A southern Kentucky hospital system paid kickbacks to cardiologists to refer patients for chest-cracking bypass surgeries and other cardiac procedures that the patients didn’t need, according to a federal whistle-blower suit that the company settled yesterday.
Saint Joseph Health System of Louisville agreed to pay state and federal governments $16.5 million to settle allegations it paid doctors in London, Ky., to refer patients to Saint Joseph hospitals for unnecessary heart surgeries and procedures. The so-called qui tam suit, filed under seal in 2011 by three cardiologists in Lexington, Ky., and joined by the U.S. Justice Department this month, accused three London-area cardiologists of falsifying patients’ test results to justify sending them to Saint Joseph facilities for at least eight unnecessary bypass surgeries and dozens of unneeded cardiac stents.
Saint Joseph, a unit of Catholic Health Initiatives of Denver, did not admit to violating any laws in the settlement. It settled the case “to avoid the expense and uncertainty of prolonged litigation,” according to a statement e-mailed by Saint Joseph spokesman Michael Romano.
Saint Joseph became at least the 12th U.S. hospital company in the past six years to settle federal allegations of billing for needless cardiac stenting, a lucrative procedure for hospitals that involves threading a catheter into coronary arteries and implanting a wire-mesh tube to prop open cholesterol blockages. At least eight medical trials have shown that stenting procedures, also known as angioplasties, are no better than medications and lifestyle changes at prolonging life and staving off heart attacks in most stable heart patients.
What makes the Saint Joseph case unusual is the additional allegation of unnecessary bypass surgeries, common but grueling operations that require forcing open the rib cage and can mean many months of recovery, said Peter Hasselbacher, an emeritus professor of medicine at the University of Louisville who has written about the Saint Joseph case.
“We will never get a handle on controlling medical costs until we as a public are willing to hold health-care professionals and hospitals fully responsible for these violations of trust,” Hasselbacher said.
The whistle-blower suit alleged that cardiologists Satyabrata Chatterjee, Ashwini Anand, and Sandesh Patil received kickbacks from Saint Joseph for patient referrals through a number of medical companies and partnerships. None of the doctors was a party to Saint Joseph’s settlement. Kyle Edelen, a spokesman for the U.S. Attorney’s office in Lexington, said other defendants in the case are still under civil and criminal investigation.
One of the defendants, Patil, pleaded guilty last year to Medicaid fraud for billing for an unnecessary stenting procedure, and he is now serving a 30-month sentence in federal prison.
Messages left at Anand’s home were not returned. An employee at Chatterjee’s former cardiology clinic in London said the doctor has not worked there since October. He could not be reached for comment. Don Brown, an attorney for Anand and Chatterjee, did not respond to messages seeking comment.
Chatterjee has registered at least 13 health-care businesses with Kentucky’s secretary of state since 1993. In 2005, he agreed to pay $435,000 to settle separate U.S. fraud charges, after federal prosecutors accused one of his clinics in Lily, Ky., of dispensing chemotherapy without a doctor and double-billing Medicare for cancer drugs, according to filings in U.S. District Court in Frankfort, Ky. The settlement did not include any admission or denial of liability.
The whistle-blowers—cardiologists Michael Jones, Paula Hollingsworth, and Michael Rukavina—treated patients who had received allegedly unnecessary procedures at Saint Joseph hospitals in London and Lexington and learned more about their cases from medical records, their suit said. The three whistle-blowers will share $2.5 million of the $16.5 million settlement, according to a Justice Department statement.
Saint Joseph is also defending approximately 250 civil cases pending in state court in London, filed by patients who claim to have had unnecessary stents or other cardiac procedures. Many of these cases also name Chatterjee, Anand, or Patil as defendants, as well as other doctors.