Ex-employee accuses Adena Health of taking Medicare pay for unnecessary heart surgeries
CHILLICOTHE, Ohio (WCMH) -- A federal lawsuit unsealed Friday has accused a Chillicothe-based medical provider of performing unnecessary heart surgeries and taking pay from the U.S. government.
The lawsuit is a qui tam action, meaning that plaintiff Rhett Holland's attorneys sued on behalf of the United States over fraudulently obtained money. Holland was Adena Health System's vice president of quality and safety, but claimed he was fired in April 2023 in retaliation for investigating procedures for which the company took millions of dollars in false Medicare and Medicaid claims.
Holland had one type of cardiac surgery take center stage in his lawsuit: the Transcatheter Aortic Valve Replacement. He accused the medical conglomerate of "knowingly submitting false claims for payment" from Medicare and Medicaid for the procedure, which he said failed to meet the threshold of being medically necessary for patients.
As part of a "national coverage determination" to qualify for Medicare and Medicaid reimbursements for a TAVR program, Holland said Adena needed to perform at least 20 other aortic valve surgeries in the Adena Regional Medical Center within two years. Adena Health System did not meet those requirements when it launched its TAVR program in January 2022. The whistleblower noted Adena's three surgeons picked to perform TAVR surgery did so on three patients before they had received approval from Adena's board of trustees.
By March 2023, Holland's attorneys claimed in the lawsuit that Adena had performed more than 20 TAVR procedures without meeting the requirements for Medicare or Medicaid. They also wrote that the healthcare system held off on billing patients for the TAVRs so the number of surgeries could then meet the national coverage determination. Once they had passed 20 procedures, the bills went out, allowing them to retroactively qualify for Medicare or Medicaid coverage.
Adena has previously seen controversy over TAVRs and the doctors performing them. Sources inside the hospital told NBC4 in 2023 that an Adena Regional Medical Center doctor lacking credentials performed the operation on as many as three patients. Separately, sexual misconduct allegations surfaced and patients' families accused Adena of patient deaths. The medical center began firing more employees in May 2023, and stopped offering heart surgery at the end of September.
In the lawsuit, Holland's attorneys also referenced federal and state whistleblower protection laws, accusing the health system of violating them when it fired him. After he reported concerns about the TAVR program to Adena's executive leadership, the company "began a workplace investigation ... placed him on leave, and shortly thereafter, terminated his employment."
Holland sued Adena Health System, Adena Medical Center and Adena Healthcare Collaborative in October 2023, but it was months until a federal judge ordered the case be opened for public view.
Adena Health System declined to comment on the lawsuit. View the full complaint document filed by Holland's attorneys below: