Federal officials claim three Chicago hospitals exaggerated the seriousness of the conditions of some patients so they could get liver transplants sooner.
Federal officials and a bioethics expert said they know of no other case where the government accused hospitals of using fraud to increase the eligibility of patients for organ transplants.
According to prosecutors, one patient who was certified as being seven days from death was found in a hospital lobby, dressed in a clown costume, putting on a show to drum up support for a blood drive.
“By falsely diagnosing patients and placing them in intensive care to make them appear more sick than they were, these three highly regarded medical centers made patients eligible for liver transplants ahead of others,” U.S. Attorney Patrick J. Fitzgerald said.
The three institutions are the University of Chicago Hospitals, Northwestern Memorial Hospital and the University of Illinois Medical Center at Chicago.
There was no allegation anyone died for lack of a transplant because some patients were made to look more urgently in need than they were. But some doctors said it was possible.
Illinois Attorney General Lisa Madigan said in a statement that “there is no room for fraud when it comes to deciding which patient receives an organ.”
“No one should play leapfrog with peoples’ lives,” she said.
The case stems from a whistleblower suit unsealed for the first time Monday but that was filed in 1999 by Dr. Raymond Pollak, a University of Illinois Medical Center surgeon.
The other institutions were eventually added to the suit.
The University of Chicago immediately agreed to settle with the federal government and the state attorney general’s office for $115,000. Northwestern settled with the federal government for $23,587. The state attorney general’s office wasn’t involved in Northwestern’s settlement.
Neither hospital acknowledged any wrongdoing.
The state and federal governments have asked the U.S. District Court to force the University of Illinois Medical Center to pay up to $3 million in damages plus possible fines. That institution has not settled so far.
“Our physicians acted at all times with the utmost concern for the welfare of patients very ill with liver disease,” said University of Illinois spokesman Mark Rosati.
John Easton, a spokesman for the University of Chicago Hospitals, said that “contrary to the government’s allegations, the hospitals believe that all decisions about patient care were completely justified.”
Northwestern Memorial Hospital spokeswoman Kelly Sullivan issued a statement saying the hospital agreed with the need to investigate the allegations. But she added that the institution disagreed with the government’s “suggestion that intensive care unit coverage of two critically ill patients, comatose and suffering from liver failure, was unnecessary.”
There is a shortage of livers available for transplant, and only the most seriously ill patients are eligible. The United Network for Organ Sharing, set up by the federal government, decides the criteria for who is sick enough for a transplant.
But money is also a factor in the decision.
Hospitals must perform 12 transplants each year for two years with a survival rate of 75 percent or better to be eligible for Medicare and Medicaid payments to reimburse the cost of the operations.
Federal officials said one motive on the part of the hospitals was to make sure that they had performed enough operations to qualify.