Recent Healthcare Fraud Developments — September 2021
Medicare fraud is as prevalent as ever, with billions of taxpayer dollars lost each year. However, recent developments show that the Department of Justice (DOJ) has renewed its emphasis on aggressively pursuing healthcare fraud through the False Claims Act (FCA) and recovering tens of millions of dollars in settlements for whistleblowers.
Bayada Settles FCA Lawsuit For $17 Million
Bayada, a national home health care provider based in New Jersey, recently settled allegations of illegal kickbacks in return for patient referrals by agreeing to pay $17 million, the DOJ reported last week.
The whistleblower, a former Bayada employee who will receive $3.06 million from the settlement, originally filed the FCA suit in 2017. The whistleblower accused Bayada of violating anti-kickback laws by purchasing two home-health agencies in an attempt to induce referrals of Medicare beneficiaries for home health services from the seller. “When healthcare providers make or induce referrals that are based on kickback arrangements rather than the best interests of patients, they risk patient harm, threaten the integrity of federal healthcare programs and violate federal law,” a representative of the DOJ said.
DOJ Sues UPMC, Alleging Violations of the FCA
The DOJ also recently filed an FCA lawsuit against the University of Pittsburgh Medical Center (UPMC), its physician practice group, and the chair of its department of cardiothoracic surgery.
The complaint, based on allegations originally brought by a whistleblowing former UPMC physician, alleges that the defendants knowingly submitted hundreds of false claims for payment to Medicare, Medicaid, and other government health benefit programs over the past six years.
For instance, UPMC’s longtime cardiothoracic surgery chair, Dr. James Luketich, is alleged to have performed multiple, complex surgical procedures all at the same time. As a result, Dr. Luketich’s patients were forced to endure hours of unnecessary anesthesia time as he moved from surgery to surgery.
According to the government, these practices violated regulations prohibiting physicians from performing and billing the government for “concurrent surgeries” and heightened patients’ risk of serious complications.
DOJ Accuses Independent Health of Fraudulent Coding
The DOJ filed yet another complaint against an established health care provider alleging violations of the FCA. This time, the government asserts that Independent Health, located in Buffalo, New York, submitted inaccurate information concerning the health of patients enrolled in Medicare Advantage Plans.
Because sicker patients generally create larger reimbursements, health care providers such as Independent Health have an incentive to use unsupported diagnosis codes to inflate payments from Medicare. Due to the vast importance of ensuring accurate diagnosis codes—both for patients and the government—the DOJ has signaled that it “will continue to hold accountable health plans or providers that report unsupported diagnoses to inflate risk adjustment payments.”
At Price Armstrong, we have extensive experience litigating medical billing fraud cases under the False Claims Act. We work hard to protect whistleblowers every step of the way under the False Claims Act while maximizing their recovery. Contact us for a free initial consultation and review of your case.