Dirty Dental Appliances and Non Sterile Surgical Instruments? Yikes!
[Post updated May 2021]
When we first wrote this post, it was to report about the Detroit Medical Center. Now a Pennsylvania hospital system is getting fined for filthy dental tools. We can’t believe that well into the 21st century hospitals can’t seem to grasp the concept of keeping their equipment sterile.
Detroit Medical Center and Dirty Surgical Instruments
DMC boasts that it is one of the largest teaching hospitals in the United States. Affiliated with Wayne State University and Michigan State University, medical students from around the world learn their craft at DMC. According to a recent investigation by the Centers for Medicare and Medicaid Services (CMS), however, interns at Detroit’s largest hospital were operating on patients with dirty, unsterile instruments.
Things were so bad that the feds began “termination proceedings.” The hospital was set to lose its federal funding in just two months.
In a 14 page report, the feds blasted the facility for unsanitary conditions. Included in the report:
- Improper sterilization of surgical instruments – one in three sets of instruments inspected were not sterilized
- Lack of training on sterilization and infection control
- Hospitals workers putting dirty gloves back into a box of clean gloves
- Lack of sanitation audits
- Blood on floors / failure to sanitize operating rooms between surgeries
- Destruction of training records – what records that did remain showed instances where more than half of the staff missed required training on sterile cleaning procedures
The inspection by CMS was done without notice (a surprise) and was based on a whistleblower complaint. If handled properly, whistleblowers can receive large cash awards for their inside information of Medicaid and Medicare fraud. (More on that below.)
The Detroit News has been covering problems at DMC and with its corporate owner Tenet Healthcare for years. In a feature article this week, the paper interviewed a sterile processing expert who was aghast at the findings. He said, “If I had the ability I would not let a patient go in there until there’s a lot of re-education, retraining and personnel changes.” Another expert said that “This is insanely basic stuff – people don’t do things this foolish even at home.”
Unfortunately, only the state can shut down the hospital. CMS has the ability to shut off federal funding which would preclude the facility from accepting any Medicare or Medicaid recipients or federal employees as patients.
DMC traces its roots back to 1863 and the founding of Harper Hospital. The following year Harper began treating Civil War patients. It grew until 1985 when many of Detroit’s major hospitals merged into the present day Detroit Medical Center. In 2013, the for-profit Tenet Healthcare acquired the hospital system.
Problems with sanitation seem to begin at the same time Tenet Healthcare took over. The Detroit News reports that in June of 2014, ophthalmologists were “so fed up” with sterility issues that they threatened to take patients to other hospitals for surgery.
The system hired a person in October of 2014 to manage sterilization procedures. Several months later the paper reports that she contacted Tenet and considered herself a whistleblower. She told the parent company that she was not getting any support from hospital administrators to make changes.
Upper Allegheny Health System and Dirty Dental Instruments
Five years later and we are again learning of another claim of dirty, non sterile medical equipment. In May 2021 the Justice Department settled a whistleblower lawsuit brought against Upper Allegheny Health Systems, the operator of hospitals and dental clinics in New York and Pennsylvania.
Between 2010 and 2015, UAHS submitted false claims to Medicaid for dental services that were performed using drills that had not been appropriately sterilized. Dental drills – called handpieces – are required to be heat sterilized between each patient use. Upper Allegheny didn’t have enough drills and therefore didn’t have time between patients to properly sterilize their tools. Instead the company directed personnel to use wipes to clean the drills between patients.
Because Medicaid is paid for with state and federal tax dollars, the use of unsterilized equipment violates both the Federal False Claims Act and New York False Claims Act.
Upper Allegheny Health Systems settled without an admission of wrongdoing and agreed to pay a $2.7 million penalty. In announcing the settlement, Buffalo’s U.S. Attorney issued a statement saying,
“It is inconceivable that a healthcare business would seek to cut corners when it comes to the appropriate cleaning and sterilization of medical devices. This settlement under the False Claims Act holds UpperAllegheny accountable for the risks created for patients in the past, while ensuring that in the future patient safety will be preserved and that taxpayers will only pay for services which are properly provided.”
