Eight Utah hospitals were among the hundreds of medical facilities nationwide to reach a settlement with the federal government Friday for reportedly violating Medicare coverage requirements while providing implanted cardiac devices to patients.
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An ICD is a battery powered device, implanted in the body and connected to the heart, that spots and treats chaotic, life-threatening heart rhythms.
The devices cost $25,000 each, and Medicare has strict rules for what patients can receive the devices and when.
In the claims that ended in settlements, the Justice Department alleged the hospitals implanted the devices during the Medicare-prohibited periods between 2003 and 2010.
The government’s case stems from a complaint filed seven years ago by two whistleblowers from Louisville, Ky., Leatrice Richards, a registered cardiovascular nurse and Medicare-compliance and reimbursement consultant, and Thomas Schuhmann, also a consultant. The rules expressly prohibit, the DOJ said, implantation during these waiting periods, with certain exceptions.
“We 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”, Benjamin C. Mizer, principal deputy assistant attorney general with the Justice Department, said in a release.
The hospital, along with 30 others in the Community Health Systems network, was implicated in a DOJ investigation into cardiac devices implanted in Medicare patients in violation of Medicare regulations, according to a DOJ news release.
The DOJ continues to investigate additional hospitals, the agency said.
Numerous South Florida hospitals that agreed to the settlement are owned by a few of the largest healthcare systems in the country, including Tennessee-based Hospital Corporation of America, which agreed to pay $15.8 million, and Tenet Healthcare headquartered in Texas, which will pay $12.1 million. The precise amount Hamot paid was not immediately available, though the government said a total of four UPMC-affiliated hospitals, including Hamot, paid a total of $5.4 million.
In response, the New Jersey hospitals, including a representative from Robert Wood Johnson, said the settlement indicated no admission of guilt and that the allegations were not related to the quality of care.
Nearly 500 hospitals, covered by 70 agreements, have agreed to settle whistleblower claims that they billed Medicare for specific cardiac procedures that did not qualify coverage. Medicare will not pay, though, if a defbrillator is implanted in a patient earlier than 40 days following a heart attack and 90 days following bypass surgery or angioplasty, an operation to unblock clogged arteries.
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St. Jude, St. Joseph and Mission hospitals are the three Orange County affiliates under St. Joseph Health System named in the lawsuit. Call him at 435-674-6253.
