New York-Presbyterian Queens Hospital has agreed to pay over $2.5 million to resolve fraud allegations related to a former physician who performed medically unnecessary surgeries on patients with implantable cardioverter defibrillators for more than four years.
The surgeon replaced the batteries in ICDs earlier than necessary. Battery replacement in these devices can only be done via a surgical procedure, which carries risk. As a result, the standard of care is to replace the battery when it reaches the elective replacement interval (ERI) and no earlier.
The physician, who was not named, made 114 orders for replacement ICD batteries between January 2009 and June 2014, before they reached the ERI. In doing so, he subjected patients to unneeded and risky surgeries that ranged from $500 to $50,000. The hospital then submitted reimbursement claims to federal healthcare programs.
“This more than $2.5 million settlement rectifies that New York-Presbyterian/Queens was paid by the federal government for unnecessary procedures,” said United States Attorney Breon Peace in a statement.
Following an internal investigation, the hospital learned what the doctor was doing and voluntarily self-disclosed his conduct to the U.S. Department of Health and Human Services, Office of Inspector General.
Most of the procedures cost between $8,000 and $9,000, a spokeswoman for Peace’s office told Patch
. The hospital will pay $2,588,882.50, resolving claims that the doctor’s decisions violated the False Claims Act.
The False Claims Act states that any individual who knowingly submits false claims to the government is required to pay double its damages and a $2,000 fine for each of those claims.
Because of current inflation the government can ask for triple the amount in damages, according to the Justice Department.
The matter was handled by Assistant United States Attorney Michael Blume of the Office’s Civil Division.