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U.S. reaches settlement with 457 hospitals over cardiac device

U.S. reaches settlement with 457 hospitals over cardiac device

UPMC and the US Department of Justice have reached a $5.4 million settlement in the case of false-claim violations that included cardiac devices’ implantation against Medicare guidelines in patients and receiving Medicare payments.

The US Justice Department said on Friday the hospitals were implanting a certain type of device too soon after the bypass surgery of patients, heart attack or angioplasty. It involved implantable cardioverter defibrillators, which detect and treat life-threatening heart rhythms by shocking the heart back to a normal beat.

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.

They stand to receive $38 million from the settlements, Mr. Vroon said, while the department continues investigating additional hospitals and health systems for performing unnecessary procedures against science-based guidelines.

WakeMed officials said disputed ICD claims represented less than 2 percent of the ICD implant procedures performed at WakeMed during the 10-year period.

Medicare coverage for a cardiac defibrillator pays about $25,000.

TGH cooperated fully with the government, the hospital statement said, and “agreed to the settlement to avoid costly and distracting litigation”.

Elizabeth and CHI Nebraska Heart, as well as CHI Good Samaritan in Kearney, were among 17 hospitals owned by Catholic Health Initiatives that were part of the $250 million nationwide settlement announced Friday.

The Department’s investigation has resulted in major reductions in patients undergoing surgical procedures to implant ICDs. There is a 40-day waiting period to implant an ICD in a heart attack patient and a 90-day waiting period for bypass/angioplasty patients.

Cooper Health System in Camden, Deborah Heart and Lung Center in Browns Mills, Hackensack University Medical Center, Robert Wood Johnson University Hospital in New Brunswick and The Valley Hospital in Ridgewood joined more than 450 other hospitals in 70 health networks to settle the charges.

Florida Health Sciences Center, Inc. better known as Tampa General Hospital, is listed as paying $2 million.

“The settlements announced today demonstrate the Department of Justice’s commitment to protect Medicare dollars and federal health benefits”, said Wifredo A. Ferrer, U.S. Attorney for the Southern District of Florida.

The cardiac-device lawsuit is unrelated to a qui tam whistle-blower action pending in U.S. District Court in Erie against a group of UPMC Hamot cardiologists.

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