Did SC doctors omit crucial step in doing colonoscopies? That is issue in lawsuit

Two former employees of a Columbia medical practice that performs thousands of colonoscopies and other digestive tract screenings each year are suing the practice and eight of its doctors, saying it improperly billed Medicare for millions of dollars.

The federal civil lawsuit by two former registered nurse anesthesists, Jeffrey Harbit and Alan Inglett, contends that doctors at Consultants in Gastroenterology, its two related practices and eight doctors who work there omitted a crucial but time-consuming step in performing colonoscopies in order to increase the number of procedures and make more money.

To be reimbursed by Medicare, the doctors and their practices had to certify they had done all required procedures correctly but they did not, the lawsuit asserts.

In legal filings and a press statement, the practice and the doctors have denied the allegations, which they say were made by two “disgruntled employees,” and made it clear they intend to fight the lawsuit.

“We are very proud of the work and accomplishments of our practice and we will not allow false and defamatory allegations made by disgruntled employees to alter our mission, vision and focus,” the defendants said in a statement released Wednesday by their lawyer, Debbie Barbier of Columbia.

Two of the lawsuit’s four claims were dismissed earlier this week by U.S. District Judge Michelle Childs.

“Our physicians are confident that they will prevail on the remaining claims and they intend to vigorously defend this case,” Barbier said.

But Bill Nettles, one of the three lawyers for the plaintiffs, said the two remaining claims are the most important.

Childs’ ruling keeps the lawsuit alive and allows discovery — pre-trial evidence-gathering — to now begin in earnest, Nettles said.

“We are pleased with the judge’s ruling,” said Nettles, who is handling the case with Bert Louthian and Fran Trapp of Columbia.

Colonoscopy visual screenings of the large intestine are major preventive tools in catching colon cancer in early stages when it can be stopped from spreading. Early detection markedly improves a person’s chance of survival. Colonoscopies are among the preferred screening methods recommended for many people over 45, according to the American Cancer Society.

The lawsuit is what is called a whistleblower, or qui tam, legal action. Such lawsuits can be brought under the Federal False Claims Act against organizations that receive federal money as a way to help the government recover government money that has been spent improperly. Typically, insiders — people who work for the organization alleged to commit the fraud — bring these cases to a private attorney’s attention.

In this lawsuit, the plaintiffs claim that the medical practice billed some 5,500 procedures billed to Medicare each year.

“Virtually all of these procedures did not meet required conditions of coverage/payment and were not eligible for reimbursement,” the lawsuit said.

In seeking reimbursement, the clinic had to certify that all pre-procedure steps were carried out, especially a procedure where the physician meets briefly with the patient to assess their fitness for getting anesthesia, the lawsuit said.

“Plaintiffs Harbit and Inglett observed that patients receiving anesthesia and having endoscopic procedures were typically not seen by a physician prior to being prepped and transported to the procedure room of the Defendants’ ambulatory surgery facilities,” the lawsuit said.

“This resulted in approximately 5.3 million dollars of damage to Medicare annually. These fraudulent practices have been occurring since at least July of 2012,” the lawsuit said.

“Procedures (colonoscopies) were scheduled so close together that there was no time to perform preanesthesia/pre-procedure exams,” the lawsuit alleged.

Doctors and clinics “falsified records to show” the required pre-procedure and pre-anesthesia procedures took place, when in fact they did not, the lawsuit alleged.

These omissions “maximized profit for Defendants,” the lawsuit contended.

Patients undergoing colonoscopies typically are sedated while having the procedure done. As registered nurse anesthesists, Harbit and Inglett took part in delivering the medicine used to render a person unconscious, their lawsuit said. Harbit worked at Consultants in Gastroenterology from 2012 to 2018; Inglett, from 2017 to 2019.

The lawsuit was filed in 2019 under seal. In such a case, lawyers from the U.S. Department of Justice study the lawsuit and decide whether to formally be a part of it or not.

In this case, the Department of Justice decided not to formally take part in the lawsuit.

Barbier, the doctors’ attorney, said Wednesday that the lack of participation by Justice lawyers and this week’s dismissal of two of the four claims in the plaintiffs’ lawsuit are “significant victories for Consultants in Gastroenterology.”

Plaintiffs’ lawyer Nettles said Justice lawyers could have asked Judge Childs to dismiss the case but did not.

Barbier’s statement also said, “Consultants in Gastroenterology is one of the largest gastroenterology practices in the state. For almost 30 years, we have been dedicated to improving the health of thousands of South Carolinians. We have nine Board certified physicians who proudly provide the highest quality care in the Midlands.”

Barbier also said the doctors and their practice have garnered multiple national and state awards for colon cancer prevention activities and helped develop the statewide screening program called the Colon Cancer Prevention Network that provides screening for the uninsured.

If the plaintiffs win or settle their lawsuit, most of the money will go to the government, but they will get a percentage. The more money recovered, the more money the plaintiffs will get.

Besides Consultants in Gastroenterology, individual doctor defendants are Gabe Saleeby, March Seabrook, John Schaberg, Eugene Stuart, Rajeev Vasudeva, James A. Richter, Matthew Thomas, and Erick Singh. The related practices are S.C. Endoscopy Center and S.C. Endoscopy Center Northeast.

This story was originally published April 1, 2021 at 5:00 AM.