Posted on 02/11/2020 6:15:25 PM PST by ransomnote
Tenet Healthcare Corporation and its affiliated hospital Desert Regional Medical Center (DRMC), a general medical and surgical hospital located in Palm Springs, California, have agreed to pay $1.41 million to resolve allegations that they violated the False Claims Act by knowingly charging Medicare for implanting unnecessary cardiac monitors, the Justice Department announced today.
“Providers that bill for unnecessary services and devices contribute to the soaring cost of health care,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “The Department of Justice holds accountable those providers that impose unnecessary treatments upon patients and pass the inflated costs on to federal health care programs.”
Medicare only reimburses services and treatments that are reasonable and medically necessary. This settlement resolves allegations that DRMC knowingly charged Medicare for unnecessary cardiac monitors (often called loop recorders) that DRMC cardiologists implanted in beneficiaries from 2014 to 2017.
“Invasive medical procedures, such as implanting heart monitors, are not without risk,” said Timothy B. DeFrancesca, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Therefore, when these procedures are medically unnecessary, as contended in this case, people in government health programs are put at needless peril, and taxpayers end up with the bill.”
The settlement resolves allegations filed in a lawsuit by Michael Grace, a former DRMC employee, under the qui tam provisions of the False Claims Act, which permit private individuals to sue for false claims on behalf of the government and to share in any recovery. The civil lawsuit is docketed in the Central District of California and is captioned United States ex rel. Grace v. Tenet HealthCare Corp.; St. Francis Hospital-Memphis; Desert Regional Medical Center; and Apollo MD, Case No. 17-CV-1481. As part of this settlement, Grace will receive $240,789 as his share of the government’s recovery.
The resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
This matter was investigated by the Commercial Litigation Branch of the Department of Justice’s Civil Division, and the Office of Inspector General for the U.S. Department of Health and Human Services.
The claims resolved by this settlement are allegations only and there has been no determination of liability.
The year 2020 marks the 150th anniversary of the Department of Justice. Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.
“Invasive medical procedures, such as implanting heart monitors, are not without risk,” said Timothy B. DeFrancesca
...
It’s about as risk free as a procedure can get. The recorder goes just beneath the skin. There’s no physical contact with the heart.
I will have a great post soon. For now bfl
“Medicare only reimburses services and treatments that are reasonable and medically necessary. This settlement resolves allegations that DRMC knowingly charged Medicare for unnecessary cardiac monitors (often called loop recorders) that DRMC cardiologists implanted in beneficiaries from 2014 to 2017.”
We all KNOW this is just the TIP of the iceberg! My Dad relies on Medicare and Medicaid for his healthcare.
I can’t begin to tell you how many times they’ve brought him back from the brink of death in the past five years. And he’s hardly in bad shape compared to others in his ‘Skilled Living Facility.’ (aka ‘Nursing Home.) (Survived Sepsis, survived Cancer, for now...) but his quality of life absolutely sucks. Why keep prolonging it? Answer: For the money he generates!
If we had to pay for all of his treatments for this and that, we’d both be living in a box under a bridge! There is an AMAZING amount of fraud, waste and abuse baked right into the cake when it comes to this.
Grrrrr!
Your Dad can refuse supportive measures, you know. Sorry you’re so bitter.
“It’s about as risk free as a procedure can get. The recorder goes just beneath the skin. There’s no physical contact with the heart.”
True, but I am conflicted on this one. Loop recorders can be very helpful, but they are probably overused, and given that ANY procedure generates income, there is incentive for implanting them.
LOL! You don’t know me very well.
My complaint isn’t with DAD, it’s with how EASY it appears to be to pad/falsify medical treatments so hospitals and facilities can gouge the rest of us Taxpayers.
I’ve never said a cross word about my Dad. He and my Grandpa raised me. They were/are the best thing to happen to me. Right now Dad isn’t capable of making decisions for himself; it’s all on me for now.
They helped to make me the Fiscally Conservative gal I am, today. If he had a clue as to how much is being spent on his behalf, he’d not be the Dementia-riddled Happy Camper he is, either. :)
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