Compliance Today (October 2020)
A series of enforcement actions in July resulted in hundreds of millions of dollars in fines for organizations in the healthcare industry. Several cases were brought to court under the qui tam provisions of the False Claims Act, in which private parties can bring suit on behalf of the government and are eligible to share in any recovery.
The fines range from $16.7 million, paid by Longwood Management Corporation and 27 affiliated skilled nursing facilities for submitting fraudulent claims,[1] to more than $642 million paid by Novartis Pharmaceuticals Corporation for violations of the False Claims Act, including paying kickbacks to doctors.[2]
The COVID-19 pandemic has given criminals opportunities to engage in fraud through manipulation of telemedicine protocols, including a case prosecuted in the Southern District of Georgia involving billions of fraudulent claims.[3] This nationwide case involves charges against 26 telemedicine providers that billed as much as $480 million in fraudulent charges. A Department of Justice news release stated that, as telemedicine becomes more prevalent during the pandemic, “vigilance in ensuring that fraud and kickbacks do not usurp the legitimate practice of medicine by electronic means is more important than ever.”
Other enforcement actions include fines of $122 million for alleged illegal kickbacks paid by Universal Health Services Inc., UHS of Delaware Inc., and Turning Point Care Center LLC;[4] $72.3 million in fines for similar crimes committed by the Oklahoma Center for Orthopaedic & Multi-Specialty Surgery;[5] a guilty plea regarding fraud committed by a Mississippi businessman;[6] and a 42-month prison sentence for the former CEO of Comprehensive Pain Specialists, a company based in Tennessee.[7]
Several enforcement actions also included corporate integrity agreements with the Department of Health & Human Services Office of Inspector General that require independent reviews and the establishment of an effective compliance program.
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