The government claims the organizations violated both anti-kickback law and the False Claims Act.
The lawsuit (Fry v. Health Alliance of Greater Cincinnati) filed in 2003 alleges that, from at least 1999 to 2004, cardiologists, including those employed at Ohio Heart, were allocated time at Christ Hospital?s Heart Station, an outpatient cardiology testing unit where patients receive non-invasive heart procedures.
Cardiologists who generated revenue or referred cases for Christ Hospital were then granted the opportunity to perform and bill for procedures, and any follow-up procedures, at the Heart Station. The amount of time allocated was based on the amount of coronary arterial bypass graph procedures and catheter lab revenues generated by each cardiologist or cardiology group for Christ Hospital, formerly a member of the Health Alliance, during the previous year.
Many of these procedures performed at The Heart Center were billed to Medicare and Medicaid; federal law makes it unlawful for physicians to receive financial kickbacks for patient referrals.
“The government’s intervention in this case demonstrates the Justice Department?s continued commitment to ensuring that medical decisions are based on the medical needs of the patients and not on unlawful financial incentives paid to physicians,? says Acting Assistant Attorney General Jeffrey S. Bucholtz, of the DOJ?s Civil Division, according to the DOJ.
The Christ Hospital and Ohio Heart have defended their practices, saying, ?No unnecessary procedures were performed and no incorrect billing occurred at any time. The parties maintain all allegations are baseless and will mount a vigorous defense,? according to a joint position statement (here and here) posted by the organizations.
The whistleblower lawsuit was filed by Harry Fry, MD, who worked for both Christ Hospital and Ohio Heart.
