A nonprofit community hospital system in Ohio and a physician group have agreed to pay more than $4.4 million to settle allegations over Medicare billing, according to the U.S. Department of Justice (DOJ).
EMH Regional Medical Center in Elyria will pay $3.9 million and the North Ohio Heart Center $541,870 as part of a civil settlement based on allegations that they submitted false claims to Medicare between 2001 and 2006. John Schaeffer, MD, chairman and president of North Ohio Heart Center, said in a statement that the settlement is not an admission of wrongdoing.
The DOJ alleged that the hospital system and the then-independent physician group performed angioplasty and stent placement procedures on patients who had heart disease but whose blood vessels were not sufficiently occluded to require the particular procedures at issue. The case was initiated by the filing of a whistleblower complaint under the False Claims Act.
Schaeffer said that the settlement focused on whether or not Medicare covered some procedures performed during the period under review that were then considered cutting edge. “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,” he said.
On Sept. 1, 2010, 22 cardiologists at North Ohio Heart Center and 24 primary care physicians at its primary care division, Ohio Medical Group, joined the EMH Regional Healthcare System. Schaeffer said that the group has passed all Medicare audits, “whether regarding stent procedures or any other service.”
Stuart F. Delery, principal deputy assistant attorney general in the DOJ’s Civil Division, described the settlement as part of DOJ’s efforts to crack down on misuse of healthcare funds. “Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of healthcare and puts patients at risk,” he said in a release.
As part of the settlement, whistleblower Kenny Loughner, former manager of EMH’s catheterization and electrophysiology laboratory, will receive $660,859. The DOJ said it has used the False Claims Act to recover more than $10.1 billion since January 2009 in cases involving fraud against federal healthcare programs.