Federal officials said EMH Regional Medical Center (EMH) has agreed to pay the United States $3,863,857 and North Ohio Heart Center Inc. (NOHC) has agreed to pay the United States $541,870 to settle allegations that they submitted false claims to Medicare, the Justice Department announced Friday.
EMH is a non-profit community hospital system located in Lorain County.
During the relevant time period, NOHC was an independent physician group located in Lorain County that practiced at EMH.
Friday's settlement resolves allegations that between 2001 and 2006, EMH and NOHC performed unnecessary cardiac procedures on Medicare patients.
Specifically, the United States alleged that EMH and NOHC performed angioplasty and stent placement procedures on patients who had heart disease but whose blood vessels were not sufficiently occluded to require the particular procedures at issue.
This came to light when a whistleblower filed a complaint under the False Claims Act. Under the FCA, private citizens can bring suit for false claims on behalf of the United States and receive a share of the recovery obtained by the government.
The whistleblower in this matter, Kenny Loughner, was the former manager of EMH's catheterization and electrophysiology laboratory.
As a result of today's settlement, Loughner will receive $660,859 of the United States' recovery.
The following statement was issued by John Schaeffer, M.D., Chairman and President, North Ohio Heart Center:
"We have mutually agreed to a civil settlement with the government following a review of stent procedures physicians in our practice provided to Medicare patients between 2001 and 2006. We will abide by the terms of the settlement. The settlement is not an admission of wrongdoing; rather, we settled this matter so we can put it behind us and move forward. It's very important to note that this settlement is only about whether or not Medicare covered some procedures we did six to ten years ago that were considered cutting edge at the time."
"As the physicians on the ground when these decisions were made and the procedures were performed, we felt confident we were making the correct choices for our patients. We still do, and we are gratified that NOHC has passed every Medicare audit ever done - whether regarding stent procedures, or any other service. Moreover, we are consistently recognized for being among the best providers of cardiac care in the country. We earned that reputation by providing high-quality care at a competitive price."
"In health care, that's called delivering value, and that's what we do. In fact, for the third year in a row, EMH received the HealthGrades Cardiac Care Excellence Award and is ranked among the top five percent in the nation for overall cardiac services and cardiology services. NOHC is a big reason for those awards. As leaders in cardiac care, we have always been early adopters of new technology when we believe using it will help improve our patients' lives. That was certainly the case when drug-eluting stents were first introduced. We were using the best technology available to take care of a high risk population. We still are."
"Cardiac care has progressed significantly in just the past few years, as all areas of medicine have. All cardiologists, including our physicians at North Ohio Heart Center, are implanting fewer stents than in the past because delivering optimal medical therapy with lifestyle changes reduces the need for these procedures, We intend to continue serving our patients and the community as we have for the past 35 years: by providing high-quality cardiac care at a competitive price. In other words, by delivering value."
"Most doctors act responsibly. These few didn't," said U.S. Attorney Steven M. Dettelbach. "Patient health and taxpayer dollars have to come before greed."
"Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and puts patients at risk. Today's settlement evidences the Department of Justice's efforts both to protect public funds and safeguard Medicare beneficiaries," said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Justice Department's Civil Division.
This resolution is part of the government's emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009.