Last Friday, federal regulators finalized and announced the settlement of a whistleblower suit alleging that a group of doctors performed medically unnecessary cardiac procedures on patients. The settlement requires an Ohio hospital to pay $3.9 million and a physician group to pay $541,870. The settlement resolves a whistleblower lawsuit filed in 2006 by the former manager of the hospital’s catheterization lab. According to the complaint, physicians urged nurses and others to falsify complaints of chest pain to justify unnecessary angioplasties. The complaint also alleged that doctors developed a strategy of treating patients in stages, forcing patients to come back for multiple procedures so as to increase Medicare billings.
An angioplasty is a cardiac procedure in which a clogged blood vessel is opened. The procedure often requires insertion of a device called a stent to keep the blood vessel from closing again. The whistleblower suit alleged that the physicians and hospital caused unnecessary angioplasties to be performed which increased Medicare costs and also put patients at risk from unnecessary procedures. The high rate of cardiac procedures at the Ohio hospital, EMH Regional Medical Center, was the subject of a New York Times article in August 2006. A study demonstrated that Medicare patients in the town where the hospital is located were receiving angioplasties at a rate nearly four times the national average. That finding prompted questions from insurers and raised concerns that patients were being over-treated because of the high fees the cardiac procedures generated.
The settlement with the United States Department of Justice is the latest in a series of actions brought against cardiologists and hospitals related to questionable cardiac procedures and overtreatment of patients. Unnecessary heart procedures, such as angioplasties, not only expose patients to unnecessary risk but cause federal health programs such as Medicare to be burdened with expensive, unnecessary medical costs.
The False Claims Act allows private individuals to sue on behalf of the government to recover money improperly charged the government. The person bringing forth the allegations of wrongdoing, known as a whistleblower, stands to receive a share of the money recovered by the government.