Cape Cod Hospital Ordered to Pay $24.3M Over False Claims

According to the U.S. Attorney’s office, Cape Cod Hospital has reportedly settled for more than $24.3 million in response to allegations that it did not comply with Medicare cardiac surgery requirements.

According to the investigation, the hospital’s clinicians did not assess their patients before performing transcatheter aortic valve replacements (TAVRs). During this treatment, a synthetic heart valve is used to replace a broken one. Regrettably, the hospital failed to adhere to the Medicare reimbursement standards for these assessments.

The settlement states that some TAVR operations performed by Cape Cod Hospital between 2015 and 2022 were reported to Medicare without meeting the required NCD standards. Because of this, the hospital broke the False Claims Act by submitting fraudulent claims to Medicare, totaling millions of dollars.

Sometimes, physicians don’t do an excellent job of evaluating patients to see whether they can handle the surgery. Furthermore, there were instances when the physicians doing the TAVR neglected to document and relay their results to the other members of the medical staff.

In a statement, Cape Cod Hospital made it clear that they were not accused of harming patients who had TAVR treatments or of fraudulently invoicing Medicare for procedures that were not performed.

According to the facility, the relevant doctors either left the hospital or were never employed there. By including experienced cardiac surgeons from Beth Israel Lahey Health in its Heart Team, Cape Cod Hospital has strengthened its documentation processes and gained confidence in its ability to provide Medicare-compliant, high-quality medical treatment.

Bruce Johnston, who chairs the board of trustees, praised CEO Michael Lauf and his staff for their leadership. He also spoke about the remarkable new facility, which is now under construction. It will house a cutting-edge cancer center, consolidate the cardiology programs at the hospital, and provide 32 surgical and medical beds to accommodate the increasing demand. It will be called the Edwin Barbey Patient Care Pavilion.

Richard Zelman, a cardiologist at Cape Cod, was instrumental in starting and overseeing the institution’s TAVR program. He sued the hospital in 2022, claiming that his dismissal was due to his exposure to what he saw as the institution’s immoral practices that put profit above patient care.

As the whistleblower, Zelman is expected to get around $4.36 million from the settlement. Gregg Shapiro, who is defending Zelman in the case, said that the settlement sum is being touted as the most significant recovery ever achieved by a Massachusetts hospital under the False Claims Act.