Disclosing known or suspected fraud to regulators can have its benefits. As reported in a previous post, the Department of Justice (DOJ) issued policy guidance in 2019 on providing credit in False Claims Act (FCA) settlements to corporations for "disclosure, cooperation, and remediation" (the Policy Guidance). Since then, the industry has been watching to see how DOJ implements this Policy Guidance.
Two settlements announced earlier this month seem to demonstrate that DOJ is applying the Policy Guidance in resolving FCA cases. Although the facts of these two settlements differ significantly, they highlight the benefits of self-disclosure, cooperation with the government in its investigation, and proactive efforts to remediate non-compliance.
Weirton Medical Center (WMC), a hospital located in West Virginia, paid $1.5 million to settle FCA allegations predicated on alleged violations of the physician self-referral law, which is commonly known as the Stark Law. The Stark Law prohibits a hospital from billing Medicare for certain services referred by physicians with whom the hospital has a financial relationship, unless that relationship satisfies an exception. The government contended that WMC paid its physician referrers in excess of fair market value and/or based on the volume or value of the physicians' referrals, which meant that the arrangements could not meet any potentially applicable exceptions.
While most FCA cases are brought by...
ST. GEORGE, Utah (ABC4) — A Utah podiatrist and two nurses have been federally indicted on fraud charges after they allegedly submitted fraudulent claims to Medicare for skin substitute services, ...