DOJ Settles ‘Overtreated’ Medicare patients Allegations for $4.4 Million
After coming under fire for allegedly performing angioplasty cardiac procedures at a rate much higher than the national average and prompting a whistleblower lawsuit filed under the False Claims Act (FCA), a Lorain County, Ohio community hospital and a physicians group have settled with the United States for $4.4 million for allegedly ‘Overtreated’ Medicare patients.
A statement by the US Attorney’s Office explains that the government had alleged EMH Regional Medical Center (EMH) and the North Ohio Heart Center Inc (NOHC), performed “unnecessary cardiac procedures on Medicare patients” between 2001 and 2006 prompting a whistleblower lawsuit with allegations of ‘Overtreated’ Medicare patients.
In August 2006, the New York Times reported that some insurers were questioning the high rate of angioplasties being performed at the Elyria, Ohio facility. Two months later, the former manager of the catheterization and electrophysiology lab at EMH filed a whistleblower lawsuit claiming that physicians urged staff to falsify patient complaints regarding chest pain. He also raised concerns regarding why patients were receiving multiple procedures. The hospital denied his allegations.
The NY times reported that after analyzing Medicare data, a researcher at Dartmouth Medical School found that statistics showed that the national average for angioplasty procedures was 11.3 per 1,000 Medicare patients, while the statistics for Elyria averaged 42 per 1,000.
According to the 2006 NY Times article, at least one of the issues surrounding cardiac treatments for blocked coronary arteries is a lack of research regarding the long term efficacy of the three primary courses of treatment; bypass surgery, angioplasty, or drugs. Physicians generally decide who gets what, and when, seemingly without many checks and balances along the way. In that article, EMH allegedly said that nearly half of the profits generated by the facility came from cardiac services.
The U.S. Attorney for the Northern District of Ohio said, “Most doctors act responsibly. These few didn’t. Patient health and taxpayer dollars have to come before greed.” However, the DOJ statement said that “there had been no determination of liability,” regarding the allegations.
North Ohio Heart Center released a statement following the agreement saying there had been no “admission of wrongdoing; rather, we settled this matter so we can put it behind us and move forward.” The statement also said that the NOHC has “passed every Medicare audit ever done,” and that “as physicians…we felt confident we were making the correct choices for our patients. We still do.”
EMH released a statement saying, “no patients, to our knowledge, were ever at risk, and there is no question that the patients treated had heart disease and some degree of blockage,” the NY Times reports. The hospital also said that it was having his cardiac care procedures peer reviewed.
Under the terms of the settlement, the NOHC is to pay $541,870 and EMS will pay $3.9 million. For his role in the whistleblower lawsuit, the former EMH employee will receive $660,859 from the $4.4 million recovery. The allegations were investigated by the Department of Justice, FBI, U.S. Attorney’s Office for the Northern District of Ohio, and the Department of Health and Human Services.
The case is captioned United States ex rel. Loughner v. EMH Regional Medical Center, et al., Case No. 1:06-cv-2441 (N.D. Oh.)