The University of Pittsburgh Medical Center (UPMC) has reached a $5.4 million settlement with the US Department of Justice in the case of false-claim violations involving implantation of cardiac devices against Medicare guidelines in patients receiving Medicare payments.
The US Justice Department said that the hospitals were implanting the cardiac device too soon after the bypass surgery of patients, heart attack or angioplasty. It involved implantable cardioverter defibrillators, which detect and treat life-threatening heart rhythms by shocking the heart back to a normal beat.
‘Many hospitals in the US were implanting the cardiac device at a cost of $25,000 each to Medicare, within 40 days after a patient had a heart attack or within 90 days after a patient had undergone bypass surgery and angioplasty’
Four UPMC hospitals - Passavant, Presbyterian, Hamot and Mercy - are among 457 hospitals that have reached settlements totaling nearly $258 million for violating Medicare billing rules.
The investigation began from a complaint filed seven years ago by Leatrice Richards, a registered cardiovascular nurse and Medicare-compliance and reimbursement consultant, and Thomas Schuhmann, also a Medicare-compliance and reimbursement consultant. They stand to receive $38 million from the settlements. The amount represents about 15 percent of the settlement amount.
The Justice Department took action against hospitals that implanted cardiovector defibrillators, at a cost of $25,000 each to Medicare, within 40 days after a patient had a heart attack or within 90 days after a patient had undergone bypass surgery and angioplasty.
The Department continues to investigate additional hospitals for performing unnecessary procedures against science-based guidelines. The investigation has resulted in major reductions in patients undergoing surgical procedures to implant ICDs.
"The settlements 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.