The Department of Justice recently ramped up healthcare fraud investigations and prosecutions and shows no intention of slowing down. Indeed, the DOJ’s recent settlement with Oglethorpe, Inc. and its top executives offers key lessons for healthcare companies doing business with Medicare and Medicaid. This Insight will cover everything you need to know about the case, four key lessons, and five steps to help protect yourself against civil and criminal liability under the False Claims Act (FCA).
What Happened?
Oglethorpe is an operator of psychiatric hospitals based in Tampa, Florida. The DOJ alleged that the company – along with its leaders – knowingly failed to return Medicare overpayments identified by the company’s consultants. The overpayments were from 2021 through the present, and involved beneficiaries admitted to multiple behavioral hospitals and facilities who allegedly did not qualify for inpatient psychiatric care, according to the DOJ’s May 27 settlement announcement.
The company faced liability under the FCA, which is the DOJ’s primary tool for recovering funds from companies and individuals alleged to have knowingly submitted false claims to the government. But one thing made matters worse for Oglethorpe:
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