Arkansas Democrat‑Gazette | February 19, 2016 | By Andy Davis
Arkansas Heart Hospital has agreed to pay $900,000 to settle claims that it billed Medicare for implanting cardiac devices in situations that violated the program’s payment guidelines, the U.S. Department of Justice announced Wednesday.
The Little Rock hospital was among 51 hospitals that entered settlements during the “final stage” of a nationwide investigation into devices implanted from 2003 through 2010, the Justice Department said in a news release.
The settlements announced Wednesday involved hospitals in 15 states and totaled more than $23 million, the release says.
The same investigation led to a settlement, announced by the Justice Department in October, in which St. Bernards Medical Center in Jonesboro agreed to pay $850,000.
It was among 457 hospitals in 43 states that the Justice Department said had settled at that time for a total of more than $250 million.
According to the Justice Department, the investigation concerned cardioverter defibrillators that were implanted in patients who had recently had heart attacks, heart bypass surgery or angioplasty, a procedure that opens blocked heart arteries.
The devices, which cost about $25,000 to implant, detect and treat abnormal heart rhythms by delivering an electric shock to the heart, according to the release.
In most cases, Medicare excludes such devices that are implanted less than 40 days after a patient’s heart attack or less than 90 days after bypass surgery or angioplasty, the release says.
The purpose of the rule is to allow time for the heart to improve to the point that an implanted device may be unnecessary, the release says.
A call to the administrative offices of Arkansas Heart Hospital seeking comment wasn’t returned Thursday.
Harry Hutchison, chief financial officer at St. Bernards Medical Center, said in a statement that his hospital’s settlement involved a “small number of procedures” in which the devices were implanted “to address serious medical conditions such as improving overall heart function and/or avoiding the risk of sudden cardiac death.”
The hospital followed “best clinical practices,” but those practices had not been incorporated into Medicare’s payment guidelines at the time the procedures were performed, Hutchison said.
“The settlement agreement is not an admission of liability by St. Bernards and was entered into solely to avoid the delay, uncertainty, inconvenience and expense of protracted litigation on the claims in questions,” Hutchison said.
The investigation stemmed from a lawsuit filed in Florida by a cardiac nurse and health care reimbursement consultant under the federal False Claims Act, which allows citizens to file lawsuits on behalf of the United States and receive a portion of a judgment or settlement, the release says.
The plaintiffs received more than $3.5 million as a result of the settlements announced Wednesday and more than $38 million from the settlements announced in October.
The plaintiff’s attorney, Bryan Vroon of Atlanta, said in a phone interview that the investigation led to a nationwide reduction in the implant surgeries, saving the Medicare program billions of dollars.
“It’s a major victory for the Medicare program,” Vroon said.