The following is a summary of the federal Department of Health and Human Services’ Office of Inspector General (OIG) reports of fraud and abuse enforcement activity across the country.[1] The enforcement actions reported are based upon federal and individual states’ activity.

The summaries reflect areas of OIG’s and individual states’ current and recent enforcement activity.[2] Knowing where regulators’ attention is focused can help healthcare providers identify areas of focus for compliance and risk assessment activities. Although not all the enforcement actions may be relevant to any one provider’s healthcare business, there may be some summaries that could be used as examples in compliance program education programs (“What to avoid”), or used in developing a risk management plan.

Of Note in this Issue:

1. Diagnostic reference lab settlement for paying above fair market value for office space to physician-lessors seen as payment for referrals. Federal and Massachusetts settlement reported.

* Corporate Integrity Agreement (not yet reported) to be executed following settlements.

2. Three year Integrity Agreement to be executed in settlement.
3. National dialysis provider alleged to routinely perform certain procedures with End Stage Renal Disease (“ESRD”) who were receiving dialysis, without sufficient clinical indication that the patients needed the procedures.
4. Medicare Advantage Plan settled allegations of FCA and AKS violations in its used of gift cards to induce referrals

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