On May 16, the U.S. Attorney’s Office for the District of Massachusetts announced that Cape Cod Hospital agreed to pay $24.3 million to resolve alleged violations of the federal False Claims Act (FCA) for knowingly failing to follow Medicare’s requirements for certain procedures performed.
Beginning in 2015, the hospital offered transcatheter aortic valve replacement (TAVR) procedures for patients who suffered from aortic stenosis, a serious heart condition that restricts blood flow from the heart to rest of the body. The TAVR procedure replaces a patient’s damaged heart valve with an artificial one. Prior to performing the procedure, the hospital was required under Medicare rules to conduct an independent examination of prospective patients to evaluate their suitability for TAVR, document the rationale for their clinical judgment, and make the rationale available to the medical team performing the TAVR procedure. For some claims, an insufficient number of physicians evaluated the suitability of the procedure, and on others, the physicians did not document or share their clinical judgment with the team performing the TAVR procedure.
The settlement, which stemmed from a qui tam action filed by a physician formerly employed by the hospital, resolved claims submitted by the hospital from November 2015 through December 2022. The physician will receive about $4.36 million as the relator’s share of the settlement.
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