Medicare Fraud Case Extends to Hawaii: Queen’s Settles for $1.5M

The Honolulu Star-Advertiser reported on 10/31/15 Queen’s Medical Center agreed to pay $1.5 million to the U.S. Department of Justice (DOJ), one of 70 settlements totaling more than $250 million in a case that involved 457 hospitals in 43 states.  The government alleged the hospitals implanted cardioverter defibrillators, or ICDs, in Medicare patients too soon after suffering a heart attack or had recent heart bypass surgery or angioplasty.  Medicare coverage requires a 40-day waiting period after a heart attack and 90 days for bypass and angioplasty to give the heart a chance to recover on its own, making the $25,000 defibrillators unnecessary.  The Associated Press story in the Star-Advertiser followed a news release issued by the U.S. Department of Justice on 10/30/15.

The Star-Advertiser cited a study led by Duke University in 2011, which found that almost 25% of 111,707 patients who received cardioverter defibrillators received no clinical benefit and developed significantly more complications after the procedure, including death.

This case was brought forward by a whistleblower lawsuit filed in Florida by a cardiac nurse and health care reimbursement consultant seven years ago. The hospitals denied allegations they intentionally submitted false claims for implantations of ICDs; however, they agreed to settlements totaling $250 million.  The whistleblowers will receive $38 million from the settlements.

The U.S. Department of Justice gave credit to the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which was launched in 2009 by the Department of the Attorney General and the Department of Health and Human Services to focus on reducing Medicare and Medicaid financial fraud. Since 2009, DOJ has recovered more than $16.4 billion in cases involving fraud against federal health care programs.