Compliance Perspective – False Claims:
Upon learning of potential false claims submissions by a local imaging and orthopedic healthcare provider, the Compliance Officer should investigate to better understand the implications that such unlawful conduct might have on the facility. The Compliance Officer should work with the Administrator and the Compliance Committee to ensure that safeguards are in place to prevent the unlawful submission of false claims for reimbursement. An annual audit that is developed and implemented to verify that vendors providing services have not been excluded or sanctioned by the OIG will provide a safeguard for the facility.
Nine physicians who practiced and owned an Oklahoma orthopedic company have reached an agreement to pay $670,000 to settle civil claims stemming from allegations that they submitted false claims to Medicare, Medicaid and Tricare for unnecessary medical procedures involving ultrasonic guidance for needle placement imaging supervision and interpretation. The U. S. government alleges that from January 1, 2012 through December 31, 2015, the company and one of the defendants caused false claims to be submitted to Medicare, Medicaid and Tricare for a surgery assistant who did not perform the services billed.
The State of Oklahoma will receive a portion of the agreed payment total because of alleged false claims submitte
d to Medicaid.
This settlement resolves two of the allegations filed in a lawsuit by a whistleblower who formerly worked for the orthopedic company. The lawsuit was filed in federal district court in Oklahoma City under the qui tam, or whistleblower, provisions of the False Claims Act. Other claims that have been filed continue to be litigated.
In reaching this settlement, the company and the individual defendants did not admit liability, and the United States and Oklahoma did not concede that their claims lack merit. The agreement allows the parties to avoid the delay, expense, inconvenience, and uncertainty of litigating the case.
