The Justice Department continues to pile up healthcare enforcement actions — false claims, anti-kickback, and fraud. DOJ is on its way to a record year.
In a recent enforcement action, Modernizing Medicine (“ModMed”), an electronic health record (“EHR”) vendor, agreed to pay $45 million for AKS and False Claims Act violations for receiving bribes in exchange for referrals and causing users to falsely report information about federal incentive payments. (The AKS statute prohibits any person from offering or paying, directly or indirectly, any remuneration, money or any other thing of value, to secure referrals of items or services covered by Medicare, Medicaid and other federally funded programs).
ModMed violated the False Claims Act through three marketing programs:
First, ModMed solicited and received kickbacks from Miraca Life Sciences (“Miraca”) in exchange for recommending and arranging for ModMed’s users to utilize Miraca’s pathology services. Between January 2010 and December 2013, ModMed facilitated EHR donations to ModMed customers by Miraca that did not comply with the requirements of the AKS because the donation decisions took into account the volume or value of the referrals of laboratory tests or other business between EHR donation recipients that were ModMed customers and Miraca and therefore did not meet the requirements of the AKS safe harbor exception applicable to EHR donations, 42 C.F.R. § 1001.952(y).
ModMed customers submitted tainted claims for...
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