Excela Health has paid Medicare nearly $2 million to settle allegations that it submitted false claims for medically unnecessary cardiac stenting between 2009 and 2011, the U.S. Attorney's Office in Pittsburgh announced late last week.
The case involved two interventional cardiologists who had privileges at Excela's Westmoreland Regional Hospital.
Although the Pennsylvania-based nonprofit system agreed to the settlement in July, the U.S. Justice Department forbade Excela from releasing the terms until the government made it public, the Tribune-Review reported.
Excela self-disclosed the possible overstenting and overbilling and hired independent experts to review the stent procedures, the Tribune-Review noted.
"We were aware of the situation, we investigated, we self-reported, and Excela believes that was an important factor in resolving the issue," Excela CEO Robert Rogalski told the newspaper.
After self-reporting, Excela made quality improvements and has since received national accreditation for its cardiac catheterization laboratory.
In addition to the $2 million settlement, the allegedly unnecesary stent insertions also prompted several medical malpractice lawsuits against the two doctors and Excela, pending in Westmoreland County.
This summer, Hospital Corporation of America (HCA), the nation's largest for-profit hospital chain, came under federal investigation for allegedly aggressively performing cardiac services at 10 of its Florida hospitals to boost revenues and profit margins.
Meanwhile, following a spate of overstenting cases in Maryland, the state General Assembly passed legislation that mandates external peer review of coronary stent placement and whether it is medically necessary. The bill aims to create evidence-based guidelines for the use of stents.
Such legislation could help hospitals avoid costly Medicare claims denials, as medical necessity has been the most common reason for denials since the first quarter of 2010.
To learn more:
- read the DOJ announcement
- read the Tribune-Review article