Bryan Vroon and the Landmark False Claims Act Case Against More than 500 Hospitals

If you look at Bryan Vroon’s web site, you might think it’s the web site of a political philosopher.

Bryan Vroon

Bryan Vroon

There’s a quote from Kierkegaard: We create ourselves by our choices.

And then one from Teddy Roosevelt: Far away the best prize that life has to offer is the chance to work hard at work worth doing.

One from Victor Hugo: Life, misfortunate, isolation, abandonment, poverty are battlefields that have their heroes — obscure heroes, sometimes greater than the illustrious heroes.

And from Benjamin Franklin — There is no kind of dishonesty into which otherwise good people more easily and frequently fall than that of defrauding the government.

Bryan Vroon for years was a partner at the corporate law firm of Alston & Bird in Atlanta.

Then he jumped ship and opened his own plaintiff side law firm.

Since going out on his own, Vroon has brought cases against more than 500 hospitals for defrauding Medicare.

Those cases resulted in over $280 million in settlements under the False Claims Act.

Just last week, fifty-one more hospitals settled for $24 million.

Vroon represented two whistleblowers — Leatrice Richards, a registered cardiovascular nurse and Medicare-compliance and reimbursement consultant, and Thomas Schuhmann, also a Medicare-compliance and reimbursement consultant, both from Louisville, Kentucky.

They alleged that the hospitals improperly billed Medicare for surgical procedures to implant cardioverter defibrillators (ICDs).

The Justice Department negotiated 81 separate settlements with the hospital systems, including some of the largest systems in the country. HCA and Tenet Healthcare, for example, agreed to pay $15.8 million and $12.1 million, respectively.

The announcement includes a $5.9 million settlement with a San Francisco-based hospital system.

“This investigation is critically important to patient care now and in the future,” Vroon said. “Science-based medicine protects elderly patients and the Medicare Program.”

The federal investigation led by Department of Justice attorneys Jeffrey Dickstein and Amy Easton dramatically influenced cardiac care by requiring adherence to Medicare’s science-based coverage conditions.

Vroon said that the federal investigation has resulted in major reductions in the numbers of patients undergoing surgeries to implant ICDs – approximately 20,000 fewer each year.

Since the beginning of the Department’s investigation, surgeries to implant ICDs in Medicare patients have decreased by approximately 28 percent, representing a savings of over 2 billion dollars to the Medicare Program during the last five years, Vroon estimated.

The ICDs at issue were implanted in patients’ chests within days after the patients had suffered heart attacks or undergone cardiac bypass or angioplasty procedures.

Scientific studies have demonstrated that in many patients, implanting an ICD in the weeks after a heart attack is not beneficial and is potentially harmful to the heart as it heals. Such harm includes worsening heart failure. Additionally, the heart may recover function in time, rendering an ICD not only premature but never needed.

The waiting periods – 40 days after a heart attack and three months after a bypass or angioplasty procedure – are generally established in the National Coverage Determination (NCD), Medicare’s requirements for coverage. The National Coverage Determinations ensure that Medicare patients receive “reasonable and necessary” medical treatment based on science.

Numerous published studies have confirmed the importance of following the established indications and contraindications for implanting an ICD.

For example, a major study led by medical researchers at Duke University reported, “Patients who received a non–evidence-based ICD had significantly more comorbidities than patients who received an evidence-based device and were at a higher risk of post-procedural complications (including death).”

The Department of Justice worked with leading cardiology experts to develop a settlement model that permitted the hospitals to present potential evidence justifying the surgeries at issue.

Still there were approximately 10,000 surgeries found nationally where ICDs were implanted in violation of science-based medicine or the National Coverage Determination.

Vroon said that the case is a prime example of what Donald Berwick, the former Administrator of the Centers for Medicare and Medicaid Services, called “overtreatment” – or “care rooted in outmoded habits, supply-driven behaviors, and ignoring science”– which he estimated cost Medicare and Medicaid $87 billion in 2011 alone.

“The settlements in this case are a window into a much larger problem in American healthcare,” Vroon said.
Vroon praised Dickstein and Easton for the success of the case.

“Jeffrey Dickstein and Amy Easton led this investigation with extraordinary dedication to Medicare and the medical care of elderly patients,” said Vroon. “Their work over eight years was tireless and determined to ensure that Medicare patients receive needed treatment based on science.”

Vroon said that his move from Alston & Bird to private practice was not an easy one.

‘I had three small children,” Vroon told Corporate Crime Reporter in an interview last week. “They have school tuition. We have mortgages. I took out a second mortgage on my house. I leveraged my house to the max. I cashed in my retirement. There was a huge amount of risk. Ted Turner said — follow your heart but make sure you are right. I knew I was following my heart, but there were many times when I didn’t know whether I was right or not.”

[For the complete q/a format Interview with Bryan Vroon, see 30 Corporate Crime Reporter 8(12), February 22, 2016, print edition only.]

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