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More Hospital Settlements as Justice Department Ends ICD Investigation

02/22/16

  11:39:00 pm, by MedBen5   , 323 words,  
Categories: News, Health Plan Management, Hospitals, Cost savings, Heart, Third party administration

More Hospital Settlements as Justice Department Ends ICD Investigation

ICD

The U.S. Justice Department has made its final round of settlements with hospitals suspected of excessive use of implantable cardiac devices (ICDs) following a five-year study. Meanwhile, MedBen has been protecting clients from this expensive practice for nearly a decade.

According to Modern Healthcare, 51 more hospitals – several leading hospital systems among them – will pay the government $23 million to end their probe into suspected overuse of ICDs. This follows a similar settlement in 2015 by 457 hospitals for more than $250 million.

ICDs are implanted near the heart to detect and treat arrhythmia – fast, life-threatening heart rhythms – by delivering a shock to the heart. Medicare allowed their for primary prevention of arrhythmia beginning in 2005, with the caveat that it wouldn't pay for devices implanted within 40 days of a heart attack or 90 days of bypass surgery or angioplasty. Even so, upwards of 40% are implanted contrary to clinical practice guidelines, when a less expensive pacemaker, or even medication, may have been sufficient to treat the condition.

MedBen follows research-based clinical criteria for appropriate placement of ICDs. Since 2007, we have employed cardiologists to perform clinical reviews on these devices on behalf of our clients, as a standard part of our clinical review process – and have saved clients $2.5 million in the process.

ICDs are among the most expensive devices to treat abnormal heart rate, costing $40,000 or more per unit, and need to be replaced every 5 years. Therefore, MedBen believes it essential to rely on expert physician reviewers to review charges like these that aren't caught by coding software and standard claim payment reviews.

MedBen's surveillance system flags claims for possible clinical issues like ICDs, in addition to a variety of other reasons, such as large loss potential for the employer or inappropriate provider billing. We focus on ensuring that our clients pay only for appropriate care, saving money for employer and patient alike.

Clients with questions regarding MedBen’s clinical review procedures are welcome to contact President and COO Kurt Harden at 888-633-2364.

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