The Topeka Capital‑Journal | February 18, 2016 | By Morgan Chilson
St. Francis Health this week joined about 500 hospitals nationwide that settled in a U.S. Department of Justice case involving the use of cardiac devices implanted in Medicare patients.
St. Francis was one of five Sisters of Charity of Leavenworth (SCL) system hospitals that settled in the lawsuit for $1.95 million, according to the Department of Justice.
“SCL Health recently reached a settlement with the Department of Justice relating to billing guidelines for the insertion of Implantable Cardioverter Defibrillators,” SCL said in a statement. “It is important to note that the safety and well-being of SCL Health patients was never an issue and that hundreds of hospitals and health systems across the nation have settled with the DOJ over this billing interpretation issue. In the settlement, SCL Health made no admission of wrongdoing, and we will continue to work diligently to comply with all billing requirements.”
Despite the statement from SCL Health and other hospitals nationwide defending their decision to implant the defibrillators in Medicare patients, Atlanta attorney Bryan Vroon said this case wasn’t about a Medicare billing issue. He represented the two whistleblowers in the case, which resulted in a DOJ settlement with 508 hospitals for upwards of $273 million.
“It has major implications for patient care,” he said. “The Medicare national coverage determination is based on the published scientific studies, and those scientific studies address the indications and contraindications for these devices to be implanted. So it’s not just a reimbursement issue, it’s really an issue of science-based medicine.”
Vroon said each hospital cited in the case had a chance to “address and defend” why the surgeries were done.
“They had medical experts come in at these settlement meetings, so they gave the hospitals ample opportunity to justify these surgeries, and still nationally there were thousands of violations found,” he said.
The lawsuit, filed in 2008, alleges that the hospitals used the devices in violation of Medicare regulations.
In a statement released to “Modern Healthcare,” the Cleveland Clinics, which paid $1.6 million for six hospitals in the lawsuit, stood by its medical decision to implant the devices, calling the treatment “life-saving and life-extending.”
“While we believe that the charges were appropriate, we chose to settle the matter rather than engaging in expensive litigation that distracts from our mission,” the Cleveland Clinic told “Modern Healthcare.”
Vroon said many medical organizations, including the American College of Cardiology, helped to create the CMS guidelines for appropriate use of the ICDs.
The case settlements reached weren’t an admission of fault. Vroon said this is the final settlement to be reached. In October 2015, 447 hospitals settled for upwards of $250 million. This week’s settlement included 51 hospitals that settled for about $23 million.
The other four SCL Health hospitals cited in the lawsuit were Providence Medical Center, Kansas City, Kan.; Saint John’s Hospital, Santa Monica, Calif.; Saint Vincent Healthcare, Billings, Mont.; and St. Mary’s Hospital & Medical Center, Grand Junction, Colo.
Related links: List of all 51 hospitals included in the complaint: http://cjon.co/1XAF2Ei; court documents: http://cjon.co/1RbcuPd.