andDevelopment Plan; the University of Texas Southwestern Health Systems a/k/a UTSouthwestern Health Systems (collectively UTSW) agreed to pay the U.S. and Texas $1.4

million to resolve allegations that it, along with the Dallas County Hospital District d/b/aParkland Health and Hospital System (Parkland), violated the civil False Claims Act and TexasMedicaid Fraud Prevention Act, announced U.S. Attorney James T. Jacks of the NorthernDistrict of Texas. The U.S. and Texas contend defendants caused upcoded claims to besubmitted to Medicare and Medicaid for teaching physician-related items and services between2004 and 2007. Defendants fully cooperated with the investigation, and by settling, did notadmit any wrong-doing or liability.

Teaching physicians may submit claims to Medicare and Texas Medicaid for thesupervision of residents if they meet certain criteria. Claims generally are reimbursable if theteaching physician is present for the key or critical portion of the service. Supervision of a

resident is noted by coding a claim with the modifier GC. Surgeons typically are paid a globalfee which represents payment for pre-, intra-, and post-operative management of a patientscare. The United States and Texas contend UTSW submitted improper claims primarily due toits teaching physicians inadequate supervision of residents during certain key portions of pre-,intra-, and post-operative care of surgeries performed at Parkland Hospital. The United Statesand Texas allege claims with modifier GC falsely represented to the Medicare and TexasMedicaid programs that UTSWs teaching physicians properly supervised surgical residents atParkland, even though in some cases, there was no documentation by the physicians that theywere present for the critical portion of the residents pre-, intra-, and post-operative surgical care.

The U.S. and Texas initiated the investigation in response to a June 2007 whistleblower suit

brought by Larry M. Gentilello, M.D., the former chair of the Burns, Trauma, and Critical CareDivision at UTSW Medical Center at Dallas. Under the False Claims Act and Texas MedicaidFraud Prevention Act, private individuals may bring actions alleging fraud on behalf of the U.S.and Texas and collect a share of any proceeds recovered by the suit. Dr. Gentilello can receiveup to 25% of the recovery under the settlement.

U.S. Attorney Jacks praised the efforts of the Office of Inspector General of the U.S.Department of Health and Human Services (OIG). Medicare should get what it pays for. If you

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submit a claim for supervising a resident you should actually be present supervising that resident,particularly when that resident is performing surgery, said Mike Fields, Special Agent inCharge of the Dallas office of the OIG.

The case was handled by Assistant U.S. Attorney Sean McKenna and Assistant Texas

Attorney General Paula Juba. The case is captioned United States of America, et al., ex rel.LarryM. Gentilello, M.D. v. The University of Texas Southwestern Health Systems, et al.;No. 3-07-cv-1172-K(N.D. Tex.).

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