Nationwide cardiac device probe wraps up with $23M settlement

More than 500 hospitals have been implicated in FCA violations
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The final stage of a nationwide investigation into the billing practices of cardiac device implantations added more than 50 hospitals and millions in settlement dollars to an investigation that has implicated more than 500 hospitals to date.

Fifty-one hospitals in 15 states agreed to pay $23 million to settle false claims allegations tied to implantable cardioverter defibrillators (ICD), according to the Department of Justice (DOJ). Medicare rules specify that ICDs should not be implanted within 40 days of a heart attack or within 90 days of heart bypass surgery or angioplasty. DOJ prosecutors alleged that between 2003 and 2010, each of the 51 hospitals implemented devices within this prohibited time period.

Notable providers named in the settlement include six hospitals within the Cleveland Clinic Foundation ($1.6 million), 19 hospitals within Dignity Health ($5.9 million) and six hospitals within Northwell Health ($2.5 million).

The Cleveland Clinic defended itself, arguing the procedures were necessary.

"Cleveland Clinic would provide the same treatment again if presented with the same illness," the system said in a written statement, according 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."

The settlement marked the final stage of a nationwide investigation that led to more than $280 million in settlements. In October, 457 hospitals agreed to pay $250 million to settle similar claims of inappropriate implementation of cardiac devices. In general, cardiology has faced an onslaught of investigations tied to unnecessary procedures, a byproduct of a fee-for-service payment system that pays a premium for cardiac surgeries and incentivizes volume over value, according to some experts. In December, an Ohio cardiologist sentenced to 20 years in prison said the government used the Affordable Care Act to target him.

To learn more:
- read the DOJ announcement
- here's the Cleveland.com article

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