Healthcare Compliance Perspective – Lifetime Exclusion from Medicaid:
The Compliance Officer will review with the Compliance Committee the facility’s policies and procedures to ensure that routine chart reviews are occurring to assess compliance with the established standards of practice and billing guidelines. The scope of these reviews will involve both billing and medical records and focus on Medicare and as needed on Medicaid records. Staff will receive education regarding the role that internal audits play in maintaining the facility’s Compliance and Ethics Program. Audits will be developed to detect kickback payments made to individuals and physicians to obtain client referrals. The Compliance Committee will assist the Compliance Officer to assure the selection of the appropriate personnel for performing these reviews and audits.
The owner of several Virginia medical support service companies has agreed to settle a civil fraud case alleging her companies defrauded the Virginia Medicaid program of over $1 million.
The allegations involved three of the companies the woman owned and operated from 2010 to 2017. This covers the time the Government’s alleged multiple fraudulent schemes, including: 1) Submission of claims to Medicaid for reimbursement of services not provided; 2) The woman’s payment of kickbacks to an individual to induce client referrals; and 3) Submission of claims to Medicaid for reimbursement for services provided to ineligible recipients.
The settlement agreement provides for an initial payment of $50,000 and a consent judgment of $1,061,613 to resolve an action commenced under the False Claims Act and the Virginia Fraud Against Taxpayers Act. Included in the agreement is a lifetime exclusion from the Virginia Medicaid Program. The consent judgment could be settled for a lesser amount through periodic payments by the owner.
The owner and the companies were named as defendants in a lawsuit filed under the “whistleblower” provisions of the federal False Claims Act and the state Virginia Fraud Against Taxpayers Act.
