{"id":16917,"date":"2015-10-30T13:53:43","date_gmt":"2015-10-30T20:53:43","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=16917"},"modified":"2015-10-30T13:53:43","modified_gmt":"2015-10-30T20:53:43","slug":"feds-nearly-500-hospitals-pay-more-than-250-million-related-to-cardiac-devices","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=16917","title":{"rendered":"Feds: Nearly 500 Hospitals Pay More Than $250 Million Related to Cardiac Devices"},"content":{"rendered":"

WASHINGTON<\/strong><\/h2>\n
\n

\"ImagesFederalCourts\"<\/a>The federal government reached 70 settlements involving 457 hospitals in 43 states for more than $250 million related to cardiac devices that were implanted in Medicare patients in violation of Medicare coverage requirements, officials announced today.<\/span><\/p>\n

\u201cWhile recognizing and respecting physician judgment, the department will hold accountable hospitals and health systems for procedures performed by physicians at their facilities that fail to comply with Medicare billing rules,\u201d said Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department\u2019s Civil Division.<\/strong>\u00a0 \u201cWe are confident that the settlements announced today will lead to increased compliance and result in significant savings to the Medicare program while protecting patient health.\u201d\u00a0<\/span><\/p><\/blockquote>\n

Most of the settling defendants were named in a qui tam, or whistleblower<\/strong>, lawsuit brought under the False Claims Act, which permits private citizens to bring lawsuits on behalf of the federal government, officials said.<\/span><\/p>\n

The whistleblowers in this case have received more than $38 million from the settlements, according to officials. \u00a0<\/span><\/p>\n

Officials said the claims resolved by these settlements are allegations only and there has been no determination of liability. <\/span><\/p>\n

An implantable cardioverter defibrillator, or ICD, is an electronic device that is implanted near and connected to the heart.\u00a0 It detects and treats chaotic, extremely fast, life-threatening heart rhythms, called fibrillations, by delivering a shock to the heart, restoring the heart\u2019s normal rhythm.\u00a0 <\/span><\/p>\n

It is similar in function to an external defibrillator (often found in offices and other buildings) except that it is small enough to be implanted in a patient\u2019s chest.\u00a0 Only patients with certain clinical characteristics and risk factors qualify for an ICD covered by Medicare.\u00a0<\/span><\/p>\n

Medicare coverage for the device, which costs approximately $25,000, is governed by a National Coverage Determination or NCD.\u00a0 <\/span><\/p>\n

The Centers for Medicare and Medicaid Services implemented the NCD based on clinical trials and the guidance and testimony of cardiologists and other health care providers, professional cardiology societies, cardiac device manufacturers and patient advocates.\u00a0 <\/span><\/p>\n

The NCD provides that ICDs generally should not be implanted in patients who have recently suffered a heart attack or recently had heart bypass surgery or angioplasty.\u00a0 <\/span><\/p>\n

The medical purpose of a waiting period -40 days for a heart attack and 90 days for bypass\/angioplasty – is to give the heart an opportunity to improve function on its own to the point that an ICD may not be necessary, according to officials.<\/span><\/p>\n

The NCD expressly prohibits implantation of ICDs during these waiting periods, with certain exceptions.\u00a0 <\/span><\/p>\n

The Department of Justice<\/strong> alleged that from 2003 to 2010, each of the settling hospitals implanted ICDs during the periods prohibited by the NCD.\u00a0\u00a0<\/span><\/p>\n

\u201cThe settlements announced today demonstrate the Department of Justice\u2019s commitment to protect Medicare dollars and federal health benefits,\u201d said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.<\/strong>\u00a0 \u201cGuided by a panel of leading cardiologists and the review of thousands of patients\u2019 charts, the extensive investigation behind the settlements was heavily influenced by evidence-based medicine.\u00a0 In terms of the number of defendants, this is one of the largest whistleblower lawsuits in the United States and represents one of this office\u2019s most significant recoveries to date.\u00a0\u00a0 Our office will continue to vigilantly protect the Medicare program from potential false billing claims.\u201d<\/span><\/p><\/blockquote>\n

The 70 settlements, representing nearly 500 hospitals, are listed on the attached chart.\u00a0<\/a> <\/span><\/p>\n

The Department of Justice is continuing to investigate additional hospitals and health systems.<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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