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A Rutgers University neurosurgeon has been reinstated in his teaching role following an investigation into accusations that he oversaw what are known as "ghost surgeries" -- surgeries the attending surgeon billed for, but for which he or she was only minimally present.

Anil Nanda, MD, was also accused of being dishonest about his removal from a chair position at his previous place of employment, Louisiana State University (LSU) Health Sciences Center Shreveport, during the hiring process at Rutgers.

In rehiring him, Rutgers cited the investigation's conclusion that there wasn't sufficient evidence that Nanda skipped the most important parts of the surgeries, though these critical windows are defined at the discretion of the attending physician -- in this case, Nanda himself. The conclusions made on his initial hiring and workplace complaints while at Rutgers are somewhat less clear.

Nanda had been placed on paid administrative leave in April and stripped of leadership roles, but on Monday, Rutgers ended his administrative leave, restoring his faculty position as a professor "subject to his satisfying licensing, medical staff privileging, and contractual requirements of his employment agreement," according to a statement from a Rutgers spokesperson.

"Upon his return, Dr. Nanda will also be subject to supplemental training and supervision," the statement noted. One of Nanda's attorneys, Michael Critchley Sr., JD, of the law firm Critchley, Kinum & Luria, told 麻豆传媒 that this refers to training that would apply to Nanda's colleagues, too. "There's no training that's going to be specifically designated Dr. Nanda's training. There will be training across the group," he said.

Nanda was previously chair of the department of neurosurgery at Rutgers Robert Wood Johnson Medical School and Rutgers New Jersey Medical School, and chief of neurosurgical services at University Hospital in Newark and Robert Wood Johnson University Hospital, but he will not retain these management positions, or the compensation for them.

Rutgers commissioned the law firm Lowenstein Sandler to investigate the allegations against Nanda independently, which summarized its findings in a report.

Nanda was the attending physician for two surgeries on Nov. 4, 2021, scheduled at separate times: a craniotomy, to access a tumor in the brain for biopsy, and a laminectomy, in which bone from the spine is removed to relieve pressure on the nerves. Nanda spent 8 and 10 minutes in the operating room during the two surgeries, respectively, which each lasted over 2 hours.

For the craniotomy, Nanda attended the patient's "time-out," in which the surgical team reviewed the patient's history and procedure, then left the building to attend a virtual symposium he was hosting in his office. He then came back for the biopsy portion of the surgery. He did not scrub in, but watched from a distance for 3 minutes. According to Lowenstein Sandler's summary, "Dr. Nanda deemed this the critical portion of the procedure, as this is when bleeding and other complications can occur. If Dr. Nanda had needed to jump in to assist, he would have needed to go outside the OR and scrub in before he could help as he was not sterile."

During the second procedure, Nanda was present for the "time-out," and then again for 6 to 8 minutes to remove the most compressed part of the spine. According to the summary of the investigation, a neurosurgery expert was unsure whether Nanda was absent for a critical part of the procedure, but again, the federal standards from CMS allow Nanda to determine what the critical portion of a given surgery is.

There's also no CMS requirement that teaching physicians scrub in, or even conduct any portion of the procedures themselves -- just that they be available to supervise. The surgeries, according to the summary, were successful. "The quality of the results of Dr. Nanda's surgeries is the measuring stick by which he should be judged, and here, it is undisputed that the results were excellent," Nanda's attorneys said in an emailed statement to 麻豆传媒.

The investigation also looked into later allegations from local media outlets around Nanda's hiring at Rutgers in 2018. Specifically, reports claimed that Nanda was removed from his previous neurosurgery chair position at LSU around the same time that LSU conducted an audit of its neurosurgery department. The audit stemmed from a complaint about Nanda's billing for concurrent surgeries, and LSU ended up paying fines and restitution to HHS's Office of Inspector General for his and other surgeons' procedures.

Nanda did tell Rutgers about the audit and his removal as chair during the hiring process. The summary concluded that "there is no reliable evidence that Dr. Nanda lied to Rutgers about his removal or that his removal at LSU was for cause."

However, Nanda didn't disclose that he had the vast majority of the refunded cases in his department (82%) and told Rutgers his audit "came out clean," which was "not entirely truthful," according to the summary.

Nanda is also the subject of a number of workplace-related complaints, which are being investigated separately by Rutgers. He's a defendant in an ongoing lawsuit brought by a female coworker for wrongful termination and discrimination. Among the allegations are that Nanda excluded her from meetings, fired or suspended her supporters, stole gifts she intended for chief residents, and "belittled, degraded, and further defamed" her.

A counterclaim from Nanda suggested that the coworker was attacking him because he rejected her request to open a pediatric neurosurgery division and appoint her the chief.

"Dr. Nanda made significant and aggressive changes to the Neurosurgery Departments, and brought about substantial employee turnover," the summary noted, "resulting in Dr. Nanda having ardent supporters and significant enemies within the University community."

A statement from Nanda's attorneys said, in part, "Despite the efforts of some disgruntled faculty members and staff to destroy Dr. Nanda's reputation, the report completely exonerates Dr. Nanda of the malicious and false allegations of engaging in ghost surgeries."

As a professor in the neurosurgery department at the two medical schools, Nanda's salary will be $494,671, the statement noted. Before losing his leadership positions, Nanda made $2.2 million per year.

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