Johns Hopkins Hospital is sued over ineligible Medicare claims

U.S., whistle-blower allege millions were paid for procedures not covered

January 16, 2003|By Julie Bell | Julie Bell,SUN STAFF

The Justice Department has filed a civil fraud lawsuit against Johns Hopkins Hospital, joining a whistle-blower in alleging that the Baltimore institution billed Medicare for millions of dollars in procedures involving cardiac devices that were experimental and therefore ineligible for payment.

Hopkins denied it has done anything wrong and has moved for dismissal of the federal lawsuit, which seeks $5,000 to $10,000 in penalties for each of the 556 procedures involved.

The federal lawsuit, brought in U.S. District Court in Baltimore, also seeks damages equal to three times the amount of the alleged improper Medicare payments. The payments were related to billings Hopkins submitted from 1986 to 1995.

The government did not say in its complaint exactly how much money it's seeking to recover.

But Hopkins maintains that it didn't immediately know about the policy because Medicare didn't publicize it when it was implemented in 1986.

The hospital also contends that the policy against paying for experimental devices was included in a Medicare handbook but never made part of an official regulation - meaning it amounted to a guideline without the force of law.

The policy against payment, rescinded in 1995, applied only to Medicare, Hopkins said.

"We truly believe Medicare patients should get the same care as non-Medicare patients," said G. Daniel Shealer Jr., deputy general counsel of the Johns Hopkins Health System. "Generally, this was the standard of care, and non-Medicare payers were willing to pay for it, and Medicare currently is willing to pay for it."

The federal lawsuit was spurred by a whistle-blower lawsuit filed by Kevin D. Cosens, a medical device salesman. The case is one of several dozen related lawsuits filed against medical institutions across the country, the Justice Department said yesterday in a press release.

The government so far has reached settlements with 31 hospitals for a total of $42 million - an average of about $1.35 million per settlement.

The government decided to intervene in Cosens' whistleblower lawsuit in August and filed its own complaint Dec. 12. Cosens had filed his lawsuit under the Federal False Claims Act, a Civil War-era law that allows private citizens to sue on behalf of the government and receive about 25 percent of money recovered. The lawsuits were unsealed Dec. 30.

The government's complaint, however, quotes doctors expressing concerns about reimbursement. The federal lawsuit cites a March 1, 1991, memo in which Dr. Thomas R. Hendrix, chairman of Hopkins' Joint Committee on Clinical Investigation, wrote to another doctor:

"What patient in their right mind would risk the financial responsibilities involved in using an unproven experimental device for the treatment of coronary artery disease, when there is a proven device which would be covered by their health/care system?"

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