26, 2017, the U.S. Department of Justice (DOJ) announced a $13.45 million
settlement with two Texas-based cardiac monitoring companies for alleged
Medicare overbilling practices. The
companies are independent diagnostic testing facilities (IDTFs) that provide
remote cardiac monitoring services. The
DOJ alleges that the companies adopted an enrollment process that steered
ordering physicians to the most costly level of service payable by each
patient’s insurance plan.
against both companies were brought by a former sales manager under the qui tam
provision of the False Claims Act (FCA), which allows private citizens (known
as “whistleblowers”) to file complaints on behalf of the government against
those suspected of defrauding federal programs. The whistleblower in this case
is expected to receive approximately $2.4 million between the two settlements.
case is United States ex rel. John Doe v.
Spectocor Enterprise Services, LLC, et al., Case No.14-1387 (KSH) (D.N.J.).
health care providers and related vendors have become prime targets in the
government’s efforts to combat health care fraud.
and other health care vendors are on notice that the DOJ will scrutinize
the technological processes companies make available to physicians for
ordering services. While the DOJ
recognizes the positive impact medical technology has on patient care, it
also recognizes that such technology is susceptible to fraudulent misuse.
for and resolving any identified overpayments to Federal health care
programs remains a critical compliance consideration to avoid potential
health care practice group at Plews Shadley Racher & Braun LLP regularly
works with physicians, dentists, nurses, physician assistants, and other health
care providers to counsel on FCA and other regulatory issues. Additional
information about Plews Shadley Racher & Braun LLP and its health care
practice is available at www.psrb.com.
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