Nearly 500 hospitals settle with DOJ for $250M

Hospitals in 43 states will pay a combined $250 million to settle charges they violated Medicare requirements when implanting cardiac devices in patients.

The Department of Justice (DOJ) said Friday it had reached 70 settlements involving 457 hospitals accused of implanting cardioverter defibrillators in patients between 2003 and 2010, before Medicare coverage allowed.

Medicare will cover the devices, which cost around $25,000, but only if doctors wait the recommended 40 days after a patient has had a heart attack and 90 days after a patient has had bypass surgery to do the implant. The waiting periods are to give the heart an opportunity to improve function on its own to the point that an the defibrillator may not be necessary. 

The DOJ said most of the hospitals were named in a lawsuit brought on by whistleblowers under the False Claims Act, which allows private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. 

Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a health care reimbursement consultant, filed the suit in the U.S. District Court for the Southern District of Florida. The DOJ said the whistleblowers received more than $38 million from the settlements.

“The settlements announced today demonstrate the Department of Justice’s commitment to protect Medicare dollars and federal health benefits,” U.S. Attorney Wifred Ferrer, of the Southern District of Florida, said in a news release.

The agency said it plans to investigate additional hospitals and health systems.