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Posts Tagged ‘stent scandal’

New allegations of gross medicare fraud from overstenting and unnecessary interventional procedures has been filed against surgeons in Pennsylvania, including the prestigious UPMC medical center.  This story, (based on cases dating back to 2001 and onwards), comes just as the dust in settling from an outbreak of unnecessary stent cases in neighboring Maryland.

What is overstenting?

Article by Michael R’iordan from the Heart.com re-posted below:

Cardiologists accused of defrauding Medicare by performing unnecessary cardiac procedures

Erie, PA – A new whistle-blower lawsuit filed in US District Court in Erie, PA claims that five cardiologists from two medical practices defrauded Medicare by performing unnecessary cardiac and vascular surgeries and interventional procedures between 2001 and 2005.

The suit, filed under the False Claims Act (FCA) and first reported January 22, 2012 in the Erie Times-News [1], states that as a result of the fraud, Medicare overpaid for these procedures, which wasted substantial public money, and patients were placed at significant and unnecessary risk of harm.

According to a copy of the lawsuit obtained by heartwire, the physicians named are Drs Richard Petrella, Robert Ferraro, Charles Furr, Timothy Trageser, and Donald Zone. The two medical practices named in the lawsuit are Medicor Associates Inc—and its affiliate Flagship Cardiac, Vascular, and Thoracic Surgery (CVTS)—and the University of Pittsburgh Medical Center (UPMC) Hamot (formerly known as Hamot Medical Center). The Medicor practice is the full-service cardiology center affiliated with UPMC Hamot.

The lawsuit states that from June 2001 and earlier, the defendants “knowingly, systematically, routinely, and repeatedly submitted false claims to and received reimbursements from Medicare and other federal healthcare programs for medically unnecessary cardiac catheterizations and cardiac and vascular surgical procedures, including but not limited to . . . PCI.”

As result of the false claims, the physicians received money to “which they were not entitled.”

Paid directorships and kickbacks

Dr Tullio Emanuele, who worked at Medicor and Hamot Medical Center from 2001 to 2005, filed the suit and claims that Medicor engaged in illegal “kickbacks” with Hamot Medical Center and referred cardiac patients to the hospital. In the lawsuit, it is alleged that Hamot signed contracts with Medicor and Flagship CVTS, valued at $75 000 per physician and as high as $525 000 per year, and the doctors would refer patients in need of medical procedures to Hamot Medical Center.

“Specifically, Hamot identified physicians who referred a high volume of patients and/or had potential to refer a high volume of patients for special treatment and offered remuneration to them in the guise of sham contracts for medical directorships or other similar personal service arrangements,” according to the lawsuit.

The claim states the physicians and the participating hospitals violated the federal Anti-Kickback Statute and the federal Stark Act, which says that a hospital is not allowed to submit a claim for reimbursement from Medicare if the procedure has been referred by a physician with improper financial ties to the hospital.

The suit also claims that Emanuele began to grow suspicious in 2004 when he noticed higher rates of intervention among certain physicians within the group. Between 2004 and 2005, 4408 catheterizations were performed, and Petrella, Trageser, and Ferraro had a “rate of surgical intervention following catheterization of double the junior members of the group.”

Emanuele, according to the lawsuit, believes that many of the procedures were performed unnecessarily. For example, Trageser is accused of performing a cardiac catheterization in a patient with chest pain, despite the symptomology being inconsistent with angina. Ferraro is accused of implanting a stent in an artery with moderate stenosis, even though Emanuele previously recommended medical therapy. Zone performed a cardiac catheterization and overstated the severity of stenosis, sending the patient on to CABG surgery, where he/she later died.

UPMC Hamot and the named physicians received copies of the lawsuit last week, according to the Erie Times-News, and have 20 days to respond. If they are found guilty, UPMC Hamot and the Medicor physicians would be required to reimburse Medicare at triple the cost of the original procedure. Emanuele, as the whistle-blower in the case, would be entitled to 30% of the reimbursed money.

More on similar stories here at Cartagena Surgery:

The Ethics of the Syntax Trial

Stent Scandal series:

Cardiology takes another hit

Mark Midei – or the man who started it all..

This is just a sample of the articles available here at Cartagena Surgery.. For more on this topic, look under the cardiology tab..

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Update: 12 July 2011 :  Another kind of inappropriate stenting makes this news.  In the stories below, interventionalists are placing stents in patients after a heart attack (but days to weeks after – when the artery has already closed – tissue has died).  In these cases, stents are not advised because it’s too late to salvage any heart muscle, making stents in the culprit artery useless.  (However, some interventionalists may still be placing stents inappropriately in these cases not due to fraud but because they have failed to keep up with the most recent guidelines and recommendations for treatment, which is only mildly comforting.)