Cash Rewards for Whistleblowers
The cases against Upper Allegheny Health and Tenet Healthcare were brought by whistleblowers. Under the federal False Claims Act, whistleblowers who bring these cases are entitled to between 15% and 30% of whatever the government collects from the wrongdoer. We anticipate the whistleblower in the UAHS case will receive approximately $540,000.00.
Because Medicaid is funded both by the federal government and the states, a second reward is often available from the state. In this case, New York is one of 29 states and the District of Columbia that also pays rewards.
To qualify for a reward, one needs inside or “original source” information about the fraud. Billing clerks, doctors and other medical professionals are ideally suited to earn a reward (and help stamp out greed and fraud). The whistleblower reward provisions are an essential element of the False Claims Acts and have enabled them to become what one Justice Department official referred to as “the most powerful tool the American people have to protect the government from fraud.”
Tenet Healthcare Whistleblower Claims
No discussion of the Detroit Medical Center would be complete without a special mention of its parent, Tenet Healthcare. Tenet has an inglorious reputation for healthcare fraud. The company has paid hundreds of millions of dollars in fines and penalties tied to the federal False Claims Act, a Civil War era fraud recovery statute.
In 2016 Tenet Healthcare paid $514 million to settle civil and criminal fraud charges brought under the False Claims Act and federal Anti-Kickback Statute. (The whistleblower in that case will be receiving $84 million.)
That Tenet is a “frequent flyer” in the Medicare fraud world is indisputable. The bigger question is why? Our answer? Profits before patients.
The Tenet Healthcare website says the company is a “leading healthcare services company working across the system to improve service delivery and patient outcomes.” Things are so bad at DMC, however, that CMS says there is the potential for “unsatisfactory patient outcomes”. That is regulatory speak for infections, longer recovery periods and even death.
Tenet Healthcare is a for profit company. It exists to pay dividends and make money for its shareholders. There is nothing wrong with for profit institutions, most people in the United States work hard in the hopes of making more money. When a healthcare company becomes too focused on profits, however, patients suffer.
Under the federal False Claims Act, whistleblowers can receive up to 30% of what the government receives from wrongdoers. Because the False Claims Act is an anti-fraud law, to claim an award one must do more than show mere negligence or sloppiness. In the case of DMC and Tenet, investigators have been on the hospital’s case for months regarding unsanitary conditions. The hospital’s own employee charged with cleaning up the mess reported directly to Tenet in April of 2015 about conditions. At some point, what may have been a simple lapse in housekeeping became fraud.
Why do we say fraud? Because each time a hospital sends a bill to Medicare, it certifies that it is in compliance with all Medicare and Medicaid rules. Putting dirty surgical gloves back in the box or using non sterile surgical instruments is certainly not in compliance with rules. Once you certify that you are in compliance and know that you are lying, that is a fraud.
Do You Have Information About Non Sterile Medical Devices?
If you have inside information of healthcare providers using non sterile (unsterile) medical devices or any other type of Medicare or Medicaid fraud, contact us. By doing so, you join the growing number of healthcare professionals committed to quality patient care and against greed and corruption. Our team of whistleblower lawyers will help you stop the fraud, protect you from illegal retaliation and help secure the largest award possible.
We began this story by noting that the recent CMS surprise inspection was the result of a complaint. Most whistleblowers are content to call the 800 fraud hotline number provided by CMS. Doing so can earn you an award of up to $1000. To get the large percentage awards, you must file a sealed complaint in federal court. That is where we get involved.
If you are looking to receive an award and want to insure your complaint is investigated, the best way is to not call the hotline but instead file a False Claims Act complaint. While the complaint is being investigated, it remains under seal meaning secret. Sometimes we can further protect whistleblower identities through special filing techniques.
Want to learn more? First, visit our Medicare Fraud Whistleblower information page. Ready to see if you qualify for a reward? Contact us online, by email or by phone 202-800-9791. All inquiries are protected by the attorney client privilege.
MahanyLaw – America’s False Claims Act / Qui Tam Lawyers
[For more information on Tenet, visit our main Tenet Healthcare fraud page.]
New DMC post added October 2018. Looking for DMC Whistleblowers. Post examines new allegations of poor patient care and retaliation against four physicians who tried to speak up.]