Senate Finance Committee Chairman Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) today released a Finance Committee report detailing the case of a doctor who reportedly implanted nearly 600 potentially medically unnecessary stents from 2007 through mid-2009 at St. Joseph Medical Center in Towson, Maryland, and his relationship with the manufacturer of the stents, Abbott Labs. The Senators’ report found that the questionable stent implantations cost the Medicare program $3.8 million during that period.
“Hospital patients expect their care to be based on medical need, not profits. This report sets forth alarming evidence that patients at St. Joseph Medical Center received unnecessary and potentially harmful stent implants time and again – a pattern that is shocking, disturbing and shameful. Doctors should not be performing invasive medical procedures patients don’t need, and taxpayers certainly shouldn’t be paying for these wasteful and improper implantations,” said Baucus. “Even more disconcerting is that this could be a sign of a larger national trend of wasteful medical device use, which is why we included aggressive new tools in the new health care law to fight fraud, waste and abuse. The health care law improves screening of medical providers and increases oversight to root out fraud, waste and abuse like this, shining a spotlight on problems like these and helping ensure cases like this don’t happen again.”
From fiscal year 2004 to fiscal year 2009, the Medicare Part A program paid an estimated $25.7 billion for cardiac stent procedures and approximately $108.9 billion for 6.9 million procedures related to medical devices. Fraud, waste and abuse in the health care system cost Americans at least $60 billion a year – three percent of total health care spending. Other similar cases of apparently improper cardiac procedures have been uncovered at medical facilities across the country. Baucus and Grassley launched their review of this case to look for patterns that might have implications for preventing waste, fraud and abuse in Medicare and Medicaid.
Hundreds of patients have since filed claims they received unnecessary implants. Some doctors say the case has revealed a level of inappropriate care that is more common than most patients know.
Last month, the hospital where the (unnecessary) procedures were performed agreed to pay a $22 million fine to settle charges that it paid illegal kickbacks to the cardiologist in exchange for patient referrals, denying any wrong doing. Similar cases are being prosecuted in Texas and Louisiana.
Dr. Steven Nissen, chief of cardiovascular medicine at the Cleveland Clinic, who routinely treats patients who have been given multiple unneeded stents: “What was going on in Baltimore is going on right now in every city in America. We’re spending a fortune as a country on procedures that people don’t need.”
Stents should be used only if X-rays show that most of the artery is blocked, and the patient has symptoms like frequent chest pain. Stent procedures can, in rare cases, cause bleeding, stroke or a heart attack. Once a stent is placed, it can result in a life-threatening clot that emerges weeks to months later. Stent patients must spend a year or more taking blood-thinning medications, which have their own risks.
From:
- Baucus, Grassley Outline Millions of Wasted Taxpayer Dollars, Examine Reports Of Hundreds of Improper Cardiac Stent Implantations, US Senate Commitee on Finance, December 06, 2010
- Doctor Faces Suits Over Cardiac Stents, Gardiner Harris, NYTimes, December 5, 2010
- Abbott finds “potential fraud, waste, and abuse”, Shelley Wood, Heartwire, December 6, 2010