According to a recent press release from the U.S. Department of Justice, a California-area hospital has agreed to pay $2.25 million to settle claims it unlawfully submitted false claims to the government for reimbursement on behalf of Medicare patients. Like many healthcare claims, the allegations against St. Helena Hospital involve the performance of medically unnecessary procedures on its patients, resulting in overcharges to the federal government – and, ultimately, the taxpayers.
The whistleblower in this case, who will receive $450,000 for coming forward with the information, was a former employee of St. Helena Hospital and alleged the misconduct occurred for a period spanning from January 2008 through July 2011.
Details of the Case Against St. Helena Hospital
The St. Helena Hospital is located in Napa Valley, California, and is classified as an acute care facility within the Adventist healthcare system. As such, St. Helena Hospital offers various specialized medical procedures designed to target a specific health issue, including arterial blockage.
For patients suffering from blocked or restricted arteries, a procedure known as a percutaneous coronary intervention can help relieve the restricted blood flow. Also known as an angioplasty, this procedure is regarded as somewhat common within the context of cardiac care.
During the period in question, however, St. Helena Hospital is alleged to have performed several medically unnecessary angioplasties on Medicare patients suffering from minor or moderate blood flow issues. Angioplasties, while considered common and routine, typically require an inpatient stay in the hospital and significant monitoring in the hours immediately after surgery.
Of course, this level of care is significantly more expensive than an outpatient procedure – and the whistleblower alleged that St. Helena was purposely recommending angioplasties, in order to collect a larger sum of money from the Medicare program and to ultimately pad profits.
The allegations also assert that many of the patients having received an angioplasty were in need of a cardiac intervention; however, the angioplasty procedure was not the best-suited course of action for their case and a less-invasive option would have adequately addressed the issues.
Impact of Medicare Fraud
As we reported earlier this month, healthcare fraud continues to be a major problem for the federal and state governments. Notably, anti-fraud committees and agencies recovered over $5 billion in healthcare fraud settlements in fiscal year 2014 – a record-shattering amount. The False Claims Act continues to be an integral component in the elimination of this wasteful and often dangerous form of theft.
As we have reported in the past, it is not unheard of for medical facilities and physicians to perform medically unnecessary, invasive surgical procedures on patients in order to obtain a greater reimbursement from programs like Medicare and Medicaid. This practice not only drains these important resources, it also puts patients’ lives at risk.
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