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Baylor St. Luke’s Medical Center, Medicare Fraud, Texas 2023
HOUSTON – Baylor St. Luke’s Medical Center, Baylor College of Medicine and Surgical Associates of Texas P.A. have jointly agreed to pay $15M to resolve claims they billed for concurrent heart surgeries in violation of Medicare teaching physician and informed consent regulations, announced U.S. Attorney Alamdar S. Hamdani.
BSLMC is a joint venture between CommonSpirit Health, a national hospital chain, and BCM, a medical school in Houston. BSLMC operates a teaching hospital, formerly known as St. Luke’s Episcopal Hospital, in its Medical Center. BCM employs teaching physicians and residents who perform services at BSLMC, including Dr. Joseph Coselli, 71, Houston, and Dr. Joseph Lamelas, 63, Miami, Florida. SAT is a medical practice group affiliated with various cardiothoracic surgeons, including Dr. David Ott, 77, Houston.
The investigation began Aug. 7, 2019, upon the filing of a sealed qui tam lawsuit aka whistleblower complaint. The whistleblower alleged Coselli, Lamelas and Ott – three heart surgeons who performed at St. Luke’s – engaged in a regular practice of running two operating rooms at once and delegating key aspects of extremely complicated and risky heart surgeries to unqualified medical residents.
Allegations include that the surgeons ran two operating rooms at once and failed to attend the surgical “timeout” – a critical moment where the entire team would pause and identify key risks to prevent surgical errors. They would allegedly enter a second or occasionally a third operation without designating a backup surgeon, and at times, the surgeons allegedly hid these activities by falsely attesting on medical records they were physically present for the “entire” operation.
Patients were allegedly not informed their doctor was leaving the room to perform another operation, putting them at risk and violating Medicare regulations for the convenience and greed of the surgeons.
“Patients entrusted these surgeons with their lives – submitting to operations where one missed cut is the difference between life and death,” said Hamdani. “Allegedly, the patients were unaware their doctor was leaving for another operating room. This settlement reaffirms the importance of Medicare requirements governing surgeon presence and ensuring that no physician – no matter how prominent or successful – can skirt around the rules.”
“The complete disregard for patient safety exhibited by these three doctors put patients at risk and violated Medicare regulations for their own convenience and greed,” said Special Agent in Charge Jason E. Meadows of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “This record settlement demonstrates our steadfast commitment to protecting Medicare beneficiaries and working with our law enforcement partners to utilize all the tools in our arsenal to hold accountable those who steal from Medicare and other federal health care programs.”
“Any time any one of us goes under the knife as a vulnerable patient, we implicitly trust that the surgeons and medical professionals have our best interest at heart, especially here in Houston’s world-renowned hospitals,” said Special Agent in Charge Douglas Williams of the FBI – Houston field office. “In this case, doctors gambled with their patients’ care, during complicated open-heart surgeries no less, compromising quality of care over quantity and then falsely billed Medicare.”
Key Facts
- State: Texas
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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