I just cannot believe I am writing a sequel to last year’s blog entry
about a hospital that paid $40.9 million to resolve allegations that it
was inserting stents in people’s hearts – even though they
did not need them. At the time I thought surely that case was an isolated
event. Seriously, how many cardiologists would be willing to insert stents
in patients who did not need them, just to generate a little extra revenue
by billing Medicare and Medicaid?
And then this week, along comes the story about a Tennessee hospital that is
paying $1.32 million to the Government to resolve allegations that it inserted stents in people
who don’t need them.
2015 Case
The Government found out about the unnecessary medical treatment when a
whistleblower filed a False Claims Act suit against Jackson-Madison County
General Hospital, alleging the hospital was giving patients unnecessary
cardiac services. According to the whistleblower, the hospital was billing
Medicare and Medicaid for unnecessary angioplasties, catheterizations
and ultrasound imaging, as well as unnecessary stents.
The Government, however, refused to intervene in the case. In False Claims
Act cases, the Government can decide to intervene, which basically means
to take over the case, or it can decide not to intervene. If the U.S.
does not intervene, then the whistleblower (called a “relator”)
gets between 25% and 30% of the amount recovered for the United States.
If the U.S. intervenes, the relator’s share drops to between 15% and 25%.
The Government intervened in the case against an individual cardiologist,
but did not intervene in the case against the hospital. It is hard to
figure why the U.S. decided not to intervene in such an important case,
but it’s the second time this week that a relator has won a significant
judgment in a case after the U.S. declined to intervene.
2014 Case
A year ago this month, the Government wrapped up a case against a Kentucky
hospital that stood accused of committing Medicare and Medicaid fraud.
King’s Daughter Medical Center in Ashland, Kentucky, paid a whopping
$41 million to resolve a False Claims Act case that accused it of performing
unnecessary coronary stents and diagnostic catheterizations.
When I wrote about that case, I looked up the risks of performing coronary
stents. 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 hospitals and cardiology groups are doing unnecessary stents and cardiology
procedures, they are not just engaging in Medicare and Medicaid fraud.
They also are putting patients at risk.
Hats off to the whistleblower who warned the Government about the problem
at Jackson-Madison. It is impossible to know how many people would have
undergone completely unnecessary medical procedures if he had not stepped
forward and blown the whistle. We need more heroes like this guy. And
congratulations to my colleagues Daniel Miller and Susan Schneider Thomas,
who hung tough when the Government declined the case.
As for any hospital or cardiology group that is actually performing unnecessary
heart procedures (or other medical procedures, for that matter), back
when I wrote the first blog entry about King’s Daughter, I said:
“Even before he got a heart the Tin Man would have been ashamed
of this sort of behavior.”
Can the Tin Man cry?