The Justice Department continues to pile up healthcare enforcement actions — false claims, anti-kickback, and fraud. DOJ is on its way to a record year. In a recent enforcement action, Modernizing Medicine (“ModMed”), an electronic health record (“EHR”) vendor, agreed to pay $45 million for AKS and False Claims Act violations for receiving bribes in exchange for referrals and causing users to falsely report information...
When it comes to the healthcare sector, the Justice Department and the HHS-Office of Inspector General have no shortage of investigations and targets for prosecution. The more resources made available to DOJ and HHS-OIG, the more money made for the federal government from medical care fraud. It is a very simple equation. It is like shooting fish in a barrel. BioReference and OPKO Health, Inc....
False Claims Act prosecutions continue against healthcare executives, physicians and professionals. Last year, DOJ recovered over $5.6 billion in FCA enforcement. DOJ expects total recoveries to increase in 2022. Over 95 percent of False Claims Act prosecutions involved healthcare fraud and kickbacks. Two Doctors and Eight Others Indicted for Healthcare Kickbacks In a recent prosecution in the Northern District of Texas, DOJ announced the indictment...
Akron General Health Systems, a regional hospital system based in Akron, Ohio agreed to pay $21.25 million to resolve allegations under the False Claims Act that it maintained improper relationships with referring physicians, resulting in the submission of false claims to the Medicare program. Akron General was acquired in late 2015 by the Cleveland Clinic Foundation. The timing of the case and the investigation raise...
The Justice Department’s enforcement programs are resuming – False Claims Act, FCPA and other programs will continue. The rate of enforcement, however, is subject to change once again from the impact of the pandemic. As the pandemic continues to spread, DOJ focus on pandemic related fraud and other scams will divert resources from “traditional” priorities. DOJ’s commitment to False Claims Act prosecutions in the health...
Boston Heart Diagnostics, a Massachusetts company, agree to pay $26.7 million to settle a False Claims Act case involving allegations of paying illegal kickbacks to physicians. According to the settlement, Boston Heart charged Medicare and Medicaid patients for advanced lipid testing referred by providers who received kickbacks from independent marketers at the direction of Boston Heart. Starting in 2015, Boston Heart provided advanced lipid testing...
Healthcare organizations – ranging from physician practice groups to large, multi-state hospital systems – face a variety of risks, including fraud and abuse, as well as HIPAA privacy issues. Starting from a baseline risk assessment, healthcare organizations are often juggling among competing risks and responding to enforcement threats. The design and implementation of an effective healthcare compliance program is extremely difficult and requires dedication, resources,...
