DOJ Files Another False Claims Act Case Based on OIG Exclusion Violations

oig exclusion violations

DOJ Pursuing Action on Two Separate OIG Exclusion Violations

The U.S. Attorney’s Office in Philadelphia filed a False Claims Act case last week based primarily on OIG exclusion violations. The complaint alleges that the defendant filed several documents concealing his exclusion and his role in Mental Health Clinics ostensibly run by his wife. Medicare and Medicaid do not pay for services provided, either directly or indirectly, by someone who is on the OIG List of Excluded Individuals (LEIE) or on a State Medicaid Exclusion List. The lawsuit comes on the heels of a suit with similar allegations brought by that office in May. It further evidences the increasing interest of OIG and DOJ in enforcing exclusion regulations and exclusion screening requirements.

The filing was announced by United States Attorney Zane David Memeger. He stated that, “this civil complaint reflects our focus on pursuing individuals who defraud Medicaid and Medicare, especially after they have previously defrauded those programs and been barred from participating in them.” The complaint also alleges fraudulent billing for services provided without proper supervision and by unqualified persons.

While both cases involve similar fact patterns (persons concealing their exclusion status and involvement in a company) and were filed within months of each other, it is significant to note that they arose in completely different ways. The most recent case’s complaint is a whistleblower lawsuit that was brought to the government by an ex-employee. The older case, however, arose from an OIG led investigation.

Final Thoughts

There are two clear takeaway points from these cases. First, exclusion violation enforcement cases can come to the attention of the government in several different ways. Second, the DOJ, OIG and CMS have a number of different enforcement options at their disposal! So remember, compliance is always the best option!

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Paul Weidenfeld, Co-Founder and CEO of Exclusion Screening, LLC, is the author of this article. He is a longtime health care lawyer whose practice has focused on False Claims Act cases and health care fraud matters generally. Contact Paul should you have any  questions at: pweidenfeld@exclusionscreening.com or 1-800-294-0952.

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