Justice Department Sues 27 Hospitals over Medicare Billing Practices
The Justice Department has joined a whistleblower lawsuit against 27 hospitals alleging the facilities billed Medicare for tens of millions of dollars for procedures that were not eligible for reimbursement, the Chicago Tribune reports. According to the government's claim, the hospitals -- mainly teaching medical centers -- improperly charged Medicare between 1986 and 1995 for cardiac "investigational devices" that were being used in clinical trials to determine safety and effectiveness. Because the devices, including some types of catheters, pacemakers and stents, were not FDA-approved at the time, they did not qualify for Medicare reimbursements, the DOJ contends. According to the lawsuit, the hospitals billed Medicare as if the procedures were covered and did not indicate their experimental nature (Japsen, Chicago Tribune, 12/18). The case involves hospitals in 15 states and Washington, D.C., and is part of a whistleblower suit that was filed eight years ago against more than 100 facilities. The government previously sued 13 hospitals and has settled similar cases with 31 facilities for $42 million. Two more cases are expected to be settled soon (AP/Nando Times, 12/17). The 27 hospitals sued yesterday represent the largest single "chunk" of facilities to be sued so far, according to a DOJ spokesperson. Kelly Sullivan, a spokesperson for Northwestern Memorial Hospital in Chicago, one of the 27 hospitals, said, "Medicare routinely pays for all of these devices today. The entire hospital industry openly and regularly sought reimbursement for services involving investigational devices, and did so with the knowledge and approval of Medicare" (Chicago Tribune, 12/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.