Heart patients victimized by billing fraud, unnecessary procedures

Unnecessary cardiac care billed by eastern Kentucky hospitals resulted in high-dollar false claims settlements this year. King's Daughters Medical Center (KDMC), for example, agreed to pay $40.9 million to settle allegations of filing false Medicare and Medicaid claims for needless cardiac stents and diagnostic catheterizations, the U.S. Department of Justice announced last week.

Prosecutors said KDMC subjected patients to invasive procedures they didn't need and then falsified documentation to make services look necessary. These practices reportedly pumped millions of overpaid dollars into the hospital.

"This type of alleged conduct deceives individuals when they are seeking medical treatment and are vulnerable," FBI Special Agent in Charge Perry K. Turner stated in the announcement. "The level of funds involved in this matter is staggering."

The settlement also resolves allegations that KDMC violated the Stark Law by paying some cardiologists unreasonably inflated salaries, and these doctors referred patients to KDMC, according to WSAZ-TV. The Stark Law aims to curb improperly influenced medical decisions by prohibiting certain kinds of financial relationships between doctors and hospitals.

Another civil healthcare fraud settlement, the second largest of its kind in eastern Kentucky, raised similar issues last January.

Saint Joseph London Hospital agreed to repay $16.5 million to resolve a whistleblower complaint that it billed for numerous unnecessary cardiac procedures, according to the U.S. Attorney's Office. Many procedures generated payments of between $10,000 and $15,000 apiece, the announcement stated.

Before the whistleblower's complaint, the hospital self-reported that one of its cardiologists, Sandesh Patil, inserted medically unnecessary heart stents. Patil previously pleaded guilty to federal healthcare fraud and was sentenced to 30 months in prison, the announcement stated. Saint Joseph London Hospital also was accused of violating the Stark Law and the anti-kickback statute.

Both hospitals entered into five-year corporate integrity agreements, according to the DOJ.

For more:
- read the DOJ announcements on KDMC and Saint Joseph London Hospital
- here's the WSAZ-TV article