Cape Cod Hospital has been hit with a hefty $24.3 million tab to settle federal accusations of bilking Medicare. The hospital in question reportedly charged for heart procedures that didn't meet the stringent Medicare guidelines, cutting corners on patient evaluations and raking in big bucks in the process. According to details released Thursday by the U.S. Attorney's Office, the hospital's non-compliance spree kicked off in 2015 and didn't stop until the end of last year, lining their pockets with funds they weren't entitled to for years.
The nitty-gritty of the allegations points to TAVR, a procedure to fix up patients with aortic stenosis, which basically means their ticker wasn't pumping blood the way it’s supposed to. ADetailed, independent check-ups to size up whether patients were fit for TAVR were either half-baked or not inked into records properly, a federally enforced rule aimed at maintaining patient safety. "Medicare permitted coverage for this newly developed cardiac procedure only under certain conditions, to ensure patient safety. Cape Cod Hospital ignored those rules and received millions of dollars from Medicare to which it was not entitled. This conduct persisted for years despite internal warnings," Acting United States Attorney Joshua S. Levy stated. The settlement covers hundreds of these allegedly shoddy TAVR claims to Medicare.
The Justice Department isn't letting Cape Cod Hospital off the hook post-settlement either. The hospital's now roped into a five-year pact known as a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), mandating a third-party review system for their Medicare billing strategies. It’s a sort of keep-your-nose-clean agreement ensuring they don't pull a fast one on the government's dime moving forward.
Despite the mess, the hospital did earn some brownie points for fessing up and working with the Feds, which apparently made their financial hit a bit softer. They dug up records, pulled out the problematic paperwork, and put new practices in place to avoid a repeat situation. Cape Cod Hospital essentially said, "My bad," and promised to straighten up their act according to the Department of Justice's False Claims Act policy, which cuts a break for cooperation. In a silver-lining twist, the whistleblower who gave the hospital up stands to pocket a cool $4.36 million cut from the settlement cash, for their troubles of calling out the alleged Medicare scheme.
Rooting out healthcare fraud is top-tier on the government's to-do list, with the False Claims Act acting as a power player in the good fight. Cape Cod Hospital’s payout is the latest example of the push to keep healthcare providers in line, making sure they stick to the books when it comes to billing Uncle Sam. And, with this settlement dropping, the DOJ is making it crystal clear – play by the rules or pay up. For folks looking to drop a dime, there’s a hotline open to report anything fishy with Medicare funds – HHS at 800-HHS-TIPS. This info comes straight from the top brass including Levy, Brian M. Boynton, of the Justice Department’s Civil Division, and Roberto Coviello, a big wheel at HHS-OIG.
