5 January 5-11, 2023 miaminewtimes.com | browardpalmbeach.com New Times | Contents | Letters | news | night+Day | CuLture | Cafe | MusiC | Month XX–Month XX, 2008 miaminewtimes.com MIAMI NEW TIMES | CONTENTS | LETTERS | RIPTIDE | METRO | NIGHT+DAY | STAGE | ART | FILM | CAFE | MUSIC | HYPOCRITICAL OATH? Whistleblower alleges billing fraud and lax care at Baptist Health South Florida hospital. BY NAOMI FEINSTEIN D omenico Calcaterra be- gan working at Bethesda Hospital East in January 2020 as the new chief of cardiac surgery tasked with revamping the hospi- tal’s heart surgery program. In a whistleblower complaint in Miami court, he claims that it was only months into his job at the Boynton Beach hospital when he discovered fraudulent billing to the tune of millions of dollars, severe understaffing in the intensive care unit, and violations of clini- cal standards that he says caused patient harm. Calcaterra voiced his concerns repeatedly to the hospital administration and top execu- tives, but his grievances were largely ignored, according to the lawsuit. He says he was fired a year after his hiring in retaliation for bring- ing the hospital’s dysfunction to light. “Defendants retaliated against Calcaterra by harassing, isolating, and terminating him from all positions solely on account of his protected activity,” the complaint alleges. The lawsuit was filed in Miami-Dade County Court against Bethesda Health Physi- cian Group and Baptist Health South Florida, a nonprofit hospital company. It lists counts for employment retaliation under the Florida Private Whistleblower Act and the False Claims Act, a federal law that protects whis- tleblowers and provides compensation if they uncover fraud against a government entity or program. Baptist Health South Florida is one of the largest healthcare organizations in the re- gion, operating 12 South Florida hospitals and more than 100 outpatient and urgent care fa- cilities. It acquired Bethesda East hospital as part of a 2017 merger with Bethesda Health, which has been operating in Palm Beach County since 1959. When reached by New Times, Baptist Health South Florida said it had not been served in the case and does not comment on pending litigation. Withholding Treatment? In July 2020, an uninsured 48-year-old Black patient opted not to have surgery to ad- dress his heart condition after one of Bethesda East’s doctors told him and his wife the operation was not worth the risk, the law- suit alleges. According to the complaint, two other physicians were so concerned by their colleague’s advice that they sought a second opinion from Calcaterra. Upon examining the patient, Calcaterra found the man had a life-threatening aortic dissection, a condition that could result in a fatal rupture of the aorta if not surgically re- paired immediately. “Incredibly, the treating physician did not document these details in the patient’s chart, but did document in the medical records that the patient had ‘refused the operation,’” the lawsuit states. Calcaterra believed that the patient was at risk of a rupture within a matter of days and needed an emergency operation. After con- sulting with Calcaterra, the complaint claims, the man elected to move forward with the surgery. The surgeon says the incident was part of a “pattern at Bethesda hospital” whereby the facility would “withhold treatment including needed operations to the uninsured to avoid the expenditure of resources for which there would be no compensation or compensa- tion at a rate far less than an in- sured or Medi- care patient would gener- ate.” “This was confirmed when Dr. Cal- caterra brought this near-tragic incident to the attention of the director of defendant’s risk management office, who stated that the hospital adminis- tration had been unwilling to address such is- sues... for years,” the lawsuit alleges. “We Take Care of Each Other” Calcaterra claims to have witnessed several forms of fraudulent billing practices while working as the hospital’s head of cardiac sur- gery. Among other alleged misconduct, Calca- terra says he noticed the hospital systematically conducting unnecessary post-surgical patient consultations to inflate invoices. Within a month of his hiring, Calcaterra says he asked another doctor at Bethesda East why he had ordered so many specialist consults on a patient. The doctor allegedly responded, “We take care of many uninsured patients here, and we have to compensate for the work we do for free, so we take care of each other.” Calcaterra reported the practice, known as “overutilization,” to the hospital’s assistant vice president, chief medical officer, and chief operating officer, but the issue was swept under the rug, according to the law- suit. A few weeks after Calcaterra met with the chief operating officer to report the issue, she “was abruptly fired,” the lawsuit alleges. Calcaterra says he also found that the hos- pital was misclassifying medical services as “critical care time” to inflate billing. The fa- cility allegedly disregarded the Centers for Medicare and Medicaid Services guidelines for defining and coding critical care. “These unlawful practices related to billing of ‘critical care time’ account for tens of mil- lions of dollars per year of fraudulent billing at the different Baptist Hospitals,” the lawsuit as- serts. “Calcaterra, in person, along with one of his critical care physician colleague[s]... re- ported verbally and in writing these facts to the Bethesda chain of command.” Lax Care Claims The doctor, who completed his cardiotho- racic surgery fellowship in 2007 at the Uni- versity of Miami’s Miller School of Medicine, recounts in the lawsuit how Bethesda East al- legedly dragged its feet in hiring more physi- cian assistants (PAs) to help out in operating rooms and the intensive care unit. He says he expressed his concerns several times during the summer of 2020, telling the administra- tion the lack of ICU coverage put patients’ lives at risk. In an August 2020 email, Calcaterra reached out to the hospital about the under- staffing, noting that hospital employees were reluctant to speak up for fear of retaliation, he says. Then in November of that year, not long before he was fired, he emailed administration about an incident in which the hospital alleg- edly had a “lack of any personnel” to deal with a patient in distress in the intensive care unit. Though Calcaterra worked at Bethesda East at the onset of COVID-19 pandemic, during which South Florida hospitals strug- gled to maintain sufficient personnel, he presents evidence that allegedly shows the hospital had financially motivated misgivings about hiring more physician assistants. The lawsuit claims that in response to Calcater- ra’s concerns, the president of Bethesda Phy- sicians Group once wrote that the hospital was “being asked to spend an awful lot of money here” while questioning why an al- ready-hired physician assistant would not suffice. While an executive at Baptist Health South Florida acknowledged “significant coverage issues and difficulty managing the workload,” she did little to resolve the situa- tion and failed to investigate the ICU under- staffing, Calcaterra argues. “The many concerns I have brought up through the months about problems with op- erations, processes, and quality of care have not been addressed and acknowledged,” Cal- caterra wrote in a grievance cited in the case. A “lack of basic equipment needed for ad- equate medical care,” including emergency dialysis, along with an inability to quickly process coagulation lab results, prompted yet another grievance from Calcaterra, according to the lawsuit. He claims that when he parted ways with the hospital, the lab issue still had not been addressed. During his tenure at the hospital, he claims, he had to address missteps in the hos- pital’s handling of central line catheters, its use of intravenous anti-arrhythmia medica- tion, and its purported “practice of booking and then canceling cases,” all of which he claims put patients at risk. In one of the more alarming alleged mis- haps cited in the complaint, Calcaterra claims the hospital allowed a general surgeon to carry out a pacemaker surgery despite a lack of qualifications to perform the operation. “The pacemaker was improperly implanted and contrary to any clinical justification,” the doctor says, noting that the patient wound up dying. Calcaterra claims his employment was terminated around January 2021 in retalia- tion for his complaints about the hospital’s “unlawful activity.” The doctor, a University of Rome medical school graduate, says he’s entitled to job rein- statement, backpay, and other financial dam- ages. He is represented by Gary Costales in Miami and Tina Glandian of Geragos & Gera- gos in New York. “There appears to be a practice or modus operandi of a cover-up... No investigation has taken place to the best of our knowledge, and we look forward to investigators uncovering the truth and substantiating our client’s claims,” Geragos & Geragos spokesperson Holly Baird said in a statement. [email protected] Baptist Health South Florida acquired Bethesda East hospital as part of a 2017 merger with Bethesda Health. Photo courtesy of Baptist Health South Florida | METRO | “THE MANY CONCERNS I HAVE BROUGHT UP THROUGH THE MONTHS HAVE NOT BEEN ADDRESSED AND ACKNOWLEDGED.”
