Allegations of Fraudulent Billing, Financial Kickbacks and Unnecessary Medical Procedures Infect Kentucky Hospitals

Going to the doctor is a part of life and we expect our doctors to make medical and treatment recommendations based on their clinical and diagnostic findings. Unfortunately, federal and state investigations are uncovering more and more instances of doctors nationwide making treatment recommendations to benefit their own financial well being rather than the well being of their patients, and Kentucky is not immune to this disturbing trend infecting hospitals and medical facilities throughout the nation.

A renewed focus tackling health care fraud arose in 2009 through a federal enforcement action entitled Health Care Fraud Prevention and Enforcement Action Team (HEAT), which contains the False Claims Act under which the government has recouped more than $13.4 billion since January 2009 to settle claims of fraud against federal health care programs.

Joint state and federal task forces securing these large settlements are focused on recouping millions of dollars paid out because of fraudulent billing for unnecessary medical procedures performed on unsuspecting patients. Many of these unnecessary procedures involve cardiac stents and diagnostic catheterizations, which yield big bucks for the hospitals where the procedures are done and for the cardiologists who perform them.

Doctors violate not only their Hippocratic oath to do no harm, but breach their duty of care to patients by exposing them to the unnecessary risk of infection, complications, injuries and even death by performing these unwarranted medical procedures.

There are also allegations of financial kickbacks from hospitals to doctors performing the unnecessary procedures. Hospitals are creating a climate whereby doctors are making medical decisions based on their own financial well being rather than that of their patients by tying compensation and financial incentives to the number of patients referred and the types of procedures performed in their facilities.

One such recent example is that of King’s Daughters Medical Center in Ashland, Kentucky, an independently owned facility, that just agreed to pay $40.9 million to settle claims it fraudulently billed Medicaid and Medicare millions for unnecessary coronary stents and cardiac catheterizations between January 2006 and December 2011, and paid kickbacks to doctors referring patients to King’s Daughters.

U.S. Attorney Kerry B. Harvey commented, “The conduct alleged in this matter is unacceptable, victimizing both taxpayers and patients. Treatment decisions motivated by financial gain undermine public confidence in our health care system and threaten vital federal programs upon which so many of our citizens rely.”

The nearly $41 million settlement represents the third large settlement over fraudulent billing practices in Kentucky this year. Earlier this year, St. Joseph Health System paid $16.5 million to settle similar allegations of fraudulent billing for unnecessary heart procedures performed at its medical facility in London, Kentucky, and another $15.75 million was recouped from 2 doctors over fraudulent billing practices related to unnecessary drug testing.

If you feel that you may have been the victim of an unnecessary medical procedure, please call us today. We are experienced in handling these types of cases and are already litigating many cases for patients who underwent alleged unnecessary heart procedures at King’s Daughters Medical Center. We are here to answer your questions and can help investigate whether you or your loved one were victimized by an unnecessary medical procedure.