A Medical Device Daily
The U.S. has intervened in a whistleblower suit accusing the Christ Hospital, the Health Alliance of Greater Cincinnati and The Ohio Heart Health Center (all Cincinnati) of defrauding federal healthcare programs, the Department of Justice reported. The lawsuit alleges that Christ Hospital, formerly a member of The Health Alliance, and Ohio Heart, the largest cardiology group in that region of Ohio, devised a scheme that provided cardiologists improper financial incentives in exchange for generating revenue for the hospital.
The focus of the lawsuit is an outpatient cardiology testing unit within Christ Hospital known as the Heart Station, where patients receive non-invasive heart procedures such as electrocardiograms, echocardiograms and stress tests. The lawsuit alleges that, between at least 1999 and 2004, cardiologists were allocated time at the Heart Station based solely on the amount of coronary arterial bypass graph procedures and catheter lab revenues generated by each cardiologist or cardiology group for Christ Hospital during the previous year.
Many of these procedures were billed to and paid for by various federal healthcare benefit programs, including Medicare and Medicaid. Federal law makes it unlawful to provide or receive financial incentives in exchange for patient referrals.
In this case, cardiologists, including those employed by Ohio Heart, were rewarded for referring business or generating revenue for Christ Hospital with the opportunity to bill for the patients they treated at the Heart Station and for any follow-up procedures that these patients required. This system for scheduling time at the Heart Station gave area cardiologists an incentive to perform certain cardiac procedures at Christ Hospital and prevented otherwise qualified cardiologists, who failed to generate income for Christ Hospital during the previous year, from working at the Heart Station.