title: Whodunit? Ghost surgery and ethical billing.
abstract: A senior vascular surgery resident started an autogenous radical-cephalic arteriovenous fistula procedure on a comatose patient in the surgical intensive care unit (SICU), expecting you to arrive momentarily. You were nevertheless unexpectedly detained establishing hemostasis in the main operating suite. You arrived in the SICU as the dressing was being applied. Fistula flows were excellent and there were no operative complications. The resident who began and finally completed the case was highly skilled and in the final month of his vascular training; you had supervised his satisfactory performance of many procedures like this one during the last 2 years. The patient's elderly wife had consented to the procedure, which she was told you would be directly supervising while the resident performed the surgery. When the operation was over you met with her to explain your emergency conflict and assure her that you checked the resident's work and found it entirely satisfactory. She accepted your explanation and was relieved that the operation went well. The patient's multiple comorbidities nevertheless necessitated an extended postoperative stay in the SICU, where you personally cared for him. The resident had dictated routinely that you attended the procedure, and your billing clerk had no reason to doubt the operative report's accuracy when she submitted your surgical fees to Medicare and the patient's private insurer, which paid to their contractual limits without challenge. On many occasions you have had your billings shorted by both. The resident since has graduated. What should you do?
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX 77030, USA. jwjones@bcm.tmc.edu
authors.forename: James W
authors.initials: JW
authors.lastname: Jones
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Richman
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000191:economics / Q000941:ethics*; D016121:Brachiocephalic Veins / Q000601:surgery; D002983:Clinical Competence / Q000191:economics; D017281:Cost of Illness; D017048:Health Care Costs / Q000941:ethics*; D006801:Humans; D007396:Internship and Residency; D010350:Patient Credit and Collection / Q000941:ethics*; D017060:Patient Satisfaction; D010817:Physician-Patient Relations / Q000941:ethics*; D017534:Radial Artery / Q000601:surgery