Settlement Inked In Stent Case

SALISBURY — Peninsula Regional Medical Center (PRMC) this week agreed to pay $1.8 million to settle allegations it was aware of, but failed to take action against, a cardiologist convicted late last month on health care fraud charges after performing over 100 unnecessary cardiac stent procedures on patients.

In July, a federal jury convicted John R. McLean, 59, of Salisbury, on six counts of healthcare fraud over a four-year period from 2003 to 2007 during which he submitted insurance claims for inserting unnecessary cardiac stents, ordered unnecessary tests and made false entries in patient medical records in order to defraud Medicare, Medicaid and private insurers.

According to evidence presented at trial, McLean had a private medical practice in Salisbury and hospital privileges at PRMC. From at least 2003 to 2007, McLean performed cardiac catheterizations and implanted unnecessary cardiac stents in more than 100 patients at PRMC. He then falsely recorded in the patients’ medical records the existence or extent or coronary artery blockage, known as lesions, observed during the procedures in order to justify the submission of claims to health care benefit programs.

The other shoe fell this week when PRMC agreed to pay a $1.8 million settlement allegedly failing to prevent the unnecessary cardiac stent procedures carried out by McLean at the hospital. The allegations resolved by the settlement agreement include the failure of senior medical staff at PRMC to follow up on evidence presented through the complaints of staff in the cardiac catheterization laboratory about the medically unnecessary nature of the procedures McLean was performing as part of his health care program fraud scheme.

Under the settlement agreement, the hospital agreed to repay monies it received from federal health benefit programs between April 24, 2003 and Dec. 4, 2006 for medically unnecessary procedures performed by McLean.

As a result of the settlement, PRMC also entered into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services and the Office of Inspector General, which requires the hospital to take steps to ensure accurate billing for patients. The agreement also requires the hospital to appoint physician executives to oversee medical staff on quality of care matters, among other things.

Meanwhile, McLean faces a maximum of 10 years in prison for health care fraud and five years for each of the five counts of making false statements related to health care matters. The government is also seeking a forfeiture of over $700,000, representing scheme proceeds.

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