UVA Health Surgeons Sound Alarm on Upcoding

More light has been shed on allegations of a toxic work environment at the University of Virginia School of Medicine and UVA Health.

About a year ago, surgeons had raised concerns that they were pressured by leadership to upcode in an effort to bring in more money, according to The Daily Progress.

The news outlet obtained an audio recording from a meeting last November that was attended by surgeons, the department chair, and representatives for the health system’s billing and coding team.

“You’re going to get in a lot of trouble if somebody tells [a surgeon] you need to bill 99291 on every one of these patients like that,” a surgeon said during the meeting. “That is what gets universities in trouble.”

“We’re the ones that would get fined and go to jail,” the surgeon said, according to The Daily Progress.

Surgeons said there was “tremendous pressure” from senior leadership to charge patients more, particularly at the system’s flagship hospital UVA Medical Center in Charlottesville, according to the article. Doctors were told to do so by using the CPT code 99291, which indicates a doctor spent 30 to 74 minutes administering critical care services.

This code brings in $1,060 and 4.5 relative value units, while a similar code (99232) brings in only $200 and about 1.39 relative value units, the article stated.

Troubles at UVA Health first came to light in September, when 128 faculty employed by UVA Physicians Group authored a letter of no confidence in UVA Health CEO Craig Kent, MD, and School of Medicine dean Melina Kibbe, MD, calling for their immediate removal.

They sent the letter to the university’s Board of Visitors, and their signatures were protected out of fear of retaliation, though they would be made available to Board of Visitors members who wanted to see them.

Among the allegations in the letter were compromised patient safety; a culture of fear and retaliation; excessive spending on C-suite executives and support; and bullying and harassment of trainees.

UVA President Jim Ryan responded with a letter to medical school faculty, supporting Kent and Kibbe (who is also the editor of JAMA Surgery), but members of the UVA faculty senate — notably member Stephen Culp, MD, PhD — voiced their support for the physicians. In response to administration’s claims that the 128 signatories represent a small part of the 1,400 School of Medicine faculty and 30,000 UVA Health employees, Culp said the letter likely has broader support, but many are fearful of retaliation.

After receiving the letter, the UVA Board of Visitors retained the law firm Williams & Connolly to investigate the claims it raised.

In a letter to Virginia Attorney General Jason Miyares shared anonymously via email with MedPage Today, the doctors said they requested funding for their legal defense, but were told by the Board that Miyares denied that funding.

They said many have already been contacted by Williams & Connolly — which they noted has defended Elizabeth Holmes of Theranos — and that some members of the group were urged by UVA leadership to talk with investigators without legal representation.

“We will be discussing patient safety issues including deaths, financial malfeasance including criminal fraud, and retaliatory incidents that have resulted in some of our colleagues being demoted and fired,” the letter stated. “We have been advised consistently by attorneys and others that under no circumstances should we engage in interviews concerning these serious matters with UVA’s retained litigators without having our own legal representation present.”

The group has not yet received a response from the attorney general, they told MedPage Today.

A spokesperson for UVA Health shared a statement with MedPage Today that confirmed Williams & Connolly was retained to “conduct an independent review of the complaints and allegations” raised in the September letter.

“In the interest of fairness to all parties, the University will not have further public comment while the review is proceeding,” the statement continued. “We encourage all interested faculty members to participate in this independent effort.”

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