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Cardiac Stent Healthcare Fraud

Devices inserted into narrow or totally obstructed coronary arteries, to avoid the need for open-heart surgery, and which force the vessels to remain open, are referred to as “stents.” Major questions have been raised concerning the overuse of stents. In particular, there has emerged evidence of illegal kickbacks from stent manufacturers to physicians to incentivize stent placements, when appropriate medical justification was missing for a given patient. Such evidence prompted a formal investigation by the United States Senate Committee on FinanceThe Committee concluded in 2010 that, at a  single hospital, a single practitioner was responsible for the placement of as many as 585 unnecessary stents without clear medical indications, and were thus clear examples of fraud, waste, and abuse.

Indications for appropriate use of stents have been widely published, both in Europe and the United States. Generally speaking, there must be clear evidence for current, active coronary artery disease, either with usual patient physical exertion or inducible in the setting of stress testing. There should also be evidence of blockage in arteries which nourish those portions of the heart that have so far not sustained damage.

In addition to the cardiac stent fraud reported by the US Senate Finance Committee, in November 2011 the US Attorneys’ Office for the District of Maryland reported the conviction and sentencing of a Cardiologist to 97 months in prison. The sentencing was the result of an alleged scheme in which a physician submitted insurance claims of inserting unnecessary cardiac stents, ordered unnecessary tests and made false entries in patient medical records, in order to defraud Medicare, Medicaid and private insurers.

Failure to subject patients to appropriate selection criteria for invasive or non-invasive procedures, as well as failure to secure informed consent, constitute serious neglect of a physician’s obligations to practice safe medicine. Moreover, serious specific concerns have been raised on the practice of coronary stent placement, in particular, the value of stents in managing coronary artery disease, and whether adequate patient education and informed consent are consistently provided for this procedure.

Therefore, coronary stenting has gained the attention of regulators for safety, appropriate patient selection, compliance with patient education, and potential healthcare fraud under the False Claims Act.

REAL PEOPLE making real change Meet Some of our Heroes

Joe Strom

Johnson & Johnson
$184 Million

Joe Strom contacted us in 2005. We were very grateful that he did. We immediately formed an all-star legal team and a process to stop a very harmful pharmaceutical marketing strategy. It was this process we set into motion that ultimately returned hundreds of millions of dollars to the U.S. Treasury, and a portion of that, very well-deserved, into Joe’s bank account.

Joe told us a very troubling story about the off-label promotion of a pharmaceutical drug for patients who already suffered from chronic heart failure.

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Bruce A. Moilan Sr.

$27 Million

Bruce Moilan was a seasoned hospital systems expert by the time he contacted our Firm. At the time he decided to file his qui tam lawsuit, he was employed by South Texas Health System as a System Director for Materials Management. In this position, he oversaw $24 million in annual purchases of supplies and equipment and helped determine budget, reduction and cost analysis throughout the contract bidding and negotiations process. His job was to insure proper implementation for purchasing, receiving and management of inventory, for McAllen Hospitals, L.P.

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Kathleen Hawkins

Dignity Health
$37 million

Kathleen Hawkins, RN MSN, had been employed by Defendant, Catholic Healthcare West (CHW) for approximately 6 years when she decided she had had enough of trying to change the hospital system from within.

CHW, a California not-for-profit corporation that operated hospitals in California, Arizona, and Nevada, was at the time the eighth largest hospital system in the nation and the largest not-for-profit hospital provider in California.

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"I collaborated with Nolan, Auerbach and White on a broad variety of cases where whistleblowers stepped forward to disclose tactics employed by large companies to influence physicians' medical decision-making in patient care. They provide ample resources to not only optimize their client cases, but in doing so consistently leverage best medical evidence to further patient safety and resource utilization.”

— Fred Polsky M.D., Former Medical Director, CMS Zone 7 Integrity Contractor

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