The settlements keep rolling in from the government's yearslong, nationwide investigation into the suspected overuse of implantable cardio-defibrillators.
HCA recently became at least the sixth hospital system to settle with the government to resolve allegations stemming from the probe. The Nashville-based hospital operator agreed to pay the government $15.8 million, it disclosed in an August filing with the Securities and Exchange Commission.
HCA did not admit to any wrongdoing as part of the settlement. Attempts to reach HCA for further comment were not immediately successful Monday morning.
The U.S. Justice Department had been reviewing certain billing and medical records related to the devices at 95 HCA hospitals, the system said. HCA had operating revenue of $36.9 billion in 2014, according to Modern Healthcare's financial database.
Other health systems that have settled similar allegations with the government include Iasis Healthcare; Catholic Health Initiatives; St. Joseph Health based in Irvine, Calif.; Tenet Healthcare Corp.; and MedCath Corp., a now defunct chain of heart hospitals. None of those companies admitted liability as part of their settlements.
The Justice Department hasn't publicly spoken about the investigation, which started more than four years ago and is thought to involve hundreds of hospitals. A spokeswoman for the department said Monday that its policy is to neither confirm nor deny investigations.
The government's investigation has raised the ire of physicians who argue that Medicare's coverage rules for the devices conflict with other medical guidelines.
The implantable cardiac devices cost $40,000 or more, and their use increased after Medicare changed its rules in January 2005 allowing them for primary prevention of arrhythmia. The rules say the devices cannot be implanted within 40 days of a heart attack or 90 days of bypass surgery, but many doctors have chosen to implant them in such circumstances anyway.
Colin Zick, a partner at Foley Hoag in Boston, said that in such investigations the Justice Department sometimes likes to go after the biggest players first.
“From the government's perspective, they try to get it like water running downhill, get some momentum and then it really starts moving,” said Zick, who has represented providers targeted in the investigation. Going after the largest providers first can send a message to smaller ones, he said.
This isn't the first time the government has launched a national healthcare investigation that led to a series of settlements. A broad investigation into kyphoplasty—the injecting of cement into fractured vertebrae—led to settlements with 55 hospitals in 2013 for more than $34 million.
“Over the course of 20 years, you've seen a real evolution in the government's approach, and their ability to access and manage the data,” Zick said.
The defibrillator investigation has been driven by extensive data-mining of Medicare claims. It has been credited with lowering the number of the devices implanted in recent years.