The Ohio Heart & Vascular Center was recently named in a claim against The Health Alliance and The Christ Hospital. We continue to be focused on the healthcare needs of the community while we mount a vigorous defense against these baseless allegations. This statement explains our position on the claim.
Situation
The Department of Justice is pursuing a claim that the Health Alliance of Greater Cincinnati and The Christ Hospital provided remuneration to cardiologists in exchange for physicians referring patients to the hospital for heart services.
Patient care is not in question. 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.
Essentially, the government claims cardiologists were rewarded for referrals by being given the opportunity to do required readings of cardiac tests in the Heart Station at The Christ Hospital. Physicians were assigned through the Heart Station scheduling to read tests performed on unassigned patients – individuals who arrived at the hospital without a previous relationship with a cardiac specialist.
The claim apparently dates back to a 1999 allegation made by a physician formerly on the medical staff of The Christ Hospital.
The Christ Hospital took reasonable and appropriate steps to ensure that the Heart Station was always covered so that anytime a patient needed to have cardiology tests read, a qualified cardiologist would be available. No payments were ever made to physicians for referrals.
The government claims violations on two fronts:
The Anti-Kickback Law, which requires specific intent to defraud a federal program (such as Medicare or Medicaid). There have been no allegations of incorrect billings of these programs.
The False Claims Act, which does not apply in this case because the parties could not have filed any false documents or made any false claims with regard to the federally funded programs since no incorrect billing occurred and no unnecessary tests were ordered.
Why the fundamental claim doesn’t make sense
First, Heart Station assignments of physicians were for readings of cardiac tests which are not highly reimbursed services. Reimbursement rates for these types of services range from $8 to $40 per reading.
Secondly, historic data shows the cardiologists gained few, if any, additional patients through their work in the Heart Station. The records show an unassigned patient was not more likely to follow-up with the physician who read the test and thereby become a patient of that physician. The cardiac test results were forwarded to the patients’ primary care physicians.
What’s at stake
This case is an attack on Greater Cincinnati and its health care delivery system. The magnitude of the financial exposure puts at risk the future of The Christ Hospital, repeatedly recognized by US News & World Report as one of the nation’s top hospitals.
Ohio Heart and Vascular Center is a pre-eminent heart specialty practice in the region and was one of many cardiology groups which provided test readings at the Heart Station at TCH during the time in question. Ohio Heart inexplicably has been singled out in the claim. Also named in the action is Medical Diagnostic Associates, a billing services firm for all cardiologists who performed services at the Heart Station. MDA ceased operations in 2005.
Together, The Christ Hospital and the physicians of Ohio Heart serve more than 243,000 patients throughout the Tristate region (Ohio, Kentucky, Indiana). The Christ Hospital, with its urban location, has operated for more than 115 years based on a mission of providing care for the city’s most needy residents. The hospital provides nearly $21 million annually in charitable care.
Health care industry impact
This action by the government will have long-lasting effects on the people of the Tristate region, and will impact the entire industry. The government, using a novel theory, is questioning how a hospital assigned qualified physicians to interpret cardiac tests. This is a management and scheduling decision made in every hospital across the country on a routine basis.
This case is an attempt by the federal government to use the court system to change policy and bypass procedures to change regulations. HHS has debated regulations related to the topic of opportunity for fees and remuneration for years. Numerous publications have chronicled the agency’s work to expand the definition of remuneration, specifically in the area of specialty hospitals and large specialty group practices.
Congress and federal regulators have not seen the need for any change.
All hospitals must staff and manage interpretation of routine medical tasks, such as reading x-rays or other test results. The government’s attempt to regulate this aspect of hospital management could have serious expense and staffing effects.
What’s next
Since becoming aware of the claim, The Christ Hospital and its cardiologists fully cooperated with the authorities including providing them with requested documents. In view of the fact that the documents establish that The Christ Hospital at all times acted in compliance with relevant regulations, the parties are disappointed that the government has elected to proceed with such a flawed case.
The Christ Hospital is a former member of the Health Alliance of Greater Cincinnati. The claims were initiated during the time the physicians and medical staff of Christ Hospital were part of the Health Alliance.
The Christ Hospital and its cardiologists seek immediate dismissal of the claims and call on business leaders and residents of Greater Cincinnati to share their opinions with their representatives on the impact this case could have on health care in the region.
For more information go to http://www.tchcincinnati.com
Media inquiries should be directed to attorney Kenneth Seibel, spokesperson for The Ohio Heart & Vascular Center, (513) 381-6600, ext. 10.
