Unnecessary Procedures Allegedly Performed in NE Ohio

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(Courtesy: Medtronic via MGN Online)

LORAIN COUNTY, Ohio — A non-profit community hospital system and an independent physician group in Lorain County will pay $4.4 million to resolve claims that unnecessary cardiac procedures were performed on Medicare patients.

According to the U.S. Attorney’s Office for the Northern District of Ohio, EMH Regional Medical Center (EMH) has agreed to pay the United States $3,863,857 and North Ohio Heart Center Inc. (NOHC) has agreed to pay $541,870 to settle the false claim allegations.

EMH and NOHC were accused of unnecessary angioplasty and stent procedures between 2001 and 2006.

“Most doctors act responsibly. These few didn’t,” said Steven M. Dettelbach, United States Attorney for the Northern District of Ohio. “Patient health and taxpayer dollars have to come before greed.”

The former manager of EMH’s catherization and electrophysiology lab, Kenny Loughner, brought the issue to the forefront by filing a whistleblower complaint.

He will be awarded $660,859 of the money paid to the United States.

“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,” said Stuart F. Delery, Principal Deputy Assistant Attorney General of the Justice Department’s Civil Division.

The settlement resolves claims only and does not determine any liability, the U.S. Attorney’s Office said.

A statement from John Schaeffer, M.D., chairman and president of NOHC, said:

“We have mutually agreed to a civil settlement with the government following a review of stent procedures physicians in our practice provided to Medicare patients between 2001 and 2006.  We will abide by the terms of the settlement.  The settlement is not an admission of wrongdoing; rather, we 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, and we are gratified that NOHC has passed every Medicare audit ever done – whether regarding stent procedures, or any other service.

Moreover, we are consistently recognized for being among the best providers of cardiac care in the country.  We earned that reputation by providing high-quality care at a competitive price.  In health care, that’s called delivering value, and that’s what we do.  In fact, for the third year in a row, EMH received the HealthGrades Cardiac Care Excellence Award and is ranked among the top five percent in the nation for overall cardiac services and cardiology services.  NOHC is a big reason for those awards.

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.

We intend to continue serving our patients and the community as we have for the past 35 years:  by providing high-quality cardiac care at a competitive price.  In other words, by delivering value.”

The investigation was conducted by the U.S. Attorney’s Office for the Northern District of Ohio, the Justice Department’s Civil Division, the Office of the Inspector General of the Department of Health and Human Services and Federal Bureau of Investigation.