False cardiac procedure Medicare claims by Cape Cod Hospital cost $24M

Cape Cod Hospital has agreed to pay more than $24.3 million to resolve allegations that it did not follow Medicare cardiac procedure rules, according to the U.S. Attorney’s office.

Investigators found that the hospital’s physicians did not perform patient evaluations for transcatheter aortic valve replacements, a procedure known as TAVR that involves replacing a patient’s damaged heart valve with an artificial one, in compliance with the rules for Medicare reimbursement.

From November 2015 to December 2022, Cape Cod Hospital knowingly submitted “hundreds of claims to Medicare for TAVR procedures that did not comply with the applicable NCD (National Coverage Determination) requirements,” according to the settlement, meaning the hospital submitted millions of dollars of false claims to Medicare in violation of the False Claims Act.


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