Healthcare Compliance Perspective:
Facilities should consistently audit various aspects of their compliance programs and complete corrective action plans for any noncompliance that is detected. Any Corrective Acton form should identify the nature of the noncompliance, immediate corrective plan for resolving the specific problems, as well as recommendations to reduce likelihood of noncompliance recurring in the future.
An oncology company providing integrated cancer care throughout the United States and employing specialists in radiation oncology, medical oncology and urology will pay the government $26 million to settle accusations it violated the False Claims Act. The government alleges that the company submitted, or caused to be submitted, claims for certain services provided pursuant to referrals from physicians with whom they had improper financial relationships. The company also made self-disclosures about the submission of false verifications regarding the company’s use of electronic health records software.
The settlement resolves self-disclosed conduct regarding payments made by the government as part of the Medicare Electronic Health Records (EHR) Incentive Program. Physicians who attest to their meaningful use of certified EHR technology may receive incentive payments and avoid downward adjustments to certain Medicare claims. The company disclosed that it knowingly submitted, or caused the submission of, false attestations to CMS concerning employed physicians’ use of EHR software. The company further reported that, in support of the attestations, its employees falsified data regarding the company’s use of EHR software, fabricated software utilization reports, and superimposed EHR vendor logos onto the reports to make them look legitimate.
Also resolved in the settlement are government allegations of violations of the physician self-referral law known as the Stark Law. The government alleged that the oncology company and some of its related subsidiaries and affiliates violated the FCA by submitting or causing to be submitted claims for services related to referrals from physicians whose compensation did not satisfy any exception to the Stark Law.
The Stark Law allegations were originally brought in a lawsuit filed by a former employee, under the qui tam provisions of the False Claims Act. The “whistleblower” will receive $2,000,000 as his share of the recovery associated with the Stark Law allegations.
The company has also entered into a new five-year Corporate Integrity Agreement with the HHS-OIG, to undertake substantial, specified compliance reforms.
