Baptist Memorial Hospital-DeSoto in Southaven, Baptist Memorial Hospital-Golden Triangle in Columbus and Baptist Memorial Hospital-North Mississippi in Oxford were part of the $250 million deal.
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The alleged violations involve an implantable cardioverter defibrillator – an electronic device implanted near, and connected to, the heart – which detects and treats life-threatening irregular heart rhythms by delivering a shock to the heart and restoring its normal rhythm.
The device costs about $25,000 and Medicare requires providers to wait 40 days after a heart attack or 90 days after a bypass or angioplasty before implanting the device. The waiting periods are to give the heart an opportunity to improve function on its own to the point that an the defibrillator may not be necessary.
The case started as a whistleblower lawsuit in Florida, and the government took the position that hospitals could not bill Medicare for charges related to an ICD insertion if the physician’s medical decision to insert one was based on clinical criteria not specifically listed in Medicare’s 2005 coverage guidelines or if the patient’s medical record did not contain documentation that addressed each of the Medicare criteria. The Trinity spokeswoman said the hospital fully cooperated with the Justice Department and that its doctors acted in patients’ bests interests.
“These patients are advised that they talk to their physician if they have questions about the device and its use for cardiac conditions”, St. Joseph Health said in the statement. “Our office will continue to vigilantly protect the Medicare program from potential false billing claims”.
Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a health care reimbursement consultant, filed the suit in the U.S. District Court for the Southern District of Florida. “Guided by a panel of leading cardiologists and the review of thousands of patients’ charts, the extensive investigation behind the settlements was heavily influenced by evidence-based medicine”. They received more than $38 million from the settlement, the Justice Department said. The Department of Justice said that additional hospitals and health systems are being investigated for similar billing procedures.
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There were no findings of wrongdoing or liability on behalf of our affiliated hospitals; however, we agreed to the settlement to avoid the continuing delay, uncertainty, inconvenience and expense of protracted litigation. One of the most powerful tools in this effort is the False Claims Act, according to the government’s statement. Call him at 435-674-6253.
