- The Department of Justice has reached settlements, totaling $23 million, with 51 more hospitals accused implanting cardiac devices in Medicare patients in violation of Medicare coverage requirements.
- Among those settling were six hospitals operated by the Cleveland Clinic Foundation, for $1.6 million, and 18 run by San Francisco-based Dignity Health, for $5.9 million. A list of the hospitals can be found here.
- The settlements conclude a sweeping nationwide investigation that focused on more than 550 hospitals. In October, 457 facilities agreed to pay the federal government $250 million to settle charges of overusing the cardiac devices.
Most of the cases were brought by a whistleblower under the False Claims Act.
Under a National Coverage Determination, patients must wait 40 days following a heart attack and 80 days after bypass surgery or angioplasty before receiving an implantable cardiac defibrillator, which costs about $25,000. The idea is to first see if the heart can recover enough of its own function to make an ICD unnecessary.
No determinations of liability were included in the settlements, according to Modern Healthcare.
But according to the DOJ, between 2003 and 2010, each of the settling hospitals implanted ICDs during those waiting periods, in direct violation of the NCD. The investigation was “heavily influenced by evidence-based medicine,” the agency said.
These settlements underscore the government’s determination to combat healthcare fraud. Since January 2009, the Health Care Fraud Prevention and Enforcement Action Team has recovered more than $27.4 billion in falsified claims — more than $17.4 billion of which involved federal health programs. HEAT is a joint initiative of the DOJ and HHS.