King’s Daughters Hospital Finalizes Angioplasty-Abuse Settlement.

The Verdict is In– Or Is It?

[See Addendum below.]

The agreement between King’s Daughters Medical Center and Hospital and various government investigatory and prosecutorial agencies to settle claims that the hospital submitted improper bills to Medicaid and Medicare has finally been signed. Not that we did not see it coming. A Kentucky record-setting amount of least $40.9 million now flows back into public coffers. Perhaps some of the money also goes into the pockets of a whistle-blower– I am waiting for the actual settlement text.

Has justice been done? If we believe the U.S. Attorney and the FBI agent on the case– surely!  Settlement language stated or implied that King’s Daughters “knew, deliberately ignored or recklessly disregarded the fact” that its cardiologists were putting things inside their patients’ hearts who did not need them; that some doctors were in effect being over-paid to submit their patients to what I have termed angioplasty abuse; that the hospital and its doctors were stealing money from patients and taxpayers; and that motivated by financial gain, public confidence in our healthcare system was threatened. Tough talk indeed.

On the other hand, the hospital admits no wrongdoing and in its statements gives me the [probably intended] impression that it is doing its community a favor by not squandering further valuable resources over allegations on “old cases.” I guess we are supposed to just let sleeping (or injured) dogs lie. The hospital points to external reviews that are said to confirm that it is meeting national standards in at least some aspects. [I have written much already of my growing lack of faith in some such hospital-rating organizations– at least the commercial ones that charge hospitals for the privilege of being evaluated or which charge the hospitals to use their ratings ratings in advertising!] Continue reading “King’s Daughters Hospital Finalizes Angioplasty-Abuse Settlement.”

Troubles Persist at King’s Daughters Hospital.

Settlement proceedings with federal agencies ongoing.

A measure of the difficulty facing our Louisville Hospitals.

Last March I gave an update on the struggle of King’s Daughters Hospital in Ashland, KY to recover from the abrupt decrease in patient volume and income following the disclosure of a Federal investigation of their cardiac program. Several years of financial boom and building turned into a bust of multi-million dollar losses and a downgrading of their bond rating. A paragraph in their FY2013 Audit led me (and pretty much everyone else) to believe that the hospital had reached a settlement with the Department of Justice and Inspector Generals’ offices. My efforts to obtain a copy of the settlement from Kentucky authorities was unfruitful despite apparent cooperation with my request. A report in today’s Modern Healthcare gives the reason why as well as an interim financial update.

The jury is still out!
In fact, settlement discussions were indeed in progress but are not final. The $48.9 million mentioned in the footnote of the audit referred to a reserve set aside to cover any fine and associated legal costs. The Hospital corrected the misleading language.

“Standard accounting principles require a reserve be set to reflect potential exposure for legal matters once the amount can be reasonably determined. Unfortunately this accrual was reflected in the audit footnote disclosure as though a final settlement agreement had been executed. While it is true King’s Daughters has been in ongoing negotiations with the Department of Justice, a final settlement has not occurred. King’s Daughters will update this notice if a final settlement with the Department of Justice is reached.”

Ongoing losses despite some improvements.
As of March 2014 the hospital reported a 13.5% decrease in admissions and a 15.2% decline in patient days for the year. Meaningful savings in operating expenses were won and the state’s expanded Medicaid program led to a decrease in “self-pay” uninsured patients. These gains were lost to unspecified severance benefits, and consultant and legal fees. The hospital, like others, continues to pay a heavy price for its alleged angioplasty-misadventures. Continue reading “Troubles Persist at King’s Daughters Hospital.”

Catholic Health Initiatives Agrees to Pay $37 Million to Settle Class-Action Lawsuit for Angioplasty Abuse.

bemine2As reported in the Baltimore Sun last week, Catholic Health Initiatives (CHI) agreed to pay up to $37 million to settle civil claims of unnecessary coronary artery stenting at its St. Joseph Hospital in Towson, Maryland. The class action suit by some 273 patients was one of several federal and civil lawsuits against the hospital for the placement of, or billing for medically unnecessary invasive cardiac procedures beginning years before 2010. The settlement still needs the approval of court officials and an agreement of at least 60% of other plaintiffs to join the case. These and apparently other plaintiffs have the option not to join the settlement. The books are not obviously closed on the case. The Hospital’s principal invasive cardiologist, Mark G. Midei, is named in other open actions, but not this case.

Cost of doing business? Slap on the hand? Fair outcome?
Although this sounds like a lot of money, it amounts only up to $134,000 per patient before plaintiff’s attorneys take 40% and repayments are made to Medicare, Medicaid, and private insurance companies who paid for the “allegedly” unnecessary medical procedures. Frankly, I anticipated a higher penalty given my understanding of the severity of the “alleged” deeds. Naturally, as we have come to see in these cases, CHI admits no wrongdoing, presumably knuckling under to an alternative interpretation of heavy-handed litigation and to avoid further uncertainty and legal expense.

CHI settled earlier with the Federal Government for $22 million for illegal kickbacks. In May 2013, the Hospital settled confidentially with another 200 or so patients for unknown sums. CHI sold its unfortunately but inevitably-tainted hospital (but not its tort liabilities) to the University of Maryland in 2012. In my opinion, and based on what I have read from independent examination of the facts, including a US Senate investigation, I would not personally have visited the hospital for services. Regretfully, when all the facts in cases like this are kept from the public, confidence and trust can be lost for a long time. No one is served well, save perhaps attorneys for the plaintiffs. Continue reading “Catholic Health Initiatives Agrees to Pay $37 Million to Settle Class-Action Lawsuit for Angioplasty Abuse.”

Major Settlement Between King’s Daughters Hospital and U.S. Department of Justice.

A $40.9 million settlement over issues of unnecessary cardiac catheterizations and coronary stents was apparently reached last February. Is it final yet?

Modern Healthcare reported yesterday on additional bad news for King’s Daughters Medical Center, including a $40.9 Million-plus settlement with the U.S. Department of Justice related to unnecessary cardiac procedures. The following language comes from the Medical Center’s annual independent audit for the fiscal year ending September 2013, as released this March 14.

“In February 2014, the Medical Center and the United States of America, acting through the DOJ and on behalf of the Office of Inspector General (OIG-HHS) of the Department of Health and Human Services (HHS) (collectively the “United States”) and the Commonwealth of Kentucky, reached an agreement to settle the DOJ’s review related to unnecessary diagnostic cardiac catheterizations and coronary stents. Under the terms of the agreement, the Medical Center will pay $40.9 million (“Settlement Amount”) to the United States. Interest will accrue on the Settlement Amount at the simple rate of 2.5%. Accordingly, $40.9 million is included in the current accrued governmental settlement at September 30, 2013 for the Settlement Amount. An additional $8 million has been included in the current accrued government settlement at September 30, 2013 for legal fees associated with the investigation and settlement. In addition to the settlement, the Medical Center will enter into a Corporate Integrity Agreement with the OIGHHS.”

Little or no news about the settlement.
I find no announcement of any settlement as of this morning on the websites of the Eastern District US Attorney, King’s Daughters Medical Center, or Kentucky’s Inspector General. I will try to ask for such. Apparently there was an additional settlement in September, 2013 of which I have no other details. Can anyone help? Continue reading “Major Settlement Between King’s Daughters Hospital and U.S. Department of Justice.”