{"id":20540,"date":"2016-02-18T11:15:15","date_gmt":"2016-02-18T19:15:15","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=20540"},"modified":"2016-02-18T12:18:17","modified_gmt":"2016-02-18T20:18:17","slug":"feds-51-hospitals-pay-23-million-resolve-false-billings-cardio-devices","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=20540","title":{"rendered":"Feds:  51 Hospitals Pay $23 Million to Resolve False Billings for Cardio Devices"},"content":{"rendered":"<p><strong><span style=\"font-size: 14pt;\">\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 <span style=\"font-size: 18pt;\">\u00a0 \u00a0 \u00a0 FLORIDA<\/span><\/span><\/strong><\/p>\n<hr \/>\n<p>&nbsp;<\/p>\n<p><span style=\"font-size: 14pt;\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-8666 alignleft\" src=\"https:\/\/cjnotebook.com\/wp-content\/uploads\/2015\/01\/Justice-Depart-300x300.jpg\" alt=\"Justice-Depart\" width=\"300\" height=\"300\" srcset=\"https:\/\/cjnotebook.com\/wp-content\/uploads\/2015\/01\/Justice-Depart-300x300.jpg 300w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2015\/01\/Justice-Depart-150x150.jpg 150w, https:\/\/cjnotebook.com\/wp-content\/uploads\/2015\/01\/Justice-Depart.jpg 320w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/>The federal government announced that 51 hospitals will pay more than $23 million related to allegations involving cardiac devices that were implanted on Medicare patients, according to officials.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">Only patients with certain clinical characteristics and risk factors qualify for cardioverter defibrillator, or ICD under Medicare, officials said Wednesday.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">The 51 hospitals are located in 15 states: \u00a0Click here for the listing: <strong><a href=\"http:\/\/www.justice.gov\/opa\/file\/825581\/download\">Hospitals<\/a><\/strong><\/span><\/p>\n<p><span style=\"font-size: 14pt;\">Most of the settlements like this one are a result of whistleblowers who brought these cases to light under the False Claims Act, officials said.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">In this case, a lawsuit was filed in federal district court in Florida by Leatrice Ford Richards, a cardiac nurse and Thomas Schuhmann, a health care reimbursement consultant.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">Richards and Schuhmann will receive more than $3.5 million from the settlements as a result of their shedding light on this medical problem, \u00a0according to federal authorities.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">These recent settlements represent the final stage of a nationwide investigation into the practices of hundreds of hospitals improperly billing Medicare for these devices.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">With these additional agreements, the Justice Department\u2019s investigation has now yielded settlements with more than 500 hospitals totaling more than $280 million, federal officials said.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">\u201cThese settlements demonstrate the Department\u2019s continued vigilance in pursuing hospitals and health systems that violate Medicare\u2019s national coverage rules,\u201d said <strong>Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department\u2019s Civil Division.\u00a0<\/strong> \u201cWe will hold accountable those who do not abide by the government\u2019s rules in order to protect the federal fisc and, more importantly, patient health.\u201d<\/span><\/p>\n<p><span style=\"font-size: 14pt;\"><strong>Here is what a ICD does when it is implanted, according to authorities:<\/strong><\/span><\/p>\n<ul>\n<li><span style=\"font-size: 14pt;\">An implantable cardioverter defibrillator, or ICD, is an electronic device that is implanted near and connected to the heart.<\/span><\/li>\n<li><span style=\"font-size: 14pt;\">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.<\/span><\/li>\n<li><span style=\"font-size: 14pt;\">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.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-size: 14pt;\">Medicare coverage for the device, which costs approximately $25,000, is governed by a National Coverage Determination or NCD<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">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.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">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.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">The medical purpose of a waiting period &#8211; 40 days for a heart attack and 90 days for bypass\/angioplasty &#8211; is to give the heart an opportunity to improve function on its own to the point that an ICD may not be necessary.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">The NCD expressly prohibits implantation of ICDs during these waiting periods, with certain exceptions.\u00a0 The Department of Justice alleged that from 2003 to 2010, each of the settling hospitals implanted ICDs during the periods prohibited by the NCD.<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">\u201cThe settlements announced last October and today demonstrate the Department of Justice\u2019s commitment to protect Medicare dollars and federal health benefits,\u201d said <strong>U.S. Attorney Wifredo A. Ferrer<\/strong> of Florida.\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>\n<p><span style=\"font-size: 14pt;\">\u201cWe will not stand idly by while Medicare coverage rules are ignored,\u201d said Inspector General Daniel R. Levinson of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).\u00a0 \u201cOIG worked closely with the Department of Justice to ensure such violators made substantial payments to settle these false billing claims.\u201d<\/span><\/p>\n<p><span style=\"font-size: 14pt;\">The department previously settled with 457 hospitals for more than $250 million.<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The federal government announced that 51 hospitals will pay more than $23 million related to allegations involving cardiac devices that were implanted on Medicare patients, according to officials.<\/p>\n","protected":false},"author":1,"featured_media":9884,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,3],"tags":[1846,473,179,2243],"class_list":["post-20540","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-home-main-slider","category-u-s-department-of-justice","tag-false-claims-act","tag-fraud","tag-medicare","tag-whistlebowers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Feds: 51 Hospitals Pay $23 Million to Resolve False Billings for Cardio Devices<\/title>\n<meta name=\"description\" content=\"The federal government announced that 51 hospitals will pay more than $23 million related to allegations involving cardiac devices that were implanted on Medicare patients, according to officials.\" \/>\n<meta name=\"robots\" content=\"index, follow, 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