Five Long Island hospitals are among more than 500 nationwide to reach settlements of more than $270 million in a cardiac devices case with the Department of Justice — one of the biggest whistle-blower lawsuits to date.
The settlements stemmed from a suit filed in 2008 alleging health care fraud in hospitals that inserted implantable cardioverter defibrillators, or ICDs, in Medicare patients before the federal government deemed it proper.
Northwell Health — including six of its hospitals, four of them on Long Island — agreed to pay $2.5 million and Winthrop-University Hospital in Mineola $4 million.
Both said their settlements did not mean the hospitals were engaging in fraud.
“The Justice Department is not questioning the integrity of the doctors who performed these procedures. Rather this settlement underscores the complex and complicated Medicare rules that physicians and hospitals must adhere to as they attempt to provide the best care for their patients,” Winthrop spokesman J. Edmund Keating said in a statement. “At no time was the health of patients or the care they received compromised in any way. We accept the Justice Department’s findings. Winthrop has a strong compliance program, and will be even more vigilant in following the precise regulations as stipulated by Medicare.”
Northwell spokesman Terry Lynam said in a statement, “While we deny any allegations of wrongdoing, like more than 500 other hospitals nationwide, we believed it was financially advisable to reach a settlement with the federal government rather than engage in more costly, protracted litigation.”
An electronic device inserted under the skin and connected to the heart, the ICD, which costs about $25,000, detects and treats chaotic, fast heart rhythms, called fibrillations, by shocking the heart to restore its normal rhythm.
The Centers for Medicare & Medicaid Services requires a waiting period before ICDs are implanted in Medicare patients who have recently had a heart attack or had heart bypass surgery or angioplasty.
“The medical purpose of a waiting period — 40 days for a heart attack and 90 days for bypass/angioplasty — is to give the heart an opportunity to improve function on its own to the point that an ICD may not be necessary,” the Justice Department said in a statement Wednesday.
Medicare “expressly prohibits implantation of ICDs during these waiting periods, with certain exceptions,” the agency said. “The Department of Justice alleged that from 2003 to 2010, each of the settling hospitals implanted ICDs during the periods prohibited.”
The agency announced $23 million in settlements with 51 hospitals in 15 states on Wednesday, including Northwell’s Huntington, Long Island Jewish in New Hyde Park, North Shore in Manhasset, Southside in Bay Shore, Lenox Hill in Manhattan and Staten Island hospitals.
Winthrop’s settlement was announced in October as part of $250 million in settlements with 457 hospitals in 43 states.
U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida said in a statement Wednesday that the settlements “demonstrate the Department of Justice’s commitment to protect Medicare dollars.” He said that “in terms of the number of defendants, this is one of the largest whistleblower lawsuits in the United States and represents one of this office’s most significant recoveries to date.”
But cardiologists writing in a January 2014 article in the Journal of the American College of Cardiology said there was a “disconnect” between the Medicare ICD requirements, established in 2005, and current practice that could put doctors in an uncomfortable position between doing what they thought was right for the patient and being investigated for Medicare fraud. “Simply put, a physician who follows the standards of his profession in the best interest of the patient should not be subject to civil or criminal penalties,” they said.