Federal prosecutors are investigating the billing practices of one of the nation’s highest-paid surgeons after a Spotlight Team report detailed that Dr. David B. Samadi ran two surgeries simultaneously on hundreds of occasions — a routine that colleagues said many patients did not know about.
Samadi, the chief of urology at Lenox Hill Hospital in Manhattan and a medical expert on Fox News, already is the focus of a state inquiry into how he handles his enormous caseload of prostate surgeries. Current and former Lenox Hill medical personnel say he typically relied on unsupervised residents who were still learning how to do surgery.
Now, the US attorney’s office in Manhattan is looking at Samadi, too. Federal law prohibits surgeons at teaching hospitals from billing Medicare for two simultaneous operations unless the doctor was present for all “critical parts.”
“My Office has an open investigation into the billing practices of Dr. David Samadi,” wrote Assistant US Attorney Jessica Jean Hu to the Spotlight Team in an unsolicited e-mail late last month seeking information from the Globe, which published a story about Samadi in March.
A spokeswoman for the office said no one would comment further on the investigation, which appears to be focusing on potential civil violations rather than crimes.
Samadi’s office referred questions about the federal probe to Lenox Hill. Barbara Osborn, a spokeswoman for Lenox Hill’s parent company, said the Globe inquiry was the first time the hospital administration had heard about it.
“Neither Lenox Hill Hospital nor its parent, Northwell Health, is aware of any federal investigation into Dr. Samadi’s billing practices,” she said.
Reuben Guttman, a Washington, D.C., lawyer who has represented clients in federal cases alleging health-care fraud, said it was extraordinary for a prosecutor to disclose an open investigation.
The e-mail to the Globe, he said, was a “clear signal that the matter of concurrent surgeries is extremely material to the payment of Medicare and Medicaid funds.”
The federal investigation of Samadi comes amid a growing national debate over an operating room practice that was largely unknown to the public until late 2015, when the Spotlight Team published a story about simultaneous operations at Massachusetts General Hospital. There, over the objections of several colleagues, a handful of top orthopedic surgeons would sometimes schedule two operations that overlapped for hours, requiring them to shuttle back and forth between rooms to tend to their unconscious patients.
MGH strenuously defended its practices and said its own review showed that patient care was never compromised. There have been few independent studies into whether double-booked surgery patients are more likely to suffer complications, and there is no definitive evidence that they are.
But since the Spotlight report, the US Senate Finance Committee has urged hospitals to more strictly enforce Medicare rules limiting the practice. And the nation’s largest association of surgeons has revised its guidelines for such surgeries, saying patients must be informed whenever doctors run more than one operating room at a time.
Lenox Hill officials previously confirmed that Samadi uses two operating rooms at once, but said he was present for the entirety of “major surgeries,” that he performs all robotic surgeries himself, and that his “primary concern and priority has always been the well-being of his patients.” Osborn, the hospital spokeswoman, had also acknowledged the investigation by the state medical conduct board and said the hospital would cooperate.
Lenox Hill data obtained by the Spotlight Team showed that Samadi overlapped one case with another at some point in about 70 percent of his roughly 2,200 operations between mid-2013 and mid-2016. Hundreds of times, one operation overlapped completely with another. Most of the overlapping cases occurred when he was doing a robot-assisted prostate operation in one room and had a conventional procedure going in a second.
Six medical personnel told the Globe early this year that urology residents do the vast majority of Samadi’s nonrobotic surgeries, including two-hour operations to trim away excess prostate tissue blocking urine flow.
In fact, residents who train in Lenox Hill’s urology department complained in an anonymous 2015 survey that Samadi wasn’t teaching them the intricacies of robotic surgery at all, according to medical personnel and a letter written by the agency that accredits residency programs, called the Accreditation Council for Graduate Medical Education, or ACGME.
In 2015 and 2016, the council gave Lenox Hill a warning when it reaccredited the urology residency program, citing the survey responses and other factors. In August of this year, the accrediting agency downgraded the program further, putting it on probation. That means the program “has failed to demonstrate substantial compliance” with ACGME requirements, according to the agency’s regulations.
Lenox Hill replaced Samadi as director of the residency program in July. Osborn said the hospital’s parent company decided it didn’t want department chairs to also run residency programs.
An ACGME spokeswoman would not specify reasons for the probationary accreditation. But a veteran urologist affiliated with Lenox Hill said it means the program is in danger of losing accreditation, which would end the use of residents by the department and mean a loss in federal funding.
“It’s a disgrace,” said the urologist, who insisted on anonymity for fear of reprisals.
Osborn, the hospital spokeswoman, said Lenox Hill only recently received ACGME’s findings and that “a specific action plan has yet to be developed.”
Samadi is one of the highest-paid surgeons in the country, earning $6.7 million in 2015 and attracting international patients and well-known personalities, such as “Today Show” host Matt Lauer. Although his website boasts gushing testimonials from satisfied patients, other patients have questioned how much of a role he really had in their operations.
Peter Nadler, a retired restaurateur in Manhattan, told the Globe last winter that he barely saw Samadi the day of his 2015 operation for an enlarged prostate, and that his libido vanished after the procedure, a known risk of the surgery. In January, he said, he confronted Samadi about whether the urologist or another doctor did the operation.
“That’s a horrible thing to say to your doctor,” Samadi replied, according to Nadler’s wife, Lorraine, who accompanied him to the meeting. Records obtained by the Globe show that Samadi had another operating room going for all but 25 minutes of Nadler’s case.
Jonathan Saltzman can be reached at jonathan.saltzman