Guidelines don’t curb unnecessary treatment

Doctors overusing stents  – article quote

“Hochman’s findings apply to about 100,000 Americans a year, suggesting that
about 50,000 people are having the $20,000 procedure done unnecessarily every
year.”  [if you remember from a previous post – a prominent interventional cardiologist considered 50,000 “a rare event”.]  It’s also a billion dollars worth of unnecessary procedures..

From 13 June 2011

More cases of overstenting make the news – again.. This time it’s a cardiologist and a radiologist in Tennessee.  Both are accused of ordering unnecessary tests, including angiography (cardiac caths) and performing unnecessary stenting in a scheme to defraud insurance.. The radiologist received kick backs for his patient referrals..

Article by Reed Miller  (June 10, 2011) over at Heartwire.com re-posted here.

Unnecessary stenting cases grabs government attention in Tennessee

Jackson, TN – The US Department of Justice is looking into charges of fraudulent billing leveled by a Tennessee cardiologist against another cardiologist and two hospitals.

Dr Wood Deming (Regional Cardiology Consultants, Jackson, TN) is accusing Dr Elie Hage Korban (Heart and Vascular Center of West Tennessee, Jackson) of “blatant overutilization of cardiac medical services, including, but not limited to, cardiac sonography, scintigraphic stress imaging, angiography, angioplasty, and stenting” in order to defraud government insurance programs, according to documents filed with the US District Court for Western Tennessee. Deming also alleges that the executives of Jackson-Madison County General Hospital and the Regional Hospital of Jackson and radiologist Dr Joel Perchik (Advanced Radiology, Jackson, TN) condoned or assisted in Korban’s fraud in addition to engaging in a bilateral kickback and self-referral scheme [1].

Deming is seeking to collect a portion of whatever fines the government collects from the defendants in this case, as provided for by the “whistleblower” provisions in federal antikickback and false-claims laws.

According to Deming’s complaint, from 2003 onward the hospitals’ executives allowed Korban to routinely order numerous unnecessary diagnostic studies at the hospitals, including transthoracic echocardiography, scintigraphic stress imaging, and transesophageal echocardiography, and then ordering that the patients be transported by ambulance to one of the hospitals for unnecessary catheterization, coronary angiography, and other coronary and peripheral intervention procedures. The complaint alleges that many of these patients underwent coronary angiography after a negative stress test on the premise that they were still having chest pain, but the records were fraudulently dictated to reflect symptoms that were not present. In many cases, Korban subsequently performed unnecessary interventional procedures including stenting, and patients were then admitted to one of the hospitals for recuperation, Deming alleges.

Deming also alleges that Perchik and the hospitals’ leadership “engaged in a pattern of bad-faith peer review of any physician who chose to oppose the hospitals’ drive for excess and inappropriately collected remuneration, such that such physicians were eliminated from the medical staff if they chose to speak out as whistleblowers concerning any aspect of the scheme,” according to the documents. He also accuses Jackson-Madison County General Hospital of paying for referrals from Medical Specialty Clinic, a group practice led at the time by the hospital’s chief of the medical staff, Dr Charles Hertz. Deming alleges that these illegal payments for referrals were concealed in a series of real-estate transactions.

A statement issued to heartwire from Jackson-Madison County General said that the hospital “is fully cooperating with government investigators and because this is an ongoing investigation we have no further comment.” In a prepared statement, the Regional Hospital of Jackson said it is “pleased that the United States chose not to intervene in the portion of the relator’s lawsuit that named the hospital and a former administrator.”

Likewise, staff at Korban’s office responded saying, “At this time, we have no comment,” and the lawyer for Deming did not return calls.

Deming filed his complaint in 2007, but it remained under seal until Assistant US Attorney William Siler notified the court in May that his office intends to pursue a case against Korban [2]. The US attorneys have agreed to investigate only Deming’s allegations against Korban for false and fraudulent billing for unnecessary cardiac stent procedures that caused the submission of false claims by the hospital. The US attorney’s office in Memphis will file its own complaint against Korban within the next two months.

However, the Department of Justice will not intervene on any of the other charges against any of the other defendants, including the hospitals, but charges against the other defendants cannot be dismissed without approval of the Department of Justice, which also reserves the right to intervene in those actions later.

As first reported in the Jackson Sun [3], last week, US District Judge Dernice Bouie Donald acknowledged the US Attorney’s plan to intervene and ordered that Deming’s complaint be unsealed and served on the defendants with 120 days [4].”

I still think this is only the tip of the iceberg.  If cardiology researchers themselves estimate that over 11% of stents were not ‘appropriate’ with another 38% being ‘undetermined’ (statistics from a previous post) – well, that’s a heck of a lot of folks that got stents that didn’t really need them.

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