By Wayne Allen
On Wednesday King’s Daughters Medical Center (KDMC) and the United States Department Of Justice (DOJ )announced a settlement has been reached over an ongoing investigation into false billing for unnecessary cardiac procedures and kickbacks.
According to DOJ within the terms of the settlement KDMC has agreed to pay $40.9 million to resolve the allegations.
According to released information from DOJ, Assistant Attorney General Stuart F. Delery of the Justice Department’s Civil Division, U.S. Attorney Kerry Harvey for the Eastern District of Kentucky and Special Agent in Charge Derrick L. Jackson at the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Kentucky region made the announcement.”
Delery said in a released statement, “Hospitals that place their financial interests above the well-being of their patients will be held accountable. The Department of Justice will not tolerate those who abuse federal health care programs and put the beneficiaries of these programs at risk by providing medically unnecessary care.” Within the investigation the government alleged that between 2006 and 2011, KDMC billed for numerous unnecessary coronary stents and diagnostic catheterizations performed by KDMC physicians on Medicare and Medicaid patients who did not need them.
The government also alleged that the physicians falsified medical records in order to justify these unnecessary procedures, which allegedly generated millions of dollars in Medicare and Kentucky Medicaid reimbursements for KDMC. “The conduct alleged in this matter is unacceptable, victimizing both taxpayers and patients,” Harvey said in a released statement. “Treatment decisions motivated by financial gain undermine public confidence in our health care system and threaten vital federal programs upon which so many of our citizens rely. We will not relent in our efforts to protect the public from the sort of systematic misconduct alleged in this case.” According to the information released by DOJ. the settlement also resolves allegations that KDMC violated the Stark Law by paying certain cardiologists salaries that were unreasonably high and in excess of fair market value.
In connection with the settlement, KDMC has agreed to enter into a Corporate Integrity Agreement with HHS-OIG, which obligates the hospital to undertake substantial internal compliance reforms and to commit to a third-party review of its claims to federal health care programs for the next five years. In a response to the settlement KDMC released a statement, “The Medical Center’s leadership team made the difficult decision to settle the investigation, rather than continue to drain valuable resources on government allegations related to old cases. The settlement is not an admission of wrongdoing on behalf of the Medical Center.”
KDMC then highlighted some of the achievements of it’s cardiac care,During the past several years, independent reviewers have confirmed that the cardiac care at King’s Daughters meets or exceeds national standards. In January, the Accreditation for Cardiovascular Excellence (ACE) organization awarded provisional accreditation to King’s Daughters’ cardiac catheterization and percutaneous coronary intervention (PCI). King’s Daughters is the only hospital in Kentucky, Ohio or West Virginia to achieve this distinction and one of fewer than 20 facilities nationwide to have demonstrated clinical practices that satisfy the rigorous ACE requirements.
Wayne Allen can be reached at 740-353-3101, ext. 228 or on Twitter @WayneallenPDT