Investigational Cardiac Device Billing Targeted By Four DoJ Complaints
This article was originally published in The Gray Sheet
Executive Summary
Department of Justice lawsuits against four hospitals for improperly billing investigational cardiac devices may hinge on whether changes to Medicare manuals can occur without a formal rulemaking process
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Experimental cardiac device billing
Justice Department takes on 27 additional hospitals for improper Medicare billing of devices, bringing to 40 the total number of cases it is prosecuting in support of whistleblower suits from 1986-1995. DoJ has reached settlements with 31 hospitals for a total of roughly $42 mil. and "is in the process of finalizing settlements with two other hospitals," according to a Dec. 17 release. In related cases, DoJ filed four civil complaints between Oct. 31 and Nov. 5 (1"The Gray Sheet" Nov. 25, 2002, p. 9)...
Experimental cardiac device billing
Justice Department takes on 27 additional hospitals for improper Medicare billing of devices, bringing to 40 the total number of cases it is prosecuting in support of whistleblower suits from 1986-1995. DoJ has reached settlements with 31 hospitals for a total of roughly $42 mil. and "is in the process of finalizing settlements with two other hospitals," according to a Dec. 17 release. In related cases, DoJ filed four civil complaints between Oct. 31 and Nov. 5 (1"The Gray Sheet" Nov. 25, 2002, p. 9)...
MEDICARE MANUAL LANGUAGE BARRING COVERAGE OF INVESTIGATIONAL DEVICES IS "INVALID," JUDGE DECLARES; HCFA UNLIKELY TO RECOUP FUNDS PAID TO HOSPITALS IN PAST
Language in the Health Care Financing Administration's 1986 Medicare manuals barring coverage of investigational devices is void "for failure to comply with the rule-making requirements of the Administrative Procedures Act," Judge John Davies of the U.S. District Court in Los Angeles ruled April 8.