Close to 500 hospitals nationwide are set to pay approximately $250 million to settle allegations under the False Claims Act that they implanted cardiac defibrillators in violation of Medicare rules. One of these hospitals is Lancaster Regional Medical Center located in Lancaster County, Pennsylvania. This settlement demonstrates the importance of health care providers’ strict adherence to Medicare rules when seeking reimbursement.

According to the United States Department of Justice (DOJ), these hospitals implanted cardiac defibrillators in patients who recently had heart attacks or major heart surgeries including bypass surgery and angioplasty. Medicare rules prohibit health care providers from implanting defibrillators for 40 to 90 days after a patient suffers a heart attack or undergoes a surgical procedure in order to allow the patient’s heart to improve naturally so that a device will not be necessary.

Whistleblowers tipped off the DOJ that the hospitals were installing the cardiac defibrillators in violation of Medicare rules, and then filed the lawsuit in the Southern District of Florida. The DOJ has stated that this is one of the largest qui tam, or whistleblower, lawsuits in United States history both in terms of the number of defendants and the amount recovered. According to the DOJ, the whistleblowers received more than $38 million as a result of the settlements.

The defibrillator devices cost approximately $25,000 each. This historic recovery involves 70 separate settlement agreements. The settlement that included Lancaster Regional Medical Center involved 27 hospitals that were part of the former Health Management Associates. The allegations against these 27 hospitals were settled for $7.2 million. It is unclear what percentage of this settlement will be paid out by Lancaster Regional.

These 27 hospitals that were previously part of Health Management Associates are now part of the Tennessee-based Community Health Systems (CHS). CHS also paid $13 million to settle allegations involving another 31 of its hospitals.

Philadelphia Health Care Lawyers at Michelman & Bricker, P.C. Assist Clients with Medicare Compliance Issues and the Anti-Kickback Law

The health care industry is complex and undergoes fast-paced changes. Similarly, health care laws are constantly changing at the state and federal levels. Philadelphia anti-kickback lawyers at Michelman & Bricker, P.C. have extensive experience in counseling physicians and health care companies in Medicare compliance and the requirements of Stark Law, the Civil Monetary Penalties Law, and Anti-Kickback Law. For example, we previously represented a podiatrist in negotiating the settlement of Medicare false claims allegations, using a peer-reviewed study to challenge HGSA’s analysis of billing practices, and we negotiated an integrity agreement with HHS Inspector General’s Office in order to assure continued compliance with Medicare regulations

Our offices are conveniently located in Philadelphia, Pennsylvania, Cherry Hill, New Jersey and Longmeadow, Massachusetts. Call us at 215-557-9440 or contact us online to schedule your consultation.