Latest Major False Claims Act Settlement Involves 457 Hospitals in 43 States

The Department of Justice (DOJ) recently announced another major settlement of False Claims Act allegations, involving hundreds of providers. This time, it's 70 settlements with 457 hospitals across 43 states, yielding over $250 million. The allegations related to implanted cardiac devices that the government claimed violated Medicare billing rules.

The government alleged that between 2003 and 2010, implantable cardioverter defibrillators were implanted in Medicare beneficiaries during 40- and 90- day waiting periods following heart attacks and bypass/angioplasty, respectively. A National Coverage Determination generally bars implantation of ICDs during those waiting periods. The DOJ statement announcing the settlement cited an "extensive investigation" involving thousands of patient records and a panel of leading cardiologists. The settlement arises out of qui tam cases brought against most of the hospitals, filed in Florida federal court. The DOJ reports that still more hospitals and health systems remain under investigation. "In terms of the number of defendants, this is one of the largest whistleblower lawsuits in the United States and represents one of this office's most significant recoveries to date," said U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida.

The settlements were achieved through collaboration of the Florida U.S. Attorney's Office and the Department of Health and Human Services' Office of Inspector General and is credited by the DOJ as "another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative."

This settlement announcement doesn't implicate laboratories but it's another example of coordinated federal, state and local enforcement efforts that involve hundreds of entities and significant recoveries. An upcoming G2 Intelligence webinar will address how laboratories can avoid being a target of one of these large scale investigations and what to do if they do get caught up in one of these investigation. Attend Don't Let the Government "Take Down" Your Lab: Understanding and Responding to the Current Enforcement Environment, with Robert E. Mazer, Esq. and Gina L. Simms, Esq. of Ober Kaler, on Wednesday, December 9, 2015 (NEW DATE!), at 2-3:30 p.m. Eastern. For more information or to register, click here or call G2 Intelligence customer service at 888-720-2315.

Takeaway: Coordinated federal and state, large-scale enforcement efforts and the whistleblower claims that fuel such enforcement regarding Medicare compliance continue to yield big recoveries.