Christiana Care has agreed to pay $2.5 million in settlement over allegations regarding implants of a $25,000 cardiac device to Medicare patients. The allegations came out of whistle blower lawsuit filed in Florida.
The parent of St. Francis Hospital, Wilmington, also paid $11 million in a settlement involving several hospitals.
The payments were part of a quarter of a billion dollar settlement with the Justice Department.
Christiana Care issued the following statement denying any wrongdoing:
“In November 2014, Christiana Care Health System reached agreement with the U.S. Department of Justice to settle its involvement in a government investigation of more than 450 of the nation’s hospitals and health systems for Medicare billing practices related to implantable cardiac defibrillators (ICD). Christiana Care is committed first and foremost to providing high quality, person-centered care and to maintaining regulatory compliance.”
The statement continued: “Government investigators alleged that from 2003 to 2014 these hospitals improperly billed Medicare for implanting ICDs in several cases. While we deemed these procedures to be medically necessary and good patient care, government investigators found they did not fall within Center for Medicare and Medicaid Services’ established criteria for reimbursement. We deny the allegations of improper billing and negotiated the settlement not as an admission of liability, but rather in the interest of avoiding potentially lengthy and costly litigation.”
More than 450 hospitals were part of the settlement.
“While recognizing and respecting physician judgment, the department will hold accountable hospitals and health systems for procedures performed by physicians at their facilities that fail to comply with Medicare billing rules,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “We are confident that the settlements announced today will lead to increased compliance and result in significant savings to the Medicare program while protecting patient health.”
An implantable cardioverter defibrillator, or ICD, is an electronic device that is implanted near and connected to the heart. It detects and treats chaotic, extremely fast, life-threatening heart rhythms, called fibrillations, by delivering a shock to the heart, restoring the heart’s normal rhythm, a Justice Department release stated.
The device is similar in function to an external defibrillator (often found in airports, offices, and other buildings) except that it is small enough to be implanted in a patient’s chest.
Allegations seemed to center on whether the devices were implanted too soon after a heart attack or procedure, such as a bypass.
“The settlements announced today demonstrate the Department of Justice’s commitment to protect Medicare dollars and federal health benefits,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida. “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. In terms of the number of defendants, this is one of the largest whistleblower lawsuits in the United States and represents one of this office’s most significant recoveries to date. Our office will continue to vigilantly protect the Medicare program from potential false billing claims.”
