A group of doctors who performed unusually high rates of heart procedures on patients at a community hospital in Ohio settled with the Justice Department over accusations that some of the procedures were medically unnecessary, federal regulators announced on Friday.
The settlement covered accusations that the doctors and the hospital, then known as the EMH Regional Medical Center, had billedMedicare for unnecessary medical care from 2001 to 2006. The hospital agreed to pay $3.9 million to settle the accusations, and the physician group, the North Ohio Heart Center, agreed to pay $541,870, according to a Justice Department statement.
Federal regulators had accused the doctors and the hospital of performing unnecessary procedures known as angioplasties, in which a clogged blood vessel is opened. The procedure often requires insertion of a device called a stent to keep the blood vessel from closing again.
Besides the cost to Medicare, "performing medically unnecessary cardiac procedures puts patients' lives at risk," said Steven M. Dettelbach, the United States attorney for the Northern District of Ohio, which was involved in the investigation. "Patient health and taxpayer dollars have to come before greed," he said.
The high rate of heart procedures at the hospital was the subject of a front-page article in The New York Times in August 2006. Medicare patients in Elyria, Ohio, where the hospital is located, were receiving angioplasties at a rate nearly four times the national average, a figure that prompted questions from insurers and raised concerns about overtreatment.
The concerns included whether many patients in Ohio and elsewhere were receiving expensive and inappropriate medical treatments because of the high fees the procedures generated.
The settlement represents the latest in a series of actions brought against cardiologists and hospitals for performing questionable cardiac procedures. Patients typically have a choice of treatments, and many doctors say some individuals should be treated more conservatively with medicines rather than through costly procedures.
At the time, the Elyria cardiologists defended their high rates as a result of an aggressive style of medicine, and the doctors continued to defend the medical care they provided. They said the procedures they performed were medically warranted but might not have met the government's guidelines for reimbursement.
"We choose to settle rather than go to court," said Dr. John Schaeffer, the chairman of North Ohio Heart, which is now part of the hospital system, EMH Healthcare. The government did not single out any individual physicians, and neither the hospital nor the medical group said it disciplined any of the doctors.
"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," he said in a statement on the group's Web site. "We still do."
The former manager of the hospital's catheterization lab, Kenny Loughner, filed a whistle-blower complaint in October 2006. Mr. Loughner, who will receive $660,859 from the settlement for alerting the government, described how doctors urged nurses and others to falsify complaints of chest pain to justify the unnecessary angioplasties. He also described the doctors' technique of treating patients in stages, forcing patients to come back for multiple procedures.
The government did not include the accusations in its findings, the hospital said, and they are without merit.
In a separate statement issued by EMH Healthcare, the system's chief executive, Dr. Donald Sheldon, said "no patients, to our knowledge, were ever at risk, and there is no question that the patients treated had heart disease and some degree of blockage." The hospital also said it was conducting an external peer review of its cardiac care.
http://www.nytimes.com/2013/01/05/business/us-settles-accusations-that-doctors-overtreated.html?src=recg
