Nurse-anesthetists are specially trained nurses who can administer anesthesia, generally under the supervision of an anesthesiologist who is medically trained, but are increasingly being allowed to practice unsupervised. Medicare will now allow hospitals to bill for the services of unsupervised nurse-anesthetists. While nurse-anesthetists cost less to employ than anesthesiologists, some institutions still bill for anesthesiologists= supervision of these nurses.
A lawsuit was filed in 1997 by the Minnesota Association of Nurse-Anesthetists charging Allina Health Corporation, five group practices, four hospitals and 65 doctors with billing fraud for billing Medicare for anesthesiologists= supervision where services were provided solely by nurse-anesthetists (Johnsson, 1997). According to Johnsson, the suit seeks $1 billion in damages and fines and charges that since 1991, 100,000 such claims have been filed. This is the third time the nurse-anesthetists have tried to levy the penalties of the False Claims Act against the groups: they failed in previous attempts in 1994 and 1995, and justices don't see much hope for their success at this third attempt.
The difficulty lies partly in the billing practices allowed by insurance companies. In a two-tiered structure, anesthesiologists can bill in two ways: at one level when the perform procedures themselves, and at a lower level when they supervise nurse-anesthetists carrying out the procedures. According to the nurses, this "supervision" often means the doctors are sleeping, watching television, and at times not even in the hospital. Nurse-anesthetists are complaining that when they bill for the services they actually performed, their claims are denied as "double billing" or substantially reduced by Medicare.
One troubling trend is the enormity of such claims, spurred in part by the fact that the law permits private parties to prosecute wrongdoers through whistle-blower su...