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DOJ strikes $23M settlement with hospitals over claims of improper Medicare billing for ICDs

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Benjamin Mizer

The U.S. Department of Justice has been looking into claims that some hospitals billed Medicare incorrectly for implantable cardioverter defibrillator (ICD) devices. Now the agency is set to collect $23 million from hospitals that allegedly ran afoul of federal law.

The latest agreements cover 51 hospitals in 15 states. But "claims resolved by these settlements are allegations only and there has been no determination of liability," the DOJ said in a statement. The agency has already settled with 457 hospitals for more than $250 million over related claims.

The hospitals in question allegedly implanted ICDs in patients from 2003 to 2010, even though they were prohibited from doing so under federal law, the agency said. A National Coverage Determination (NCD) for Medicare says that ICDs should not be implanted in patients who recently had a heart attack or a heart procedure and implements a mandatory waiting period.

The waiting period is meant to give the patient an opportunity to recover, so they might not even need the ICD. But the hospitals went ahead and implanted the ICDs anyway, the DOJ said. Medicare coverage for ICDs runs at about $25,000.

"These settlements demonstrate the Department's continued vigilance in pursuing hospitals and health systems that violate Medicare's national coverage rules," Principal Deputy Assistant Attorney General and head of the DOJ's Civil Division Benjamin Mizer said in a statement. "We will hold accountable those who do not abide by the government's rules in order to protect the federal fisc and, more importantly, patient health."

The settlements stem from whistleblower suits filed in a federal court in Florida. Whistleblower suits allow individuals to make claims against companies or healthcare organizations on behalf of the government, and potentially get some money back for doing so.

Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a healthcare reimbursement consultant, filed their suits in the federal district court in the Southern District of Florida. The pair will get more than $3.5 million from the latest DOJ settlements.

"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," U.S. Attorney for the Southern District of Florida Wifredo Ferrer said in a statement. "Our office will continue to vigilantly protect the Medicare program from potential false billing claims."

- here's the DOJ statement

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