A Lexington doctor who helped uncover a widespread false billing scheme at a Kentucky hospital will be featured on CBS’ Whistleblower Friday night.
Whistleblower, airing at 9 p.m. Friday, features stories “of heroic people who put everything on the line in order to expose illegal and often dangerous wrongdoings,” according to its website.
Friday’s episode showcases Dr. Michael Jones, who along with fellow doctors Paula Hollingsworth and Michael Rukavina in 2010 and 2011, played a key role in blowing the whistle on an alleged overbilling scheme at St. Joseph-London Hospital.
The doctors noticed when they treated patients who had heart procedures done at St. Joseph-London that the treatments had been unnecessary, according to a lawsuit they jointly filed in 2011. One patient in London had 17 unneeded heart catheterizations and another patient had 10 catheterization procedures and seven stents placed to improve blood flow near arteries that were near normal.
St. Joseph-London and some doctors who worked there were accused of submitting bills to government-funded programs such as Medicare and Medicaid for hundreds of unnecessary heart procedures.
The alleged wrongdoings occurred before St. Joseph merged with Jewish Hospital and St. Mary’s HealthCare in 2012 to form KentuckyOne Health.
The owner of St. Joseph-London agreed to pay a $16.5 million settlement, which was the second-largest ever in a health care fraud case in the federal Eastern District of Kentucky.
The settlement resolved the claims against the hospital, but several doctors who practiced at the hospital and their clinics were also sued by patients.
Jones decided to take action because the procedures were invasive and costly enough to potentially bankrupt patients.
“I saw many patients who underwent unnecessary heart procedures,” Jones said, according to a release from CBS. “I was concerned they were being done for financial gain.”
Kevin Wells had a pacemaker installed that was unwarranted. His wife, Ruth Wells, is a part of the CBS episode. She said Kevin’s heart felt like it was beating out of his chest.
“Kevin could have died,” Ruth Wells said, according to CBS. “He could have died on that table. And to think it was for something he didn’t need.”
Jones practices at Baptist Health Lexington.
A statement provided by KentuckyOne Health Friday stated the London hospital is demonstrating clear action to prevent this issue from recurring.
“In February 2011, following a months-long internal investigation, Saint Joseph London self-reported to Federal authorities instances of interventional cardiology procedures that lacked adequate documentation to support the clinical indication for the procedures. The internal investigation was launched as a result of the hospital’s own proactive and ongoing compliance reviews, and the hospital then self-reported to Federal authorities, one month prior to the whistleblower lawsuit,” according to the statement.
“Saint Joseph London also fully cooperated in all subsequent government inquiries concerning the interventional cardiology procedures,” the statement continued. “Since then, the hospital has demonstrated clear action to address and prevent this issue from recurring, including monitoring, reporting and ongoing audits that exceed governmental requirements. In fact, in 2017 Saint Joseph-London was recognized by the Accreditation for Cardiovascular Excellence as adhering to the highest quality standards for cardiovascular care.”