On January 7, 2013, the U.S. Department of Justice announced the settlement of claims against an Ohio hospital and a group of cardiologists who allegedly performed unnecessary angioplasties and stent placements in patients at the hospital. The hospital, EMH Regional Medical Center (“EMH”), has agreed to pay the United States $3,863,857, and the cardiology group, 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 for unnecessary cardiac procedures on Medicare patients that were performed between 2001 and 2006. The allegations claimed that angioplasties and stent placement procedures were performed on patients who had heart disease but whose blood vessels were not sufficiently occluded to require the procedures.
The former manager of EMH’s catheterization and electrophysiology lab was the whistleblower who filed a complaint pursuant to the False Claims Act (“FCA”) for which he will receive $660,859 of the settlement (under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the government).
In announcing the settlement of the whistleblower claims, an Assistant Attorney General of the Justice Department’s Civil Division stated, “Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and puts patients at risk. The settlement demonstrates the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries.” The U.S. Attorney for the Northern District of Ohio stated, “Most doctors act responsibly. These few didn’t. Patient health and taxpayer dollars have to come before greed.”
The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”) has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation that has resulted in the U.S. Justice Department recovering more than $10.1 billion since January 2009 in FCA cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion.
The case is captioned United States ex rel. Loughner v. EMH Regional Medical Center, et al., Case No. 1:06-cv-2441 (N.D. Oh.).
The need for a patient to have a stent procedure is based on a cardiologist’s professional experience and judgment. While sometimes the extent (percentage) of blockage in a cardiac artery is subject to honest, objective differences in professional opinions, when cardiologists “fudge” the extent of the occlusion or outright lie about the significance of the blockage in order to justify performing a stent procedure for which the cardiologist, the catheterization lab, and the hospital receive significant compensation, and their fraudulent scheme is discovered and exposed, they should be quickly and harshly punished and prevented from performing stent procedures unless and until their opinions are corroborated independently so that patients do not suffer the consequences of unnecessary stents.
If you or a loved one may have had a stent procedure that was unnecessary, you should promptly consult with a local medical malpractice attorney who may be willing to investigate the possible medical malpractice claim for you and file a medical malpractice case against the negligent parties on your behalf, if appropriate.
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