Friday, October 30, 2015

Justice Department Fines 457 Hospitals for Inappropriate ICD Implantations

From the Heart Rhythm Society via email today:
Today, the Department of Justice announced that it has reached settlements in its investigation of hospitals for billing Medicare for ICDs implanted in Medicare patients that did not meet Medicare coverage requirements. The announcement includes 70 settlements involving 457 hospitals in 43 states for more than $250 million.

The Heart Rhythm Society (HRS) has recognized that the misalignment between the Medicare National Coverage Determination and the clinical practice guidelines created gaps between the payment policy and clinical decision-making and places physicians and their patients in an untenable position. To help mitigate the problem, HRS published "2013 HRS/ACCF/AHA Expert Consensus Statement on the Use of Implantable Cardioverter Defibrillator Therapy in Patients Who Are Not Included or Not Well Represented in Clinical Trials”.

Moving forward, the Society’s priority is to do everything possible to assist the heart rhythm care community in managing the patient care pathway. HRS and other medical specialty societies are currently working with the Centers for Medicare and Medicaid Services (CMS) to identify the appropriate time to reopen the existing national coverage policy. The Society will provide CMS with recommendations to update the clinical indications for reimbursement. With this preparation, we stand ready to work with our partners to revise the Medicare coverage policy to reflect current clinical practice.
Outdated CMS National Coverage Decisions from 2005 just whacked hospitals. "Misalignment's" Catch-22. So much for evidence-based medicine. So much for practice guidelines. So much for innovation in health care.

CMS NCDs rule now, no matter how outdated, from now on.

The Justice Department has spoken.

-Wes

References: Justice Department press release with list of hospitals affected.
More on the history of this action here.

4 comments:

Ed Rico said...

Apparently, any disgruntled patients (or families of deceased patients) who don't qualify for ICDs under these guidelines should be directed to register their dissatisfaction with the Attorney General, instead of their EP physician or hospital administration.

Anonymous said...

Did Dr. Cassell get a commission? Seriously, if this isn't the most obvious example of the failure of our cardiology leadership in Washington, D.C, I don't know what is. Ask yourself why you pay dues to all the professional societies who are charged with preventing this sort of debacle. This is a major screw up. Nothing will be mentioned and it will be brushed under the rug while the bureaucrats who are too good to pull a chart off the door continue to climb the ladder to the next overpaying position.

You Will Know the Truth About Fast Lies and Policies said...

The Truth Will Set You Free

Domestic murder en masse.
Murder on an unprecedented scale overseas.
Murderous advisors in Washington DC...

Lying from the beginning.
Taxing us to death, proclaiming
They will keep us safe and free.

Murderous requirements mandated by ABMS subspecialties.
Murderous initiatives promoted by ABIM, AMA, and ACP.
Membership societies sending out annual requests for fees

Burning through the money.
Pissing it all away...
Faster than anyone can breathe.

And all one can do is say Jeez?!

Anonymous said...


Agree with Rico. This is sickening!