Greiner details medical school probe

By MARA McGINNIS
Reporter Assistant Editor

President William Greiner discussed details of the ongoing federal investigation of the School of Medicine and Biomedical Sciences at the Faculty Senate meeting Tuesday and urged senators to withhold judgment and be supportive of their clinical-faculty colleagues during the process.

While Greiner maintained that the investigation is "a very critical matter as far as the future of the medical school is concerned," he added that "there are no allegations that the medical school or faculty or administration in general have done anything wrong.

"At this point, all we know is that they have subpoenaed various records of certain clinical departments in the medical school and some of our faculty. We don't see any evidence that this is directed at the quality of health care or that it is the delivery of health-care services by our faculty members."

The investigation at UB is being conducted by the Western New York Health Care Fraud Task Force, which is coordinated by the U.S. attorney's office in Buffalo and includes investigators from the U.S. Department of Health and Human Services, the agency that administers Medicare. It began shortly after Jan. 1.

Greiner told senators that the probe seems to be directed at certain questions that have emerged over the past several years regarding billing practices of faculty physicians associated with teaching hospitals and medical residents.

He explained that medical residents have health-care responsibilities and act on behalf of the hospital-by whom they are usually employed-and the attending, or supervising, physician, who is supposed to be in a mentoring or teaching role.

"Specifically, the federal government has taken a position that the attending physician may not bill for services rendered by the resident unless the attending physician is physically present or providing some astringent and significant level of oversight. This is a major difference of opinion between physicians and now the federal government."

Investigators will look at the possibility that medical students billed Medicare at a rate that should be charged by faculty physicians.

"Mistakes can happen, given the volume of patients that are handled in our area hospitals, and I have no doubt that you would find mistakes in billing," said Greiner. "But I'd be surprised if we found any systematic pattern of poor behavior and I certainly think we ought to withhold judgment. Some people kind of leap to the conclusion that something must be afoul in the medical school and I don't think that is the case."

Greiner noted that UB is not the first to undergo such an investigation and that the issue has led a number of medical schools elsewhere to settle with the federal government for large sums of money. "It could come to that in this institution, but none of that is proven or substantiated at this point," he said, adding that results of the audit are not expected for six months to a year.

The process, Greiner explained, is "extraordinarily complicated" because UB clinical physicians act under practice plans that are provided for by state law, policy of the SUNY Trustees and collective bargaining agreements between United University Professions and New York State.

"The level of responsibility is not all that clear, especially since none of our physicians are employed by a hospital that is owned or controlled by the State of New York, with the exception of the residents at Roswell Park." He added that as far as he knew, the investigation is targeting faculty at the Erie County Medical Center and Kalieda Health, not Roswell Park.

Since there are multiple parties responsible for the oversight of the practice, the medical school has limited responsibility and authority, which Greiner noted is an issue Michael Bernardino, vice president for health affairs, has been trying to address since he came to UB two years ago.

"Draw no adverse conclusions whatsoever about our fellow faculty members in the clinical departments," said Greiner. "There is no reason to assume any wrongdoing in those departments. I have great confidence in our faculty."

He noted that the faculty in the departments being investigated are "hurt" and "upset" because they think of themselves as people who work hard trying to care for others. "It is a very traumatic experience and I would hope that we would all be supportive but, at the same time, do our duty and respond honestly.