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Queen’s pays $1.5M to settle allegations of Medicare fraud

  • JAMM AQUINO / AUGUST 8
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The Queen’s Medical Center paid $1.5 million to the U.S. Justice Department to settle a case involving implanted cardiac devices that were in violation of Medicare coverage requirements.

The Justice Department announced Friday that it had reached settlements totaling more than $250 million with nearly 500 hospitals in 43 states where cardioverter defibrillators were implanted in Medicare patients too soon after they suffered a heart attack or had heart bypass surgery or angioplasty.

"The Queen’s Medical Center denies any intentional wrongdoing, but has agreed to settle this matter expeditiously so that its resources may be spent on providing quality health care," said John Nitao, vice president and general counsel for Queen’s Health Systems, the hospital’s parent company, in a statement.

Medicare sets waiting periods of up to 90 days before implanting the $25,000 devices, which deliver mild electric shocks to restore a normal heart rhythm. Clinical trials have shown the heart often recovers its own rhythm during that time, making the pricey defibrillators unnecessary.

"The settlements announced today demonstrate the Department of Justice’s commitment to protect Medicare dollars and federal health benefits," said Wifredo A. Ferrer, U.S. attorney for the Southern District of Florida. "Guided by a panel of leading cardiologists and the review of thousands of patients’ charts, the extensive investigation behind the settlements was heavily influenced by evidence-based medicine."

A 2011 study, led by researchers at Duke University, of 111,707 patients who received cardioverter defibrillators found that nearly a quarter received no clinical benefit. Those patients were also shown to develop significantly more post-procedural complications, including death.

The settlements, said to be among the largest of their kind, are the result of a federal whistleblower lawsuit filed in Florida seven years ago by cardiac nurse Leatrice Ford Richards and health care reimbursement consultant Thomas Schuhmann.

Under the False Claims Act, the whistleblowers will reap about $38 million from the settlements. A portion of that will go to Bryan Vroon, their Atlanta-based attorney.

Among the large health care providers involved, Hospital Corporation of America, headquartered in Nashville, Tenn., agreed to pay $15.8 million. Ascension Health of St. Louis settled for $14.9 million.

The Justice Department says it continues to investigate additional hospitals.

Star-Advertiser writer Kristen Consillio contributed to this report. 

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