WASHINGTON—EMH Regional Medical Center (EMH) has agreed to pay the
United States $3,863,857, and North Ohio Heart Center Inc. (NOHC) has
agreed to pay the United States $541,870 to settle allegations that they
submitted false claims to Medicare, the Justice Department announced
today.
EMH is a non-profit community hospital system located in Lorain
County, Ohio. During the relevant time period, NOHC was an independent
physician group located in Lorain County that practiced at EMH. The
settlement resolves allegations that between 2001 and 2006, EMH and NOHC
performed unnecessary cardiac procedures on Medicare patients.
Specifically, the United States alleged that EMH and NOHC performed
angioplasty and stent placement procedures on patients who had heart
disease but whose blood vessels were not sufficiently occluded to
require the particular procedures at issue.
“Billing Medicare for cardiac procedures that are not necessary or
appropriate contributes to the soaring costs of health care and puts
patients at risk. The settlement demonstrates the Department of
Justice’s efforts both to protect public funds and safeguard Medicare
beneficiaries,” said Stuart F. Delery, Principal Deputy Assistant
Attorney General of the Justice Department’s Civil Division.
“Most doctors act responsibly,” said Steven M. Dettelbach, U.S.
Attorney for the Northern District of Ohio. “These few didn’t. Patient
health and taxpayer dollars have to come before greed.”
This matter was initiated by the filing of a whistleblower complaint
under the False Claims Act (FCA). Under the FCA, private citizens can
bring suit for false claims on behalf of the United States and receive a
share of the recovery obtained by the government. The whistleblower in
this matter, Kenny Loughner, was the former manager of EMH’s
catheterization and electrophysiology laboratory. As a result of the
settlement, Mr. Loughner will receive $660,859 of the United States’
recovery.
This resolution is part of the government’s emphasis on combating
health care fraud and another step for the Health Care Fraud Prevention
and Enforcement Action Team (HEAT) initiative, which was announced by
Attorney General Eric Holder and Kathleen Sebelius, Secretary of the
Department of Health and Human Services in May 2009. The partnership
between the two departments has focused efforts to reduce and prevent
Medicare and Medicaid financial fraud through enhanced cooperation. One
of the most powerful tools in that effort is the False Claims Act, which
the Justice Department has used to recover more than $10.1 billion
since January 2009 in cases involving fraud against federal health care
programs. The Justice Department’s total recoveries in False Claims Act
cases since January 2009 are over $13.8 billion.
The investigation was jointly handled by the U.S. Attorney’s Office
for the Northern District of Ohio, the Justice Department’s Civil
Division, the Office of the Inspector General of the Department of
Health and Human Services Cleveland Field Office, and the FBI. The
claims resolved by this settlement are allegations only, and there has
been no determination of liability.
The case is captioned United States ex rel. Loughner v. EMH Regional Medical Center et al., Case
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