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Settlement Reached that Doctors Over-treated and Over-billed

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Thanks to a whistleblower complaint back in 2006, a settlement of almost $4 million was reached with the Justice Department over accusations that a community hospital in Ohio billed Medicare for unnecessary angioplasty procedures, a practice that also put patients’ lives at risk.

The settlement has covered accusations by the Department of Justice against doctors and the EMH Regional Medical Center for the procedures also known as percutaneous coronary interventions (PCI), between 2001 and 2006. The EMH Regional Medical Center agreed to pay $3.9 million and the local cardiology group, North Ohio Heart Center, agreed to pay $541.870. Whistleblower Kenny Loughner, the former manager of the hospital’s catheterization lab, will receive $660,859 from the settlement.

In 2006 the New York Times reported that the PCI rate in Elyria, Ohio was four times the national average. Six years later, a study in the Journal of the American Medical Association (Oct 10, 2102) reported that the number of angioplasties is lower in states that mandate public reporting of PCI outcomes. For patients with acute myocardial infarction, their likelihood of receiving PCI in states with public-reporting programs-- such as Massachusetts, Pennsylvania and New York was 37.7 percent, compared with 42.7 percent in seven non-reporting states. Authors of the study concluded that “Public reporting may motivate physicians to look more closely at whether PCI procedures are appropriate.”

Medicare Fraud

The US Department of Justice claimed that the EMH Regional Medical Center and the physicians “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.” (An angioplasty procedure, in which a clogged blood vessel is opened, typically requires insertion of a stent, a device that keeps the blood vessel from closing again.)

According to Forbes.com, the Department of Justice said that, “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.”

This recent settlement (Jan 4, 2013) represents just one of many actions brought against hospitals and cardiologists for performing questionable cardiac procedures, despite patients usually having a choice of treatments. On the other hand, while public reporting may motivate physicians to look more closely at whether PCI procedures are appropriate, according to authors of the JAMA study, many doctors believe that patients should be treated more conservatively with medicines rather than through costly procedures.


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