The Department of Justice announced a settlement with nearly 500 hospitals related to the implantation of cardioverter defibrillators (ICD’s). The surgeries did not meet the appropriate medical conditions for Medicare coverage established in the National Coverage Determination (NCD). Medicare will generally exclude coverage for ICD procedures when a bypass or angioplasty has been performed within the last 90 days or within 40 days of a heart attack.
The settlement was in a total amount of $257 million. In addition to this being an incredibly large amount of money, the fact that the Department of Justice entered into 70 separate settlement agreements covering nearly 500 hospitals shows an incredible coordination of effort and tenacity. The large national Hospital “players” paid the largest amounts; for example NCA will pay $15.8 million and Tenet Healthcare will pay $12.1 million.
Some New Jersey hospitals are also included in the settlement. Cooper Medical Center will pay $1.2 million, Deborah Hospital will pay $1 million, Valley Hospital will pay $2.2 million and Hackensack Medical Center will pay $5.9 million.
The information and ultimate settlements were brought to light as a result of a complaint filed seven years ago by two separate whistleblowers. Both whistleblowers were Medicare Compliance and Reimbursement Consultants and were represented by an attorney specializing in whistleblower and False Claims Act cases. As a result of bringing the information to the attention of the federal government, the whistleblowers, referred to as “relators”, will share in an award of $38,227,500.
If you are aware of fraud against the state or federal government, you should contact a competent whistleblower attorney to handle your claim