Marshfield Medical, Formerly Bromedicon: Remote Surgery Monitoring Without the Promised Interpreter

Marshfield Medical, formerly Bromedicon, agreed to pay $550,000 to resolve False Claims Act allegations that it billed for remote surgery monitoring without a qualified interpreting physician. The claims described a licensed physician’s work. According to the government, some surgeries had nobody watching the data stream, while others had only an unlicensed monitor. An operating-room technician or member of the remote team would recognize the question at the center of the case: who was actually there to interpret the patient’s data?

The Department of Justice announced the settlement on March 13, 2018. The allegations concerned claims to Medicare and other federal health care programs for a service intended to help protect patients during surgery.

Remote Intraoperative Monitoring Depends on a Live Clinical Handoff

Remote intraoperative neurophysiological monitoring gives the surgeon information about the patient’s neural structures while an operation is underway. Bromedicon provided this service during procedures including brain and spinal surgeries. Electrodes on the patient transmitted a live data stream for a qualified interpreting physician to assess at a remote location.

The physician’s job was to monitor the integrity of those structures and remain in live contact with a technician in the operating room throughout the surgery. The technician connected that remote interpretation to the operating team, so relevant findings could reach the surgeon in real time. The service was intended to reduce unintended damage and guide the surgeon during the operation.

Hospitals can use their own clinicians through vendor software or buy a distant clinical service. In its telemedicine rule announcement, Medicare described how hospitals could rely on a distant hospital’s or telemedicine entity’s decisions about a physician’s qualifications and permission to practice, under an agreement. That arrangement puts a practical question behind the technology purchase: which organization supplies the professional at the other end? In Bromedicon’s case, the government focused on the professional work the company said it had supplied through that connection.

Bromedicon Allegedly Billed for Absent or Unlicensed Monitors

The government alleged that Bromedicon failed to provide a qualified interpreting physician in numerous cases between 2011 and 2015. It described two different failures, both followed by claims representing that a licensed physician employed by the company had performed the monitoring.

In some surgeries, the government alleged, nobody monitored the data stream. In others, the company’s medical director was allegedly the only monitor. The Department of Justice described that person as a foreign medical-school graduate with no license to practice medicine in the United States. The department explained that Medicare required the qualified interpreting physician to be licensed to practice medicine.

Bromedicon employed licensed physicians, yet allegedly billed for their work when nobody, or its unlicensed medical director, watched the surgical data. The licensed physician was on the payroll and on the claim. According to the allegations, that physician was missing from the monitoring itself.

Taxpayers were allegedly billed for the physician’s service, and the patient was supposed to have the benefit of that physician’s interpretation during the operation. The same missing work mattered on both sides.

Who Performed the Work Behind the Claim?

The operating-room technician would encounter the remote service through live communication. The remote team would know who was monitoring. The reimbursement claim represented the service to the federal program paying for it. The alleged mismatch lay between the person doing the work and the licensed physician whose work the claim described.

For a surgical-monitoring insider, those distinctions give the question a concrete setting. You may have worked with the person answering from the remote end, seen who was assigned to the operation, or handled the claim describing the physician’s service. Those are different views of the same surgery. We work with insiders to connect what they know about the work to what the company told the payer.

A Similar Billing Mismatch in Teleradiology

Mori, Bean and Brooks faced a related allegation about the professional work behind a remote interpretation claim. In its teleradiology settlement announcement, the Department of Justice alleged that the practice billed for images interpreted abroad and for domestic rereads as though the domestic radiologist had performed the original interpretation.

The department identified a domestic-performance requirement for reimbursable teleradiology. Under the alleged arrangement, an interpretation performed overseas could be followed by another reading in the United States. The claim then described that later work as the original interpretation. The location and sequence of the readings mattered to what the payer was told it had purchased.

That case concerned where an image was interpreted and how a later reread was billed. Bromedicon’s concerned who monitored the surgical data as it arrived. The common point is the representation of professional work: which clinician actually performed the service the claim described. A former radiologist at the teleradiology practice brought its whistleblower case, showing how someone who knows the work can recognize a billing account that tells a different story.

A Whistleblower Case Behind the Marshfield Medical Settlement

The Bromedicon Marshfield Medical settlement resolved a qui tam case brought under the False Claims Act in federal court in the Eastern District of Pennsylvania. The whistleblower brought the allegations into a civil case over payment for the monitoring service. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Who Watched the Surgery

If you know the remote monitoring team or saw claims for physician work nobody performed, talk with our whistleblower experts about what happened during those surgeries. We develop the case around who monitored each surgery and what was billed, with healthcare fraud whistleblower lawyers who know remote physician services. We stay beside you as your knowledge of the operating room becomes the foundation of the case.