All across this nation – in an appalling 43 states, to be exact – major hospital systems have been fined a quarter of a billion dollars recently for violating Medicare coverage protocols in the implanting of heart devices, according to the U.S. Department of Justice.
The fines specifically address what is known as implantable cardioverter defibrillators, or ICDs – electronic devices that are implanted near the heart. They detect chaotic life-threatening heart rhythms – called fibrillations – by delivering tiny shocks to the heart, restoring normal rhythm. Only patients with certain clinical characteristics and risk factors qualify for an ICD covered by Medicare.
The National Cardiovascular Registry had previously determined that 22% of all ICD implants should never have been done, because they actually failed to meet medical necessity, as defined by Medicare’s National Coverage Determination guidelines. But in more than 400 hospitals, surgeons were placing them into people’s chests anyway.
Consider that the cost of implanting an ICD device averages $35,000 and the penalties for ineligible procedures can be 300% the amount in damages for each claim. So errant hospitals are opening the door to huge liability if they allow noncompliant surgeries.
In total, 70 fines were meted out to 457 hospitals, all operated by these management systems:
- $14 million dollar fine – Ascension Health, whose main office is located in St. Louis, and 33 of its hospitals
- $11 million dollar fine – Catholic Health East, of Newtown Square, Pennsylvania, and its 13 hospitals
- $13 million dollar fine – Community Health Systems, Inc., Franklin, Tennessee, and its 31 hospitals
- $16 million dollar fine – Hospital Corporation of America, Nashville, and its 42 hospitals for
“The Department will hold hospitals and health systems accountable, for procedures performed by physicians at their facilities, that fail to comply with Medicare billing rules,” said Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division. “We are confident that the settlements announced today will lead to increased compliance and result in significant savings to the Medicare program while protecting patient health.”
If you or a family member have undergone this procedure, you can see if your local hospital is among those who have been fined for heart implant procedure violations, you can check here: