(March 1, 2019) The Department of Health and Human Services (HHS), Office of Inspector General (OIG), has continued its goal of enforcing its guidelines and rules upon medical providers participating in their programs. The OIG has kept pursuing its goal of protecting the integrity of its federal health care programs and their respective patients. Several notable cases in which the OIG found inaccuracies or fraud are highlighted below:
(February 6, 2019). Ohio Practice and Owner Settle Case Dealing with False Claims
On February 6, 2019, A doctor owned practice was forced to face allegations that they had submitted claims to Medicare for specimen validity testing (SVT), a non-covered service. SVT is a quality control process that evaluates a urine drug screen sample to determine if it is consistent with normal human urine and to ensure that the sample has not been substituted, adulterated, or diluted. To settle these allegations, the practice was forced to pay $111,706 to OIG.
(February 7, 2019). A Tennessee Based Prosthetics Company Settled a Case with OIG Over Allegations of Kick-Backs
On February 7, 2019, a prosthetics company out of Nashville, Tennessee, entered into a $681,774 settlement agreement with OIG. The settlement agreement put to rest allegations that that the organization had offered and paid illegal remuneration to two surgical practices and a prosthetist in the form of fee reductions and payments. OIG alleged that the organization cuts its monthly rate for a surgical practice based in Texas in an amount that was equal to the monthly salary that the practice paid its prosthetist, in order to induce the practice to refer prosthetics business to their organization.
(February 13, 2019). Diagnostic Services Provider Forced to Settle Allegations with OIG over False Claims
On February 13, 2019, A diagnostic services provider located in Michigan and Illinois, was left with no choice but to enter into an $878,180.08 settlement agreement with OIG. By making this settlement agreement, the diagnostic services provider was able to resolve allegations that they had submitted claims for Healthcare Common Procedure Coding System (HCPCS) code 96965, when those claims were for a procedure that was already included as a component of the duplex ultrasound procedures for which MDS submitted claims using HCPCS codes 93970 or 93971 for the same beneficiary on the same dates of service. This is a reminder that you have to be extremely cautious with your billing and have an experienced staff in your billing department or use an experienced billing agency. The OIG further contends that the claims submitted for HCPCS code 93965 were for a procedure that should not have been separately billed and was not medically necessary.
(February 25, 2019). A Mental Health Services Provider from Maine has Settled a Case Involving Allegations of Having an Excluded Individual in their Organization.
On February 25, 2019, a mental health services provider located in Caribou, Maine, was forced to enter into a $17,750.12 settlement agreement with OIG. This settlement agreement puts to rest allegations that they had employed an individual who was excluded from participating in MaineCare, Maine’s Medicaid program. OIG’s investigation revealed that the excluded individual, a counselor, provided items or services to the organizations patients that were billed to MaineCare. This is a reminder that you HAVE to screen your employees to ensure that they are not excluded from participating in State or Federal healthcare programs.
Concluding Thoughts
During the month of February, the OIG continued to take action against providers that have failed to perform their mandatory exclusion screening obligations. Frankly, the folks at Exclusion Screening have taken all of the guesswork out of these duties.
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