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Hospital Agrees to Pay Over $24 Million to Settle False Claims Act Case Over TAVR Cardiac Procedures

Posted  May 21, 2024

The DOJ recently announced that Massachusetts-based Cape Cod Hospital agreed to pay $24.3 million and enter into a corporate integrity agreement to settle a False Claims Act case concerning Medicare claims for certain cardiac procedures.

The cardiac procedures at issue, transcatheter aortic valve replacements (“TAVR”), involve replacing a diseased aortic valve with an artificial valve.  Medicare required providers to follow certain rules before performing TAVR procedures.  According to the DOJ’s announcement, “Medicare rules at the time required that, prior to performing a TAVR procedure, hospitals [1] engage specified clinical personnel to conduct an independent examination of prospective patients to evaluate their suitability for TAVR, [2] document the rationale for their clinical judgment and [3] make the rationale available to the medical team performing the TAVR procedure.”

As laid out in the DOJ’s statement, the False Claims Act case against Cape Cod Hospital alleged that from 2015 through 2022, it “knowingly submitted hundreds of claims to Medicare for TAVR procedures that did not comply with the applicable Medicare requirements.  In some instances, not enough physicians examined a patient’s suitability for the procedure, while in other instances the physicians failed to document and share their clinical judgment with the medical team responsible for the TAVR procedures.”

This case, like so many other successful False Claims Act cases, was initially brought by a whistleblower.  Here, the whistleblower was “a physician formerly employed by Cape Cod Hospital,” who, per the DOJ’s press release, “will receive approximately $4.36 million” from the resolution of the case.

This case is also notable because, according to the DOJ and the settlement agreement, Cape Cod Hospital received credit under DOJ guidelines because it “voluntarily produced materials, identified the relevant medical records, admitted that it failed to adhere to the applicable Medicare requirements and implemented appropriate remedial measures.”

This is yet another healthcare False Claims Act case where a whistleblower reported misconduct to the government and the government intervened, resulting in a substantial recovery to the government (and ultimately, to taxpayers), and changes being made at the company to hopefully prevent such misconduct from occurring again.

If you have information relating to potential healthcare fraud and would like to speak to an experienced member of the Constantine Cannon whistleblower lawyer team, please don’t hesitate to contact us for a free and confidential consultation.