Media On National ICD Settlements
Nearly 500 Hospitals Settle Largest Ever Federal False Claims Act Investigation into Cardiac Procedures on Medicare Patients
Landmark Enforcement of National Coverage Determination Recovers $257 Million, Saves Medicare More than $2 Billion
October 30, 2015
A groundbreaking federal investigation has led to nearly 500 hospitals agreeing to pay $257,650,000.00 to settle allegations that they improperly billed Medicare for surgical procedures to implant cardioverter defibrillators (ICDs). The settlement, announced today by the U.S. Department of Justice (DOJ), is the largest ever in terms of number of hospitals under the False Claims Act, and a landmark enforcement of the Medicare Program’s National Coverage Determinations to reduce unnecessary procedures in Medicare patients.
The Justice Department negotiated 70 separate settlements with the hospital systems, including some of the largest systems in the country. HCA and Tenet Healthcare, for example, have agreed to pay $15.8 million and $12.1 million, respectively.
The federal investigation stemmed from a complaint filed seven years ago by two whistleblowers – Leatrice Richards, a registered cardiovascular nurse and Medicare-compliance and reimbursement consultant, and Thomas Schuhmann, also a Medicare-compliance and reimbursement consultant, both from Louisville, KY – under the False Claims Act which permits whistleblowers to bring a lawsuit on behalf of the Medicare Program. The two whistleblowers were represented by Atlanta-based attorney, Bryan Vroon.
Through their investigation, the whistleblowers found hundreds of hospitals were billing Medicare for surgeries to implant cardioverter defibrillators that did not meet the medical conditions for Medicare coverage established in the National Coverage Determination (NCD). Medicare generally excludes coverage for ICD procedures in patients who have undergone coronary bypass surgery or angioplasty within the last 90 days or within 40 days of a heart attack. The NCD ensures that Medicare patients receive science-based “reasonable and necessary” medical treatment.
Two DOJ attorneys, Jeffrey Dickstein and Amy Easton, led the federal investigation. The investigation has changed cardiac care of Medicare patients by requiring physicians and hospitals to comply with science-based coverage conditions. The DOJ investigation has resulted in major reductions in patients undergoing surgical procedures to implant ICDs. Since the beginning of the DOJ investigation, ICD procedures in Medicare patients have decreased by approximately 28 percent. According to an analysis by Vroon, that reduction represents a savings of more than $2 billion to the Medicare Program during the last five years.
“Jeffrey Dickstein and Amy Easton led this investigation with extraordinary dedication to Medicare and the medical care of elderly patients,” said Vroon. “Their work is critically important to ensuring that Medicare patients receive needed treatment based on science.”
Whistleblowers Leatrice Richards and Tom Schuhmann also praised the work of Dickstein and Easton. “Jeffrey Dickstein and Amy Easton did exceptional work addressing an important issue for patient care,” said Richards. “Their work was comprehensive and extremely skillful in dealing with a range of difficult challenges,” said Schuhmann.
Vroon recognized Richards and Schuhmann as “smart, courageous, and committed to protecting patients and the Medicare Program.”
Three years after the federal investigation began, a major study led by researchers at Duke University found that in a national sample of 111,707 patients receiving ICDs for primary prevention, 25,145 patients or 22.5 percent were “non–evidence-based ICD implants (i.e., patients who were either excluded from the major primary prevention clinical trials of ICD therapy or shown not to benefit from an ICD in other trials).” Al-Kahtib, et al, “Non-Evidence-Based ICD Implantation in the United States,” JAMA, January 5, 2011, Volume 305, No. 1, 43, 47. The Duke University researchers further reported, “Patients who received a non–evidence-based ICDs had significantly more comorbidities than patients who received an evidence-based device and were at a higher risk of post-procedural complications (including death).” Id. at p. 47. The researchers recommended, “As such, more efforts should focus on enhancing adherence to evidence-based practice.” Id. at p. 49.
The agreed whistleblower award to Ms. Richards and Mr. Schuhmann is $38,227,500.
Click here for additional information on Introduction to the Clinical Issues for Medicare Patients.
For further information, please contact Bryan Vroon, Law Offices of Bryan Vroon LLC, at (404) 441-9806 or firstname.lastname@example.org. Vroon also represented the whistleblower in the landmark 70 million Stark settlement announced last month involving Broward Health.
How DOJ Got 500‑Plus Hospitals To Settle Over Cardiac Implants
Modern Healthcare | May 28, 2016 | By Lisa Schencker
The two federal prosecutors were skeptical.
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2 State Hospitals Settle Medicare Cardiac‑Implant Suit
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.
Health System That Includes St. Francis Settles $1.95 Million DOJ Lawsuit
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. Joseph’s, Chandler Regional Hospitals Settle Cardiac Claims
The Arizona Republic | February 17, 2016 | By Ken Alltucker
St. Joseph's Hospital and Medical Center and Chandler Regional Medical Center are among 51 hospitals that have agreed to pay more than $23 million to settle whistleblower claims over Medicare billings for implanted cardiac devices, the U.S. Department of Justice said Wednesday.
Feds Wrap National Probe Into Cardiac Devices; 51 More Hospitals Settle
Modern Healthcare | February 17, 2016 | By Lisa Schencker
Another 51 hospitals will pay the government to get out from under a federal probe into the suspected overuse of implantable cardioverter defibrillators, or ICDs. The U.S. Justice Department said the settlements announced Wednesday, which tally $23 million, mark the “final stage” of its far-reaching investigation.
Sentara Settles Lawsuit Over Allegations About Cardiac Devices
The Virginian‑Pilot | February 17, 2016 | By Amir Vera
Sentara Healthcare has settled a lawsuit over allegations that cardiac devices were implanted in patients in violation of Medicare coverage requirements.
DOJ Shows Medicare Addresses Unnecessary Procedures
Des Moines Register | December 27, 2015
A seven-year federal investigation recently revealed that thousands of elderly Medicare patients have undergone surgeries to implant cardioverter defibrillators in violation of Medicare’s science-based coverage conditions. On Oct. 30, the U.S. Department of Justice announced that it had reached settlements with 70 hospital systems involving 457 hospitals in 43 states for more than $250 million.
UPMC Pays $5.4 Million In Medicare Claims Case
Pittsburgh Post‑Gazette | October 31, 2015 | By David Templeton
UPMC has reached a $5.4 million settlement with the U.S. Department of Justice for false-claim violations involving implantation of cardiac devices against Medicare guidelines in patients and then receiving Medicare payments.
Landmark Medicare Fraud Settlement For Cardiac Device Surgery Includes 46 Florida Hospitals
Miami Herald | October 30, 2015 | By Daniel Chang
Nine hospitals in South Florida are among nearly 500 nationwide that agreed to pay $257 million in a landmark settlement of charges that they improperly billed Medicare for surgical procedures to implant cardiac defibrillators in patients, the U.S. Justice Department announced Friday.