Hospital to pay $24.3M over TAVR allegations
Cape Cod Hospital has agreed to pay $24.3 million to resolve allegations that its physicians submitted hundreds of false claims to Medicare for transcatheter aortic valve replacement (TAVR) procedures that did not comply with specific government requirements.
The hospital also agreed to enter into a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) that means its Medicare claims will be reviewed annually by an independent party.
According to the allegations, Cape Cod Hospital knowingly ignored protocol by performing hundreds of TAVR procedures from November 2015 to December 2022 without first ensuring a separate examination was performed to verify the patient was a good TAVR candidate. The hospital then filed claims to Medicare for each of those procedures.
The exact nature of the incidents varied on a case-by-case basis. With some patients, physicians failed to document their clinical judgement prior to treatment. In other cases, the data was technically required, but not by the required number of physicians.
Cape Cod Hospital did “receive credit” for cooperating with the U.S. government and providing relevant materials when requested. It also admitted that it failed to follow Medicare requirements.
“Hospitals that participate in the Medicare program must abide by applicable coverage and reimbursement rules,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in a statement from the U.S. Department of Justice (DOJ). “The department will hold healthcare providers accountable when they knowingly fail to comply with Medicare reimbursement requirements.”
“Health care providers are expected to follow Medicare rules and bill properly,” added Roberto Coviello, special agent in charge with HHS-OIG. “We are committed to pursuing allegations of False Claims Act violations as we work to protect the integrity of the taxpayer-funded Medicare program, and we encourage the public to come forward with information about such conduct.”
A whistleblower received approximately $4.36 million for its part in helping the DOJ secure this settlement.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.