27 Calif. Hospitals Reach Settlement With DOJ Under False Claims Act
On Friday, the Department of Justice announced that it has settled with hundreds of hospitals, including some in California, over alleged overuse of implantable cardioverter defibrillators under the False Claims Act, Modern Healthcare reports.
Federal officials said they will continue to investigate other hospitals and health systems (Schencker, Modern Healthcare, 10/30).
For more than four years, DOJ has been investigating hospitals for allegedly billing Medicare for using ICDs in patients who do not meet evidence-based eligibility guidelines. ICDs cost between $25,000 and $40,000.
Under Medicare coverage rules established in 2005, ICDs may be used for primary prevention (Schencker, Modern Healthcare, 9/28). However, Medicare will not cover ICDs if they are implanted:
- Within 40 days of the patient suffering a heart attack; or
- Within 90 days of the patient undergoing an angioplasty or bypass surgery (Barlyn, Reuters, 10/30).
Physicians had raised objections to the DOJ inquiry, arguing that the Medicare coverage rules conflict with other clinical guidelines.
According to Modern Healthcare, DOJ reached a settlement with more than 450 hospitals, totaling more than $250 million.
Some of these settlements with specific health systems totaled tens of millions of dollars. For example, HCA agreed to pay $15.8 million to settle on behalf of 42 hospitals. None of the hospitals that have disclosed settlements have admitted liability (Modern Healthcare, 10/30).
Calif. Hospitals Involved in the Settlement
Twenty-seven California hospitals were included in the settlement:
- Irvine-based St. Joseph Health System agreed to pay $2.7 million on behalf of 10 affiliated hospitals;
- Sacramento-based Sutter Health agreed to pay $3 million on behalf of 12 affiliated hospitals; and
- San Diego-based Scripps Health agreed to pay $5.6 million on behalf of five affiliated hospitals (DOJ release, 10/30).