Saint Joseph London (Ky.) Hospital has agreed to pay $16.5 million to resolve allegations that it fraudulently billed state and federal healthcare programs after performing unnecessary heart procedures, according to a news release from Kerry Harvey, U.S. Attorney for the eastern district of Kentucky.
The U.S. government contends physicians performed "invasive" cardiac procedures on patients when not medically necessary, including coronary stents, pacemakers, coronary artery bypass graft surgeries and diagnostic catheterizations between Jan. 1, 2008 and Aug. 31, 2011 and then billed state and federal Medicare programs for them, according to the news release.
The physicians are part of Cumberland Clinic, a physician group that provides all the cardiology services at Saint Joseph London.
Additionally, the settlement resolves allegations that the hospital violated Stark law and the Anti-Kickback Statute by entering agreements with the physicians at Cumberland Clinic to refer patients to the hospital, according to the news release.
As part of the settlement, Saint Joseph London has also agreed to a Corporate Integrity Agreement with the Department of Health and Human Services-Office of Inspector General, a series of internal compliance reforms, including third-party review of its federal healthcare program claims for the next five years.
The whistleblower lawsuit was filed by three cardiologists in the Lexington, Ky., area. The report does not specify if they were affiliated with Cumberland Clinic.
Before the whistleblowers filed the lawsuit, Saint Joseph London voluntarily informed the government that one of its cardiologists, Sandesh Patil, MD, had performed unnecessarily coronary stents, according to the news release. In this separate complaint, Dr. Patil pleaded guilty to federal healthcare fraud and was sentenced to 30 months imprisonment.
This settlement resolves allegations against the hospital, but the government will intervene in the pending civil cases brought upon individual defendants named in the suit.
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