Long Term Care & Senior Living Blog

PROVIDERS TAKE NOTE: CIVIL MONEY PENALTIES FOR FALSE CLAIM ACT AND ANTI-KICKBACK STATUTE VIOLATIONS WILL NEARLY DOUBLE AUGUST 1ST

Kyphoplasty is a minimally invasive procedure used to treat certain spinal fractures often due to osteoporosis. Since the filing of a qui tam action, more than 130 hospitals have entered settlements with the Department of Justice (DOJ) totaling approximately $105 million to resolve allegations that they mischarged Medicare for kyphoplasty procedures.

As health care costs rise and providers are faced with challenges to meet the needs and demands of consumers; Medicare looks for questionable payments made to providers to ensure federal dollars for healthcare are spent for medically necessary services as it seeks to reduce fraud and abuse in the provision of health care. One such area is Clinical labs. As discussed below, these labs require prompt attention due to the significant increased scrutiny of their operations.

The Department of Justice (DOJ) announced a settlement for claims of substandard nursing care and medically unnecessary rehabilitation therapy wherein Extendicare will pay $38 million to settle False Claims Act allegations. Rehabilitation services have been a frequent target for DOJ investigation and settlement of alleged overpayments. Once again, DOJ brings closure to an investigation of an initiative from the Health Care Fraud Prevention and Enforcement Action Team (HEAT). In addition to HEAT, this settlement arose from an investigation related to the Justice Department’s Elder Justice initiative, which coordinates the Office of Inspector General (OIG) efforts to combat elder abuse, neglect and financial exploitation.