HYANNIS, MA – Cape Cod Hospital has agreed to a $24.3 million settlement to resolve allegations under the False Claims Act. The hospital is accused of submitting claims to Medicare for transcatheter aortic valve replacement (TAVR) procedures that did not comply with Medicare’s specified evaluation requirements for patient suitability, according to Acting U.S. Attorney Joshua S. Levy for the District of Massachusetts.
Starting in 2015, the hospital began offering TAVR procedures, a treatment for aortic stenosis. However, from November 1, 2015, through December 31, 2022, it is alleged that Cape Cod Hospital failed to meet Medicare rules which mandated independent examinations by specified clinical personnel to assess patient suitability for TAVR. In some cases, insufficient documentation was provided to the medical team, and in others, not enough qualified physicians reviewed the patient’s condition.
As part of the settlement, the hospital will also enter into a five-year corporate integrity agreement with the Department of Health and Human Services,
Source: Cape Cod Hospital Settles Medicare Fraud Allegations for $24.3 Million / Shore News Network