The Department of Justice (DOJ) is aggressively pursuing false claims actions against all forms of medical practices, who the DOJ believes have improperly billed Medicare, not provided proper physician supervision and billed services to Medicare that were not medically necessary. On January 4, 2013, the United States Department of Justice intervened for purposes of effectuating the settlement of a qui tam action (filed under the federal False Claims Act or "FCA") against EMH Regional Medical Center (EMH), a non-profit community hospital system located in Lorain, Ohio; North Ohio Heart Center, Inc. (NOHC), an independent physician group in Northern Ohio that practiced at EMH; and two physicians. The suit was originally filed in 2006 by Kenny Loughner, a former manager of EMH's catheterization and electrophysiology laboratory. The complaint alleged that between 2001 and 2006, EMH and NOHC performed unnecessary cardiac procedures to Medicare patients. Specifically, the United States alleged that EMH and NOHC over-prescribed angioplasty procedures, and improperly "unbundled" angioplasty and angiogram services, leading to the routine scheduling of "serial" angioplasties. The medical providers were also accused of performing angioplasty and stent services on individuals whose blood vessels were not sufficiently occluded to require such procedures.
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