Home 5 G2 Lab and Pathology Insider 5 archive 5 Latest Major False Claims Act Settlement Involves 457 Hospitals in 43 States

Latest Major False Claims Act Settlement Involves 457 Hospitals in 43 States

By Kelly A. Briganti, Editorial Director, G2 Intelligence The Department of Justice (DOJ) announced last week another major settlement of False Claims Act allegations, involving hundreds of providers. This time, it’s 70 settlements with 457 hospitals across 43 states, yielding over $250 million. The settlements were credited by the DOJ as another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative” and resulted from collaboration between the Florida U.S. Attorney’s Office and the Department of Health and Human Services’ Office of Inspector General. The underlying allegations included claims of improper Medicare billing for implanted cardiac devices. The government alleged that between 2003 and 2010, implantable cardioverter defibrillators (ICD) were implanted in Medicare beneficiaries during 40- and 90- day waiting periods following heart attacks and bypass/angioplasty, respectively. A National Coverage Determination generally bars implantation of ICDs during those waiting periods. The DOJ statement announcing the settlement cited an “extensive investigation” involving thousands of patient records and a panel of leading cardiologists. The settlement arises out of qui tam cases brought against most of the hospitals, filed in Florida federal court. The DOJ reports that still more hospitals and health systems remain under investigation. “In terms of the […]

By Kelly A. Briganti, Editorial Director, G2 Intelligence

The Department of Justice (DOJ) announced last week another major settlement of False Claims Act allegations, involving hundreds of providers. This time, it’s 70 settlements with 457 hospitals across 43 states, yielding over $250 million. The settlements were credited by the DOJ as another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative” and resulted from collaboration between the Florida U.S. Attorney’s Office and the Department of Health and Human Services’ Office of Inspector General. The underlying allegations included claims of improper Medicare billing for implanted cardiac devices.

The government alleged that between 2003 and 2010, implantable cardioverter defibrillators (ICD) were implanted in Medicare beneficiaries during 40- and 90- day waiting periods following heart attacks and bypass/angioplasty, respectively. A National Coverage Determination generally bars implantation of ICDs during those waiting periods. The DOJ statement announcing the settlement cited an “extensive investigation” involving thousands of patient records and a panel of leading cardiologists. The settlement arises out of qui tam cases brought against most of the hospitals, filed in Florida federal court. The DOJ reports that still more hospitals and health systems remain under investigation. “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,” said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.

This settlement announcement doesn’t implicate laboratories but it’s another example of coordinated federal, state and local enforcement efforts that involve hundreds of entities and significant recoveries. An upcoming G2 Intelligence webinar will address how laboratories can avoid being a target of one of these large scale investigations and what to do if they do get caught up in such an investigation. Attend Don’t Let the Government “Take Down” Your Lab: Understanding and Responding to the Current Enforcement Environment, with Robert E. Mazer, Esq. and Gina L. Simms, Esq. of Ober Kaler, on Wednesday, December 9, 2015 (NEW DATE!), at 2-3:30 p.m. Eastern. Click here to register or call, G2 Intelligence customer service at 888-720-2315, for more information.