WASHINGTON, DC — The medical center and cardiology practice in Elyria, OH at the center of an "unnecessary-PCI" investigation six years ago have agreed to pay the US government more than $4.4 million to resolve False Claims Act allegations .
In the settlement announced today, the EMH Regional Medical Center will pay $3.83 million, while the North Ohio Heart Center (NOHC) will pay $541 000.
The hospital's former cath-lab manager, Kenny Loughner, who brought the case to the attention of the Department of Justice, will receive $660 859 from the settlement.
An "unabashed enthusiasm for angioplasties" among cardiologists in the town of Elyria was first reported in the New York Times in August 2006, as covered by heartwire at the time. That article noted that the cardiologists involved were not accused of wrongdoing--rather, that the rate of PCIs and stenting in this Midwestern town was four times higher than national averages.
Today's announcement now specifies, however, that "between 2001 and 2006 EMH and NOHC performed unnecessary cardiac procedures on Medicare patients, [specifically] 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."
Since 2006, unnecessary stenting and PCI appropriateness have become buzzwords in cardiology, following a number of high-profile cases of physicians accused or found guilty of implanting stents where not clearly warranted.
The Ohio settlement, notes the Department of Justice announcement, is part of a broader initiative to squelch this particular form of medical fraud.
"Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of healthcare and puts patients at risk," Stuart F Delery, principal deputy assistant attorney general of the Justice Department's civil division, is quoted in the statement. Since 2009, the Justice Department's False Claims Act has helped recover more than $10.1 billion in cases involving fraud against federal healthcare programs, the statement notes.
Heartwire from Medscape © 2013 Medscape, LLC
Cite this: Ohio Unnecessary-Stenting Case Settled for US $4.4 Million - Medscape - Jan 07, 2013.