Faculty at the University of Virginia School of Medicine and UVA Health in Charlottesville alleged leadership had created a toxic work environment within the medical school and health system and signed a no-confidence letter addressed to the rector and Board of Visitors of the university in September.
Initially, concerns stemmed from surgeons who claimed they were being pressured by leadership to "upcode" certain procedures to increase revenue. According to an audio recording of a division meeting in November 2023, obtained and reported by The Daily Progress Oct. 17, UVA surgeons expressed fears they could face fines or jail time as a consequence of the upcoding.
Here are 15 other takeaways from the report:
1. UVA surgeons, their department chair, and representatives from the health system's billing and coding team were present at the recorded meeting.
2. The chief of the surgery division told surgeons they needed to learn how to "document appropriately" in response to pushback from surgeons who had been instructed to upcode and bill under CPT code 99291, indicating 30 to 74 minutes of critical care services.
3. One CPT code brings in $1,060 and 4.5 relative value units, while a similar code yields $200 and 1.39 relative value units, according to the report.
4. A surgeon responded to the department chair, expressing disagreement: "In many ways, it's our liability on the line; we're the ones that would get fined and go to jail. ... I think it’s really up to everyone's heart." The surgeon continued, "You’re going to get in a lot of trouble if somebody tells [a surgeon] you need to bill 99291 on every one of these patients like that. That is what gets universities in trouble."
5. Surgeons at the meeting spoke to The Daily Progress anonymously, fearing retaliation, and "left the meeting in November with a growing sense of unease given the direction they had received from their higher-ups."
6. One surgeon, who has since left UVA, said, "For us to bill more would be fraud, because we're already billing more than we think we should."
7. A member of the surgery department said there was a need to bring in a third party to audit physician and hospital staff billing practices, but an audit never occurred.
8. There was reportedly "tremendous pressure" from senior leadership to continue upcoding after the meeting. Although physicians ultimately decide which billing codes to use, they said hospital leadership "made their preferences known."
9. The Daily Progress requested data on the frequency of CPT code 99291 usage between 2017 and 2023 via a Freedom of Information Act request, which has not been fulfilled.
10. These accounts were publicized in a letter of no confidence in UVA Health CEO Craig Kent, MD, and medical school dean Melina Kibbe, MD, published by physicians and faculty on Sept. 5.
11. One claim in the letter alleged that UVA Health "disregarded valid reports of fraudulent billings and requests by senior leaders to fraudulently modify patient records to obfuscate adverse outcomes and boost productivity metrics."
12. The Daily Progress interviewed Michael Cannon, director of health policy studies at the Cato Institute, who said upcoding is more common than the public realizes and is incentivized by the structure of federal medical insurance programs.
13. Mr. Cannon added that, given the "rampant" nature of upcoding, the fact that over 100 physicians pushed back against pressure to continue the practice indicates genuine concern that it could amount to fraud.
14. In a statement to The Daily Progress, a UVA spokesperson said the university would not comment while a legal team, brought on by UVA President Jim Ryan and the Board of Visitors, investigates the allegations.
15. Drs. Kibbe and Kent did not respond to The Daily Progress's requests for comment regarding the allegations.