CHILLICOTHE, Ohio — A federal lawsuit unsealed Friday has accused Adena Hospital of performing unnecessary heart surgeries and taking money from the U.S. government.
The suit filed against Adena Health System alleges the healthcare provider knowingly submitted false claims for payment to the United States government for medical procedures known as Transcatheter Aortic Valve Replacements (TAVRs).
The lawsuit, filed in federal court, claims that from January 2022 to the present, Adena Health System, Adena Medical Group, and Adena Health Center “knowingly submitted false claims for payment…relating to medical procedures…which procedures were not reasonable and necessary.”
According to the lawsuit, the TAVR procedures did not meet the requirements of the National Coverage Determinations (NCDs), which are national payment policies issued by the Department of Health and Human Services. The NCDs outline specific criteria that must be met for medical procedures to be considered reasonable and necessary for Medicare coverage.
The lawsuit further alleges that Adena Health System retaliated against a whistleblower who reported these concerns, terminating their employment.
“Prior to their submission of Part A claims…for reimbursement of facility expenses incurred in performing TAVRs beginning in January 2022, [Adena Health System and Adena Health Center] had not met the minimal prerequisite volume of aortic valve procedures in the prior two years as mandated by the CMS-NCD,” the lawsuit states.
The lawsuit also alleges that Adena Health System billed the government for these procedures despite knowing they did not meet the NCD requirements. This, the lawsuit claims, constitutes a violation of the False Claims Act, a federal law that imposes liability on individuals and companies who defraud government programs.
The whistleblower, who served as Vice President of Quality and Safety, claims they “raised concerns, informed and reported [Adena’s] noncompliance with the NCD and its violations when performing TAVR procedures.” They also claim to have reported “issues of patient health and safety.”
Adena Health System has not yet responded publicly to these allegations. The healthcare provider is accused of violating multiple sections of the False Claims Act, including those related to knowingly submitting false claims, using false records or statements, and conspiring to defraud the government.
The lawsuit seeks damages on behalf of the whistleblower, including back pay, front pay, and other compensatory damages. The lawsuit also seeks to recover three times the amount of money paid by the government for the allegedly false claims, plus civil penalties.
This is a developing story and will be updated as more information becomes available.