450 hospitals to pay over $250 mn for Medicare fraud
02 November 2015
Over 450 hospitals in the US state of Georgia will pay more than $250 million to settle accusations that cardiac devices were implanted in Medicare patients, in violation of guidelines.
Officials of the Justice Department said that cardiac devices should not be used till 40 days after heart attack and 90 days after bypass.
The devices were implanted during this waiting period, which was not allowed by the National Coverage Determination.
According to the Department of Justice, between 2003 and 2010, a number of Georgia hospitals implanted ICDs during the waiting period, which was prohibited by the National Coverage Determination.
According to Savannah Now, Atlanta's Department of Justice announced that the Atlanta hospitals involved in the settlement included Emory University Hospital, Saint Joseph's Hospital.
The cardiac device in question, an implantable cardioverter defibrillator, or ICD is an electronic device that is typically implanted near and connected to the hearts of patients who might potentially suffer cardiac complications.
The device detects life-threatening heart rhythms, called fibrillations, and when such rhythms happen, it delivers a shock to the heart, restoring it to its normal rhythm.
A National Coverage Determination governed the Medicare coverage for the device, which costs around $25,000. The governing body had concluded that an ICD should not be implanted in a patient who had recently suffered a heart attack, or had recently had a heart bypass surgery or angioplasty.
Generally a waiting period is observed, during which professionals seek to more accurately determine whether or not an ICD is required.
Meanwhile, the University of Pittsburgh Medical Center (UPMC) is said to have reached a $5.4-million settlement with the US Department of Justice over false-claim violations against Medicare guidelines.
Hamot, Mercy, Passavant and Presbyterian Shadyside, four UPMC hospitals, had reached settlements totaling nearly $258 million for Medicare billing rules violations.
According to the Department of Justice, the UPMC hospitals implanted cardiac devices in patients, which was against the national guidelines.
Also, the settlement had been reached to avoid protracted litigation.
As per the statement from the UPMC, the settlement with the Department of Justice showed full cooperation of the hospitals and their commitment to adhering to coverage rules set forth by Medicare.
Along with the UPMC, Saint Vincent Hospital in Erie, part of the Allegheny Health Network, also paid a $1.4 million settlement.