January 5th, 2013

Ohio Hospital and Cardiology Group Will Pay $4.4 Million to Settle Charges Over Unnecessary PCIs

In 2006, Reed Abelson in the New York Times reported that the PCI rate in Elyria, Ohio, was four times the national average. Now, six-and-a-half years later, she reports that the local hospital, EMH Regional Medical Center, has agreed to pay $3.9 million to settle accusations that it billed Medicare for unnecessary PCIs. And the local cardiology group, North Ohio Heart Center, has agreed to pay $541,870.

The U.S. Department of Justice alleged that the hospital and the physicians “performed 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.”

In its press release, the DOJ said, “Billing Medicare for cardiac procedures that are not necessary or appropriate contributes to the soaring costs of health care and puts patients at risk. Today’s settlement evidences the Department of Justice’s efforts both to protect public funds and safeguard Medicare beneficiaries.”

In a separate statement, Dr. John Schaeffer, the Chairman and President of North Ohio Heart Center, defended the quality of its care and said that it had “settled this matter so we can put it behind us and move forward.”

“It’s very important to note that this settlement is only about whether or not Medicare covered some procedures we did six to ten years ago that were considered cutting edge at the time. As the physicians on the ground when these decisions were made and the procedures were performed, we felt confident we were making the correct choices for our patients. We still do…”

Schaeffer defends his group’s aggressive early use of drug-eluting stents but acknowledges that optimal medical therapy now plays a more central role:

“As leaders in cardiac care, we have always been early adopters of new technology when we believe using it will help improve our patients’ lives. That was certainly the case when drug-eluting stents were first introduced. We were using the best technology available to take care of a high risk population. We still are.

Cardiac care has progressed significantly in just the past few years, as all areas of medicine have. All cardiologists, including our physicians at North Ohio Heart Center, are implanting fewer stents than in the past because delivering optimal medical therapy with lifestyle changes reduces the need for these procedures.”

The case was initiated by a whistleblower complaint. The whistleblower was the former manager of the hospital’s catheterization and electrophysiology laboratory. He will receive $660,859 as a result of the settlement.


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