Health Care

Mount Sinai, Cleveland Clinic hospitals settle false claims charges

Cleveland Clinic Florida in Weston was among a group of six affiliated hospitals to pay $1.6 million in fines this week to settle charges of filing false claims with Medicare for implanting cardiac devices in patients.
Cleveland Clinic Florida in Weston was among a group of six affiliated hospitals to pay $1.6 million in fines this week to settle charges of filing false claims with Medicare for implanting cardiac devices in patients. Cleveland Clinic Florida

Two South Florida hospitals paid millions in fines this week to settle charges that they filed false claims with Medicare for implanting cardiac devices in patients during a waiting period when doctors are supposed to hold off and see if the patients recover on their own.

Mount Sinai Medical Center in Miami Beach and Cleveland Clinic Florida in Weston were among 51 hospitals nationwide to pay more than $23 million in fines, closing a sweeping federal investigation into hundreds of hospitals for improperly billing Medicare for implantable cardioverter defibrillators or ICDs.

According to the Justice Department, Mount Sinai paid $1.9 million in fines while Cleveland Clinic Florida and five affiliated hospitals paid $1.6 million.

Mount Sinai officials declined comment. Cleveland Clinic issued a written statement that said, in part, “Cleveland Clinic would provide the same treatment again if presented with the same illness. … While we believe that the charges were appropriate, we chose to settle the matter rather than engaging in expensive litigation that distracts from our mission.”

ICDs are implanted near and connected to the heart, where they deliver electric shocks that treat life-threatening changes in cardiac rhythms.

Medicare reimburses hospitals about $25,000 for each implanted device, but patients first must meet certain criteria before coverage kicks in. Doctors are required to wait and see if the heart improveson its own — 40 days for a heart attack and 90 days for heart-bypass surgery or angioplasty.

Federal officials alleged that from 2003 to 2010, each of the settling hospitals implanted ICDs during the prohibited waiting periods.

Most of the settling hospitals were named in a whistleblower lawsuit filed in federal court in Miami by Leatrice Ford Richards, a cardiac nurse, and Thomas Schuhmann, a health care reimbursement consultant. The whistleblowers have received more than $3.5 million from the settlements, according to the Justice Department.

With these additional agreements, the Justice Department’s investigation has now yielded settlements with more than 500 hospitals totaling more than $280 million. Among the South Florida hospitals included the earlier settlement are Aventura Hospital and Medical Center, Kendall Regional Medical Center and Palmetto General Hospital in Hialeah.

  Comments