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Settlement Reached with 51 Hospitals for Allegedly Improperly Implanting ICD’s
March 4, 2016
The Department of Justice (DOJ) announced on Feb. 17 that it had reached settlements worth a total of more than $23 million with 51 hospitals in 15 states for allegedly improperly implanting implantable cardioverter defibrillators (ICDs) cardiac devices in Medicare patients.
The claims were allegations, and the DOJ did not determine the hospitals were liable, according to a news release.
In October, the DOJ settled similar allegations worth $250 million with 457 hospitals in 43 states. In all, it has reached settlements worth more than $280 million with more than 500 hospitals.
The DOJ said the most recent settlements were the final ones related to hospitals allegedly improperly billing Medicare for ICDs.
Six hospitals affiliated with the Cleveland Clinic Foundation and the Mount Sinai Medical Center in Miami Beach, Fla., were among the 51 hospitals to settle on Feb. 17.
“Cleveland Clinic would provide the same treatment again if presented with the same illness,” the Cleveland Clinic said in a statement to Cleveland.com. “The only question was whether Medicare would reimburse part of the cost of the treatments. 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.”
According to the DOJ, the hospitals that reached settlement agreements each allegedly improperly implanted ICDs from 2003 to 2010. Each ICD costs Medicare approximately $25,000.
Under Medicare’s national coverage determination (NCD), ICDs are only appropriate for certain patients and should not usually be implanted in patients who had a recent MI or underwent a recent heart bypass surgery or angioplasty. The NCD notes that hospitals should typically wait 40 days following an MI and 90 days following a heart bypass surgery or angioplasty before implanting and ICD.
“These settlements demonstrate the Department’s continued vigilance in pursuing hospitals and health systems that violate Medicare’s national coverage rules,” Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division, said in a news release. “We will hold accountable those who do not abide by the government’s rules in order to protect the federal fiscal and, more importantly, patient health.”
Read More – Source: DOJ reaches settlements with 51 hospitals for allegedly improperly implanting ICDs | Cardiovascular Business
by Tim Casey