“Move along, there’s nothing to see here!” ~ Lt. Frank Drebin
Nearly 400 people have joined a suit against St. Joseph London Hospital in London, Kentucky and 11 cardiologists who practice there. The essence of the suit is that several cardiologists did hundreds of unnecessary heart procedures and the hospital failed to prevent this excessive care.
Andrew Wolfson in the February 17, 2013 Courier-Journal reports that the lead plaintiff, a 67-year old man, had more than 2 dozen heart procedures over 20 years. After becoming concerned with his never ending course of treatment he had his medical records reviewed by a cardiologist in Lexington who indicated there was no apparent reason for a number of the procedures performed upon him (and billed to Medicare). The plaintiff has sued the hospital’s parent company, Catholic Health Initiatives, alleging a conspiracy among the hospital and a number of its cardiologists to conduct expensive, unnecessary procedures which resulted in at least 2 deaths and significantly jeopardized the health of many others.
Additionally, the U.S. attorney’s office in Lexington is investigating the medical necessity of these procedures and the financial relationship between the St. Joseph system and the cardiology group. The plaintiff’s cardiologist, Dr. Sandesh “Sam” Patil is the subject of a federal criminal healthcare fraud investigation. Also, the hospital was cited in 2011 by the Centers for Medicare and Medicaid for failing to review the medical necessity of 3,367 cardiac catheterizations performed there the year before.
It seems exceedingly clear that the hospital chose not to watch. Large patient volume from a particular group can result in selective vigilance. You and your insureds are at risk in any hospital. At some, normal medical risks can be compounded by a lack of or intentionally poor monitoring of the medical staff. Is anybody here on your side? Our accredited utilization review can help with that.
Call us, We can do better.
Posted in OMCA