Hospitals to Pay $250M to Settle Cardiac Claims

     (CN) – Nearly 500 hospitals in 43 states will pay a total of $250 million to settle claims to implanted cardiac devices in Medicare patients in violation of coverage requirements, the U.S. Justice Department announced Friday.
     The settlement by the 457 medical institutions related to a device that detects aberrant, life-threatening heart rhythms — fibrillations — and deliver a mild electric shock to return the recipients heartbeat to normal.
     The problem, the Justice Department said, is that only certain patients, those with specific medical characteristics and risk factors, qualify to have the device, known as an implantable cardioverter defibrillator, implanted.
     Each device costs about $25,000.
     According to the Justice Department, Medicare guidelines instruct doctors not to implant the devices in patients who recently suffered a heart attack or had other procedures, such as heart bypass surgery.
     In each case cited by the agency, the hospitals implanted the devices in patients within the Medicare-mandated waiting period. In the case of heart attack victims, the waiting period is 40 days. For those who have undergone a bypass operation or other cardiac surgery, the waiting period is 90 days.
     The implantations, which occurred between 2003 and 2010, were brought to light by a federal whistleblower lawsuit brought by Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a health care reimbursement consultant, under the False Claims Act.
     They received more than $38 million from the settlement, the Justice Department said.

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