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Monday
Mar142016

Two whistleblowers split $3.5 million from defib implant settlement

A cardiac nurse and a healthcare reimbursement consultant are splitting $3.5 million as their share of a $23 million settlement by 51 hospitals that allegedly violated Medicare coverage rules about implanting heart defibrillation devices in patients.

Leatrice Ford Richards and Thomas Schuhmann filed a qui tam lawsuit on behalf of the United States in federal district court in the Southern District of Florida.

They alleged hospitals were charging Medicare for implantable cardioverter defibrillatos, or ICDs, for patients who weren't elegible. 

Only patients with certain clinical characteristics and risk factors qualify for an ICD covered by Medicare.

Each device costs about about $25,000.

ICDs work like external defibrillators often found in airports and office buildings. But ICDs are small enough to be implanted in a patient’s chest. 

There's a 40-day waiting period before an ICD is implanted in a patient who has suffered from a heart attack and a 90-day waiting period for a patient who has had by-pass surgery or angioplasty.

"The medical purpose of a waiting period. . .  is to give the heart an opportunity to improve function on its own to the point that an ICD may not be necessary," the DOJ said.

From 2003 to 2010, each of the 51 settling hospitals in 15 states allegedly implanted ICDs during the waiting periods. 

A list of the settling hospitals is here (pdf).

The settlements were the final stage of a nationwide investigation into the practices of hundreds of hospitals improperly billing Medicare for the devices. With the latest resolutions, the DOJ's s investigation has produced settlements with more than 500 hospitals totaling more than $280 million.

The qui tam or whistleblower provisions of the False Claims Act permit private citizens to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment awarded against a defendant. 

This lawsuit was U.S. ex rel. Ford et al. v. Abbott Northwestern et al. No. 08-cv-20071 (S.D. Fla.)

The DOJ said the claims resolved by the settlements were allegations only and didn't determine liability.

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Richard L. Cassin is the publisher and editor of the FCPA Blog. He can be contacted here.

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