Local hospitals settle whistleblower allegations

Local hospitals settle whistleblower allegations

Mount Sinai Medical Center and the Cleveland Clinic Florida were two of 51 hospitals to reach settlements with the U.S. Department of Justice related to cardiac devices implanted in patients in violation of Medicare coverage requirements, the DOJ announced Wednesday.

The DOJ reached combined settlements of more than $23 million from the 51 hospitals. Combined, the DOJ’s investigation into hospitals’ billing of Medicare for the cardiac devices had resulted in more than $280 million settlement from over 500 hospitals.

Wednesday’s news follows an approximately $250 million settlement in October, when the DOJ announced settlements with almost 500 hospitals .

Miami Beach-based Mount Sinai agreed to pay $1.9 million. Cleveland Clinic Florida Health System is one of six hospitals under the Ohio-based Cleveland Clinic Foundation umbrella mentioned in the DOJ release that agreed to pay a total of $1.6 million.

Mount Sinai did not return a request for comment.

Cleveland Clinic said in a statement to Crain’s that the organization “ would provide the same treatment again if presented with the same illness … The only question was whether Medicare would reimburse part of the cost of the treatments. While we believe that the charges were appropriate, we chose to settle the matter rather than engaging in expensive litigation that distracts from our Mission.”

The DOJ’s investigation alleged that the settling hospitals gave patients implantable cardioverter defibrillators ahead of an established waiting period. The defibrillators detect and treat life-threatening heart rhythms. ICD devices cost approximately $25,000.

The waiting period varies depending on situation, but exists to give patient’s hearts the opportunity to heal following a heart attack or bypass/angioplasty.

The settlements are the result of a whistleblower suit filed in the Southern District of Florida by a cardiac nurse and a health care reimbursement consultant. It is one of the largest whistleblower suits in the United States.

“The settlements announced last October and today demonstrate the Department of Justice’s commitment to protect Medicare dollars and federal health benefits,” U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida said in a statement. “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.”

Original story.

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