Healthcare News & Insights

Whistleblower complaint: Centers pay $4.4M to resolve FCA allegations

Let your managers and supervisors know that if an employee ever expresses concern to them about billing practices at your hospital, they need to take these complaints seriously and thoroughly investigate the claims. If not, they could end up in hot water, paying big fines.

After all, while it takes time to lodge a complaint and file a lawsuit, it behooves whistleblowers to get involved because they get a portion of what’s collected.

Take a look at this case:

EMH Regional Medical Center (EMH) has agreed to pay the United States $3,863,857 and North Ohio Heart Center, Inc., (NOHC) has agreed to pay the United States $541,870 to settle allegations that they submitted false claims to Medicare, the Justice Department announced.

EMH is a non-profit community hospital system located in Lorain County, OH.  During the period in question, NOHC was an independent physician group located in Lorain County that practiced at EMH.

Initiated by whistleblower

This investigation came about from a whistleblower complaint under the False Claims Act (FCA). Kenny Loughner, a former manager of EMH’s catheterization and electrophysiology laboratory, and the whistleblower in this case, will receive $660,859 of the settlement.

It was alleged by the Justice Department that between 2001 and 2006 EMH and NOHC performed unnecessary cardiac procedures on Medicare patients.  Specifically, it was alleged that EMH and NOHC performed angioplasty and stent placement procedures on patients who had heart disease, but whose blood vessels weren’t sufficiently occluded to require these procedures.

“Billing Medicare for cardiac procedures that aren’t necessary or appropriate contributes to the soaring costs of health care and puts patients at risk.  Today’s settlement evidences the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries,” Stuart Delery, principal deputy assistant attorney general of the Justice Department’s Civil Division, said in a release.

“Most doctors act responsibly. These few didn’t,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “Patient health and taxpayer dollars have to come before greed.”

Defending their honor

According to Dr. John Schaeffer, chairman and president of North Ohio Heart Center, the settlement isn’t an admission of wrongdoing. The facilities decided to settle to put the matter to rest so they could move forward.

“It’s important to note that this settlement is only about whether or not Medicare covered some procedures we did six to 10 years ago that were considered cutting edge at the time,” explained Dr. Schaeffer. “As the physicians on the ground when these decisions were made and the procedures were performed, we felt confident we were making the correct choices for our patients. We still do, and we are gratified that NOHC has passed every Medicare audit ever done — whether regarding stent procedures or any other service.”

The chairman also noted that NOHC is consistently recognized for being among the best providers of cardiac care in the country.

Note: This resolution is part of the government’s emphasis on combating healthcare fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative.

 

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