David H. Howard, PhD Professor, Health Policy and Management Rollins School of Public Health Emory University, Atlanta, Georgia

False Claims Act Linked to Drop in Stent Surgery

MedicalResearch.com Interview with:

David H. Howard, PhD Professor, Health Policy and Management Rollins School of Public Health Emory University, Atlanta, Georgia

Dr. Howard

David H. Howard, PhD
Professor, Health Policy and Management
Rollins School of Public Health
Emory University, Atlanta, Georgia

MedicalResearch.com: What is the background for this study?

Response: Application of the False Claims Act (FCA) to medically unnecessary care is controversial, both in the courts and in the Department of Justice. Although there haven’t been many FCA suits against hospitals and physicians for performing unnecessary percutaneous coronary interventions (PCIs), the suits that have occurred have been against some of the highest-volume hospitals and physicians. Some cardiologists have been sentenced to prison.

MedicalResearch.com: What are the main findings? 

Response: We found that PCI volume declined more rapidly at hospitals that were sued under the False Claims Act. The results suggests that FCA suits have contributed to the national decline in PCI use. Although it is controversial, the FCA can discourage unnecessary medical care, saving Medicare and private payers money in the process. 

MedicalResearch.com: What should readers take away from your report?

Response: Clinicians and administrators should to take steps to insulate themselves from the threat of False Claims Act litigation. The FCA is a powerful tool for identifying and deterring costly, unnecessary care.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Some of the physicians sued under the False Claims Act were accused of miscoding patients’ stenosis to justify performing PCI and avoid scrutiny. Knowing the extent of miscoding, which probably went on at other hospitals as well, is important for establishing the validity of data in the national PCI registry. 

No disclosures

Citation:

Howard DH, Desai NR. US False Claims Act Investigations of Unnecessary Percutaneous Coronary Interventions. JAMA Intern Med. Published online September 21, 2020. doi:10.1001/jamainternmed.2020.2812

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Last Modified: Sep 21, 2020 @ 8:00 pm 

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