According to a DOJ press release, King’s Daughters Medical Center to Pay Nearly $41 Million to Resolve Allegations of False Billing for Unnecessary Cardiac Procedures and Kickbacks, the Ashland, Kentucky, hospital has agreed to pay $40.9 million to the U.S. to resolve accusations that it fraudulently billed Medicare and Medicaid for unnecessary coronary stents and diagnostic catheterizations.
Screeeeech. Wait a minute. Putting coronary stents in patients who did not need them? Performing heart catheterizations on people who had no medical need for one? Are you serious?
I am a lawyer who represents whistleblowers who bring Medicare and Medicaid False Claims Act lawsuits like this one. The allegations in this case are an object lesson in just why I feel so passionate about representing whistleblowers in these FCA cases.
Of course the case matters because Medicare and Medicaid got ripped off and all of us as taxpayers lost money that we spent hours of our lives earning.
But this case also matters because it is a way to stop truly outrageous behavior. Although Medicare and Medicaid were losers in this situation, the biggest losers were the patients who got treated like meal tickets. In DOJ’s press release, the U.S. Attorney for the Eastern District of Kentucky, Kerry Harvey, said: “Treatment decisions motivated by financial gain undermine public confidence in our health care system.”
And that’s an understatement. When we see hospitals and doctors putting profits over their patient’s health – even risking their patients’ lives to rake in more money – how can any of us trust what a doctor advises us to do? If a medical center will let its doctors perform heart surgery for no good reason, we have no choice but to wonder whether we really need the medical procedures we are advised to get.
According to the American Heart Association’s Journal, Circulation, 3.6% of patients die or have a heart attack or major adverse cardiac event during stent surgery. If the hospital did $40 million worth of these unnecessary surgeries – or even half of that in case the hospital paid double damages, as the False Claims Act requires – then clearly the hospital did more than 100 surgeries. Is it possible someone died or had a heart attack getting a stent he never needed?
You have to hope not. The hospital denies doing anything wrong, and I hope that’s right. But there are 40.9 million reasons why I’m still not sure.
By bringing attention to this sort of behavior, and forcing the hospital to pay all the money back plus double or treble damages, hopefully the FCA can deter other hospitals and doctors who are tempted to see dollar signs instead of patients.
In his remarks at the American Bar Association’s National Institute on the Civil False Claims Act and Qui Tam Enforcement, Assistant Attorney General Stuart Delery spoke about this case specifically, saying: “we routinely bring cases that are noteworthy not because they involved a billion-dollar recovery but because of the people they protected.”
The Department of Justice also announced that it had made claims against the hospital for violating the Stark Law. The Stark Law says that hospitals can’t cozy up to doctors who are referring business. Congress recognized that if hospitals paid doctors to send patients, the doctors would have incentives to send more patients than they really needed to – and, of course, the costs would get rolled back into health care costs for all of us.