AJC Watchdog: First Alert

Keeping watch on those who hold the public trust and money

Emory hospitals part of $250 million false claims settlement

Two Emory University hospitals are among 457 hospitals nationwide that agreed to pay a total of $250 million to settle allegations that they did not follow Medicare rules for implanting cardiac devices.

The U.S. Department of Justice on Friday announced the settlement, which includes hospitals in 43 states. Emory agreed to pay $2.4 million as part of the settlement of the allegations, which included cases handled at Emory University Hospital and Emory University Hospital Midtown.

The False Claims Act case revolves around an "implantable cardioverter defibrillator" or ICD. The device delivers a shock to a patient's heart to restore the heart to a normal rhythm. The DOJ's investigation found that some hospitals were not following Medicare's rules requiring a waiting period after a heart attack, heart bypass surgery or angioplasty before implanting the the device, which costs about $25,000.

Macon's Medical Center of Central Georgia was also part of the settlement. It paid $1.6 million, according to the DOJ.

The settlement is the result of a federal whistle-blower lawsuit filed in Florida by a cardiac nurse and a health care reimbursement consultant. Whistle-blowers are eligible for a cut of the settlement and in this case they have received more than $38 million, according to the announcement.

"The original complaint named more than 1,000 hospitals nationwide that were identified by data obtained through the Medicare claims payment data," Emory's statement said. "The complainant had no connection to many of the hospitals, including Emory, but based on data analysis claimed that the strict clinical criteria outlined under Medicare payment rules were not being followed."

U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida said the case was one of nation's largest whistle-blower lawsuits in terms of the number of defendants.

“While recognizing and respecting physician judgment, the department will hold accountable hospitals and health systems for procedures performed by physicians at their facilities that fail to comply with Medicare billing rules,” said Principal Deputy Assistant Attorney General Benjamin C. Mizer, head of the Justice Department’s Civil Division.  “We are confident that the settlements announced today will lead to increased compliance and result in significant savings to the Medicare program while protecting patient health.”

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About the Author

Carrie Teegardin is on the investigative team. She is a graduate of Duke University and has won numerous national journalism awards.