By: Allan M. Siegel
The U.S. Department of Justice recently announced it reached agreements
with 457 hospitals, who will pay more than $250 million to settle Medicare
billing fraud charges related to a whistleblower lawsuit. The hospitals
were charged in a whistleblower lawsuit with fraudulently billing Medicare
for implanting cardiac devices.
The False Claims Act empowers individuals with detailed knowledge of Medicare
fraud to work with a private attorney and file a whistleblower lawsuit.
If the case is successful, the whistleblower is eligible to share in as
much as 30% of an eventual verdict or settlement related to the lawsuit.
In this $250 million settlement, a federal Medicare fraud investigation
was launched after two whistleblowers filed a False Claims Act complaint
alleging that hospitals were billing Medicare for implantable cardioverter
defibrillators (ICDs) placed in patients who did not meet the requisite
medical conditions for the device. ICD devices, which are implanted near
and connected to a patient’s heart, detects and treats dangerous
heart rhythms by delivering a shock to the heart.
Only patients who meet strict medical characteristics may qualify for an
ICD covered by Medicare. The device costs about $25,000. Before implanting
an ICD, the Medicare rules require waiting 40 days after a patient has
a heart attack and 90 days after heart bypass surgery or angioplasty.
The rules explicitly prohibit implanting ICDs during these waiting periods.
According to the whistleblower lawsuit (also known as a qui tam suit),
the hospitals in this case implanted ICDs in patients before the waiting
period was over. Rather than adhere to Medicare guidelines, these hospitals
decided to violate the rules and have taxpayers foot the Medicare bill.
Several local hospitals did not escape the DOJ’s watchful eyes. Peninsula
Regional Medical Center in Salisbury, Maryland will pay $2.9 million to
settle the False Claims Act case. MedStar Health of Columbia, Maryland,
and eight other unaffiliated hospitals will pay $5 million to settle charges
it bilked Medicare with fraudulent billing practices. The eight other
hospitals footing this bill are:
- Franklin Square Hospital Center, Inc.
- The Good Samaritan Hospital of Maryland, Inc.
- Harbor Hospital, Inc.
- MedStar-Georgetown Medical Center, Inc.
- MedStar Southern Maryland Hospital Center, Inc.
- Montgomery General Hospital, Inc.
- The Union Memorial Hospital
- Washington Hospital Center Corporation
Hospitals in Washington, D.C. will also pay for violating federal healthcare
laws. The George Washington University Hospital, and 19 other unaffiliated
hospitals, are party to a $4.9 million whistleblower settlement. In addition,
Providence Hospital in Washington, D.C. and 32 other unaffiliated hospitals
will pay $14.9 million for False Claims Act violations.
The False Claims Act rewards citizens who report Medicare billing fraud
and bring whistleblower lawsuits. The whistleblowers in this case –
cardiac nurse Leatrice Ford Richards and health care consultant Thomas
Schuhmann – received more than $38 million from the False Claims
Chaikin, Sherman, Cammarata, and Siegel P.C. represents
whistleblowers but is not involved in these implantable cardioverter defibrillators settlements