Dive Brief:
- Ashland, KY-based King's Daughters Medical Center has agreed to pay the federal government $40.9 million to resolve allegations that it made millions performing medically unnecessary heart procedures.
- In its lawsuit, the government alleged KDMC physicians performed a large number of unnecessary coronary stents and diagnostic catheterizations on patients between 2006 and 2011, then falsified patients' medical records to justify the procedures — generating millions of dollars in fraudulent reimbursements from Medicare and Medicaid.
- According to a report from the Department of Justice, this is the largest settlement involving a hospital in the history of the Eastern District of Kentucky.
Dive Insight:
This is a particularly egregious case of Medicare and Medicaid billing fraud. In most cases, doctors or hospitals make extra money simply by upcoding, which isn't proper but doesn't hurt anyone physically. But in this case, it seems, doctors at the Kentucky hospital were taking patients' lives in their hands to boost reimbursement. It makes one wonder how commonly needless major surgeries are performed in American hospitals.