The US Department of Justice is vigilantly committed to protecting federal health care benefits and rooting out Medicare fraud. In what is being considered one of the largest whistleblower cases ever brought to light, the DoJ announced that 457 hospitals agreed to settle false billing claims related to cardiac devices. The 70 settlements arose out of information provided by qui tam cases under the US False Claims Act (FCA).
According to reports, hospitals in 43 states agreed to settle the allegations for a total of more than $250 million. The fraud related to facilities that filed for Medicare reimbursement for implantable cardiac devices. The case alleged these surgeries were in violation of Medicare coverage requirements.
An electronic device called an ICD, or implantable cardioverter defibrillator, is implanted in the chest and connected to the heart. When it detects life-threatening heart rhythms, it send a shock to the heart. The device acts similarly to an external defibrillator which has to be used on the patient by another person.
While an ICD can be a lifesaving device, only some patients are qualified to have their ICD implants covered by Medicare. The device costs about $25,000. The hospitals named in the qui tam suit were applying for Medicare coverage for patients who did not fit the criteria required for Medicare reimbursement for an ICD.
U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida said, “…the extensive investigation behind the settlements was heavily influenced by evidence-based medicine.” A panel of leading cardiologists guided the investigation which included a review of thousands of patients’ charts. “Our office will continue to vigilantly protect the Medicare program from potential false billing claims,” Ferrer said.
Under the FCA, private citizens are permitted to bring lawsuits related to fraudulent activity against the US. If the case is successful, the whistleblower is then entitled to receive a portion of the settlement or judgment proceeds paid by the defendant(s).
In this case, which was filed in federal district court in the Southern District of Florida, cardiac nurse Leatrice Ford Richards and healthcare reimbursement consultant Thomas Schuhmann will get more than $38 million following the hospitals’ decisions to settle. The case is far from over; in fact, the DoJ says it is going to be investigating many more hospitals.
If you have information that may lead to a whistleblower lawsuit, it’s important that you contact a savvy qui tam attorney who can determine the validity of your case and protect your rights. Contact Begelman & Orlow today for a free consultation about your concerns.