Of the various ways in which healthcare providers can violate the False Claims Act, ordering medically unnecessary procedures – particularly those involving the cardiac system – are considered particularly egregious. As opposed to illegal upcoding or kickback schemes, the performance of medically unnecessary procedures actually places patients directly in harm’s way, and all for the purpose of increasing profit margins.
In today’s post, we examine a recent settlement involving the Regional Hospital of Jackson, which is alleged to have padded profits by engaging in such misconduct. The case was brought to light several years ago by a physician employed with the hospital. His portion of the settlement was not disclosed in the Department of Justice’s press release,[1. http://www.justice.gov/usao-wdtn/pr/tennessee-hospital-agrees-pay-510000-settle-allegation-improper-medicare-medicaid] but it is not uncommon for whistleblowers to receive up to 30 percent of the ultimate recovery.
Details of the allegations against Regional Hospital of Jackson
The Regional Hospital of Jackson is located in rural western Tennessee, between the cities of Nashville and Memphis. According to the allegation,[2. http://www.beckershospitalreview.com/legal-regulatory-issues/tennessee-hospital-settles-false-claims-allegations-for-510k.html] physicians working in the hospital were engaging in several medically unnecessary cardiac procedures. More specifically, doctors are believed to have placed “needless” cardiac stents in Medicare and Medicaid patients, which is an invasive procedure involving the placement of mesh tubes in coronary arteries to help avoid the onset of coronary artery disease. Allegedly, the patients who received stents were not at an increased risk of coronary artery disease and did not present with symptoms indicating an arterial condition.
In addition, the hospital is alleged[3. http://www.jacksonsun.com/story/news/local/2015/07/14/regional-hospital-jackson-pay-settlement/30164667/] to have ordered heart catheterizations and angioplasties for patients who did not need these procedures. A heart catheterization is a diagnostic process involving the placement of a thin tube through the groin up to the heart, while an angioplasty involves the surgical unblocking of an affected artery. For both procedures, patients were required to undergo serious medical procedures for the sole purpose of maximizing profits for the hospital.
The U.S. Attorney’s Office said in a statement, “Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and harms patients….Settlements like this protect public funds and safeguard the beneficiaries of federal health care programs.”
Interestingly, a nearby unaffiliated hospital settled near-identical allegations in March 2015. In that case, one doctor was alleged to have ordered similar medically unnecessary tests, which resulted in a $1,328,465 settlement. [4. http://www.justice.gov/usao-wdtn/pr/tennessee-hospital-pays-132-million-settle-allegations-improper-medicare-and-medicaid].
Contact Berger Montague today
False Claims Act lawsuits are about more than financial recovery. As in today’s case, a successful whistleblower lawsuit can actually put a stop to misconduct that directly harms patients and subjects unknowing individuals to unnecessary medical risk. For more information about whistleblower lawsuits or to learn how the False Claims Act can help put a stop to such egregious conduct, contact one of our experienced and confidential attorneys right away.